Cancer care--a stress for health professionals

Literature related to health care professionals dealing with stress of cancer care is still in its infancy. The authors distinguish papers of general interest (the most frequent), papers identifying stressors, and papers about stress consequences. Most of them recognize death of the patients as a major stressor for health care professionals. There are also additional stressors specific to health care and work. Consequences of stressors have another important dimension: working with cancer patients is often a chronic stress which may lead to the development of burnout and poor quality of care. Little also is actually known about how coping strategies and/or support are influencing adaptation and stress consequences. The authors suggest that an important effort should be made to evaluate stress, and its consequences on poor staff communication with cancer patients and their families. Training interventions aimed at a better quality of care should be designed and their usefulness investigated. The effectiveness of training for health care professionals dealing with cancer patients is reviewed.     

Creative models of spiritual care. As healthcare delivery changes, pastoral care departments must explore alternative staffing approaches

Recognizing changes are coming to the healthcare delivery system, pastoral care departments are developing a new vision of spiritual care. As they educate and hire staff, many directors are finding that alternative staffing approaches can help them make the transition. Flexible schedules for pastoral care professionals improve the care they deliver and enhance morale. Restructuring responsibilities within the department and giving some patient populations priority can be helpful. Some facilities share chaplains' time to minimize on-call burden; others are increasingly using supervised volunteers. Pastoral care givers who are specialists in areas such as mental health and chemical dependency can often perform certain functions traditionally performed by other professionals. By assigning chaplains to a product or service line, pastoral care departments can improve the continuity of care patients receive. As parishes' role in the healing ministry takes on new meaning, healthcare institutions' pastoral care staff can help initiate and develop new parish services or provide assistance that complements existing parish efforts.     

Pastoral care's role in a reformed system. Pastoral care professionals need to promote the spiritual dimension of healing throughout the continuum of care

The emerging structure of healthcare delivery is challenging many elements of traditional pastoral care. With these changes, how can pastoral care professionals be on the cutting edge of tomorrow's pastoral care ministry? Pastoral care givers must understand that the individual with holistic needs will be at the center of the reformed healthcare system. All providers will share the responsibility and financial risk of providing high-quality care to each client. Pastoral care departments will need to develop systems to objectively measure the quality of their spiritual and religious care services, as well as patient or client satisfaction. Pastoral care professionals must take the lead in developing a vision of spiritual care that reflects the new paradigm of integrated delivery. They must also share the vision of integrated spiritual care with opinion leaders who can be advocates for an expanded vision of pastoral and spiritual care within the network. Ideally, faith communities should be centers for care, healing, and wellness, with hospitals as extensions of those communities. Within such a network, pastoral care givers can organize programs, workshops, and retreats around spirituality and wellness as part of the faith community's mission. In addition, pastoral care professionals can help clients learn about themselves and their life-styles and make healthier choices. Pastoral care givers need to recognize that within brokenness there is also wholeness, wisdom, and new opportunities. When we are free of our own agenda, we can empower others. Together, with God's grace, pastoral care givers can shape a new future and make it happen.     

Rights and respect. Legal and ethical issues challenge today's mental healthcare professionals

The special circumstances of patients in mental health facilities often make questions concerning patient autonomy, freedom of choice, and consent to treatment even more complex than they are in other contexts. Individual facilities need to identify the ethical issues they are likely to encounter and create policies that address them effectively. The advent of managed care has created unprecedented access problems for mental healthcare providers. In many cases patients must be proven dangerous to themselves or others before they can be admitted for emergency care; because it is difficult to prove this, many persons go without needed treatment. The high costs of care and prejudices against persons with mental illness also create ethical problems. The necessity of performing clinical evaluations raises important ethical issues as well. Care givers evaluating someone at the request of a school, employer, or court should be sensitive to the possible consequences of their evaluation. They should also restrict their diagnoses to their area of competency and inform clients of the purpose of the evaluation, its possible consequences, and the limits of its confidentiality. Mental health professionals must also respect patients' rights to informed consent and understand the issues of voluntary or involuntary admissions. In addition, care givers should be aware of the various issues created by the need to occasionally control patients' behavior. Finally, for mental healthcare facilities, it is essential to establish an ethics committee to address these issues.     

