Ljubičić Marija, Pavletić Gianna, Šare Sonja, Gusar Ivana, Dželalija Boris, Matek Sarić Marijana, Šimurina Tatjana, Čanović Samir, Nakić Dario, Konjevoda Suzana
Department of Health Studies, University of Zadar, Zadar, Croatia.
Department of Pulmonology, General Hospital Zadar, Zadar, Croatia.
Nurs Open. 2025 Sep;12(9):e70219. doi: 10.1002/nop2.70219.
This study aimed to investigate the relationships among palliative care, occupational nursing stress and psychological indices.
This cross-sectional study included 180 nurses employed in healthcare facilities (primary health care, outpatient clinics, hospitals, geriatric institutions and home care facilities) in the Zadar County, Croatia.
We included two groups of nurses: those providing palliative care (N = 94) and those not providing palliative care (N = 86). Data on sociodemographic characteristics, personality types, self-esteem, anxiety, depression, sleepiness, resilience and occupational nursing stress were also collected. Multiple linear regression models were used to determine the associations among palliative care, occupational nursing stress, resilience, sleepiness, anxiety, depression, self-esteem and personality traits.
Palliative care was associated with nursing stress (β = 0.36; p < 0.001), death and dying (β = 0.28; p < 0.001), inadequate preparation (β = 0.14; p = 0.022) and sleepiness (β = -0.19; p = 0.021). Nurses providing palliative care reported a lack of support (β = -0.14; p = 0.028), which was associated with workload (β = 0.44) and uncertainty about patient care (β = 0.41), p < 0.001 for both. Conflict between nurses and physicians increased the conflict among nurses (β = 0.49; p < 0.001) and uncertainty about treatment (β = 0.35; p < 0.001). Death and dying contributed to workload (β = 0.23; p = 0.006) and uncertainty about treatment (β = 0.23; p = 0.014). Nursing stress contributed to depression (β = 0.16; p = 0.009) and anxiety (β = 0.12; p = 0.043) and vice versa. These results support the hypothesis that palliative