Stress and psychological well-being among allied health professionals

This study reports findings of an online survey of 139 health professionals. Health professionals were asked about the degree and type of workplace stress they encountered, as well as general perceived stress, psychological distress, and life satisfaction. The sample comprised social workers, psychologists, occupational therapists, physiotherapists, speech pathologists, and a small number of other allied health professionals. The allied health professional groups were remarkably similar in terms of workplace stress, life satisfaction, perceived stress outside the workplace, and the depression, anxiety, and stress subscales of the Depression Anxiety and Stress Scale. There were no significant differences in these variables between those working in hospital and community settings. Compared with expectations based on normative data, more people in the present sample had Depression Anxiety and Stress Scale depression scores in the mild, moderate, severe, or very severe range. The single significant predictor of psychological distress and life satisfaction was perceived stress. In the context of an increasingly generic health care workforce, the present findings indicate that workplace stressors are also generic and that generic, interdisciplinary stress management approaches may therefore be recommended.     

Caring Toward Cure

Care determines cure and, therefore, the mode of care dictates the outcome The medical needs do not determine care, but rather define the reality within which the child has to live Where that care is given to the child should be a haven, just as home ought to be a secure place to be oneself The child participates in the therapeutic community as much as the child participates in the family Therefore, the treatment environment of the child should be designed to foster caring toward cure The care that is given will determine the truly cured child The children must be allowed to be themselves so that they can be cared for and thereby their cure assured To accomplish that, medical care must be incorporated into a normalizing, structured therapeutic community wherein the child can exercise autonomy and the care givers, compassion.     

Caring Toward Cure

Care determines cure and, therefore, the mode of care dictates the outcome The medical needs do not determine care, but rather define the reality within which the child has to live Where that care is given to the child should be a haven, just as home ought to be a secure place to be oneself The child participates in the therapeutic community as much as the child participates in the family Therefore, the treatment environment of the child should be designed to foster caring toward cure The care that is given will determine the truly cured child The children must be allowed to be themselves so that they can be cared for and thereby their cure assured To accomplish that, medical care must be incorporated into a normalizing, structured therapeutic community wherein the child can exercise autonomy and the care givers, compassion.     

Hospital design and staff perceptions: an exploratory analysis

The movement in the health care design field to focus on "patient-centered care" and "healing environments" is often reflected in the health care facilities' incorporation of features meant to mitigate the stressful nature of serious illness. These features may range from a resource center (to allow patients and families to properly educate themselves about their illness) to providing space in rooms so family members can remain with patients, to more ambient features such as soft lighting, water features, or healing gardens. Research has shown that such features can in fact have positive effects for patients and may reduce stress and speed physical healing. What is not as well understood is how (if at all) the medical staff uses these types of features. Good health care cannot be administered without health care professionals, but factors such as job stress and burnout can impair both the physical and psychological health of the staff. A supportive organizational environment is imperative, but this article will set out to show that a supportive physical environment can be just as necessary in influencing how the staff views their workplace as well as how they might fare with regard to their own health. This article will examine a subset of results from a recent employee satisfaction survey given at a medical center. Exploratory analysis and interpretation will begin to shed light on whether or not building design can have an impact (positive or negative) on staff satisfaction. This can potentially act as a springboard to guide future empirical research in the area of health care design and its impact on staff satisfaction and well-being. By analyzing findings from a recent employee satisfaction survey, we can begin to understand how the hospital staff perceives the design of their building and begin to determine if these perceptions might impact health outcomes among the employees.     

Gossip and nurses: malady or remedy?

Gossip is a natural part of every social setting and has a profound influence on organizational behaviors. As the primary care givers in the hospital setting, nurses are the front line in generating and controlling gossip. It is essential that management recognize this dynamic in the nursing workforce so they can be proactive in developing strategies to effectively control gossip. This article highlights the positive and negative aspects of gossip and provides strategies to help nursing professionals effectively manage this workplace issue. Unmanaged gossip can have a negative effect on the workplace by damaging relationships and reputations. Gossip that is managed effectively can have a positive effect on the workplace by building social bonds within the nursing unit.     

Ministering to persons who face death. Practical guidance for care givers of persons making end-of-life treatment decisions

It is time care givers learn how to minister effectively and sensitively to those making end-of-life treatment decisions. To do so, care givers need to be aware of the various meanings death and dying hold. Culture, religion, past experiences with death and dying, and current situations can all influence the way persons perceive death and dying. Sensitivity to who the patient and family are, to how they perceive the disease or illness, and to how this perception influences their ability to achieve their life goals is a critical care-giving skill. Sensitivity, however, need not result in value neutrality or tolerance. Care givers should not be mindless executors of patient or family demands. Care givers must learn to talk honestly with patients and families about how a particular disease is most likely to progress and about the types of decisions they are likely to need to make. And then care givers need to present options, remaining sensitive to the patients' beliefs, values, and interests. Persons who care for the dying will face three types of patients, who will require different types of responses. The three types are patients who welcome death, patients who accept death, and patients who fight death. For all types of patients, care givers must keep the care patient centered and responsive to patients' priorities; facilitate informed decision making; promote communication among the patient, family, and healthcare team; support autonomous decision making; mediate conflicts; and offer spiritual counseling.     

A departmental stress management plan

To reduce stress, most people and organizations need to improve their skills in recognizing and coping with stressors. Department plans like the one described provide a good method of understanding and learning to cope with specific stressors. Researchers analyzed the effects of a stress management plan for registered nurses in an acute care hospital. This plan, called stress inoculation, began with education on stress and coping skills. The nurses were then exposed to the real-life stressors and expected to use the newly learned coping skills. Later, the nurses were asked to evaluate the effectiveness of the coping skills. The results of the study showed that the nurses' stress was reduced through stress management and that coping skills were the key ingredient. Education was needed to teach the coping skills, but by itself, education showed no benefit. If supervisors and employees remain committed to the departmental stress management plan throughout the six phases, the likelihood of reducing stress, improving morale, and increasing productivity is high.     

Psychological stress experienced by health care personnel

Health care personnel consider the challenge of their work to be the principal reason for job satisfaction. Problems of work organization and the small number of personnel cause quantitative overload that has been perceived as problematic by various professional groups in health care units. Role ambiguity and role conflicts are also experienced frequently. Social contacts between patients and personnel, as well as social contacts among the personnel themselves, are sometimes thought to be very problematic. The increase in violent behavior towards health care personnel is a central stressor of their work. The way that work characteristics and strain are experienced, however, is affected by the profession and, especially, by the workplace. Psychological stress reactions are relatively common among health care personnel. The effects of work reorganization, the clarification of responsibilities, increased supplementary training and professional supervision, and the application of directions for the prevention of violence on the stress and strain of health care professionals should be studied as a means to diminish stress and increase well-being and productivity.     

The roles and duties of occupational health nurses in managing and coping with stress in the workplace]

In recent years, employees who complain about too much stress have been increasing, and stressmanagement and coping with stress in the workplace have emerged as one of the important subjects in Occupational Health. There are two approaches to measures for stress. One is to decrease the stressors, and the other is to promote employees' tolerance of the stress reaction. Therefore the roles and duties of Occupational Health Nurses (OHNs) have been described for each approach. OHNs who are close to the employees as first line professionals support each employee to live healthly and independently, and aim at contributing to the employees' QOL. For that reason OHNs' roles in measures for stress must become much more important in the future.     

The professionalization of stress management: Health and well-being as a professional duty of care?

Workplace stress associated with ongoing processes of organizational change is a major occupational and public health concern. It is also a costly economic issue—both public and private. In this paper a framework will be used that draws on Michel Foucault's genealogies of the Self to suggest that the management of stress by professionals—in a workplace environment increasingly characterized by the practices of risk management—emerges as a key element of the choices and responsibilities that frame what it means to be professional. To be (a) professional means to be a person capable of making choices and accepting responsibilities that are framed by a duty of care to manage one's health and well-being to maximize organizational performance and effectiveness. The article will examine the ways in which transformations in the organization and practice of teachers’ work have witnessed large numbers of teachers being seen, and seeing themselves, as stressed. These understandings of teacher stress have provoked a number of strategies designed to encourage individuals to take care of themselves—and to take care of themselves in ways that will make schools more effective. The authors are concerned with understanding the processes that are at work which make it possible to imagine that it is a professional duty of care to manage one's life in such a way as to be both balanced and effective in contexts of uncertainty and risk.     

Changing the culture of dying. A new awakening of spirituality in America heightens sensitivity to needs of dying persons

Americans increasingly believe there are material solutions to all problems. Though we once accepted death as a part of life, we now think that--with enough technology--death can be controlled and postponed. Throughout this century, we have moved the dying process from the home to institutional settings. But institutions have a tendency to push all care to its logical end, which leads to alienation, fragmentation, and diminishment. Alienation is the result of the isolation and regimentation found in acute and skilled nursing care facilities. When care givers are indifferent to patients' pain, or do not know how to control it, they further impair the ability of dying persons to interact with others. Care for the dying person, "system by system, organ by organ," as is typical in institutional settings, fragments the dying process into a series of medical events. And, finally, institutionalized care often results in a diminishment of respect by care givers, who may come to view the dying person more as an object of academic interest than as a human whose spiritual needs may transcend physical ones. Such behavior has begun to show us the human costs of denying death and is contributing to a reawakening of spirituality in this country. The devastating effects of alienation, fragmentation, and diminishment can be ameliorated by a heightened sensitivity to the dying person's spiritual needs. With the proper supports, the dying process can be relocated from institutions to the home. Specialized training can educate healthcare professionals about palliative care and human needs at the end of life. We can rehumanize dying persons by first rehumanizing their care givers, specifically addressing the issues of stress and burnout on the job. Ultimately, the way we give care at the end of life reflects broader issues in U.S. culture. Only when communitarian values replace individualistic ones will resources be reallocated in a manner that best serves the most people. Only then will physicians, nurses, and other care givers receive rewards for supporting the dying person when tests and treatment are no longer needed.     

Care of the dying: a Catholic perspective. Part III: Clinical context--good palliative care eases the dying process. Catholic Health Association

In the midst of a push for legalized euthanasia and assisted suicide in the United States, the Catholic healing tradition should provide good palliative care and support for dying patients. Catholic healthcare institutions can have a counterinfluence on the euthanasia movement if they strive to relieve all forms of pain-physical, psychological, social, and spiritual. Care givers must adapt their pain management methods to diverse groups of patients and their needs. Comprehensive pain management includes not only specialized clinical programs to control physical pain, but also counseling and human support to minimize psychological pain, community support groups to counter social pain, and pastoral care resources to address spiritual pain. Truthful communication lies at the heart of the therapeutic relationship. Healthcare institutions can likewise organize themselves internally to offer optimal support programs for those who are dying, their families, and their care givers. Necessary ingredients for a comprehensive approach include integrated treatment plans, hospitable environments, policies on advance directives and collaborative decision making, ethics committees that are well versed in end-of-life issues, education programs, and a hospice philosophy of care.     

Pastoral care personnel have prophetic role

Pastoral care ministers must look to the prophet's role in the Old and New Testaments to establish their own prophetic mission in health care facilities. After evaluating whether their own department acts justly, competently, and compassionately, pastoral care givers must hold themselves accountable to the signs of authentic prophecy: being motivated by love, being critical to promote constructive change, and being willing to confront others' resistance. Then the pastoral care team can begin collaborating with peers to provide a more healing environment for all staff and patients. This can be done by being available to help staff with problems, influencing policymaking, and using ministerial skills when giving sacramental care to patients. Pastoral care persons can link the facility to the outside community by finding ways to reach the needy and to address residents' unmet health needs. Eventually the pastoral care staff and their peers can work toward an active response to social justice. The challenge of being prophets requires pastoral care personnel to confront problems courageously and take advocacy positions while always showing compassion.     

Rural women's satisfaction and stress as family health care gatekeepers

Women shoulder much of the responsibility for their families' health care, making women's satisfaction with available services an important issue for their families and for women's personal stress levels. Lack of services and resulting stress may be acute for rural women, the focus of this study. In a state-wide survey, fewer than one-half of rural women were satisfied with the health services available; dissatisfaction was a strong determinant of women's stress over health care issues. Rural women are at risk for a pile-up of stressors that could impede their ability to care for themselves and their families.     

Seeing to one's self. Those who care for persons with AIDS must also preserve their own well-being

Those who care for persons with AIDS face a number of special issues. They must understand the complex clinical course of the disease, be ready to cope with its devastating effects on patients, know how to address social prejudices against persons with AIDS, and be prepared to deal with the stresses of providing care under difficult circumstances. To be effective, care givers must know how to take care of themselves. Having a philosophy of care is one key component of self-care because it gives care givers a clear sense of direction and helps them enjoy a greater sense of well-being and personal satisfaction. Creating a motivating environment, taking responsibility for the challenges and stresses of the job, building a supportive team, understanding the AIDS experience, and confronting the effects of grief are also important components in the self-care of the AIDS care giver.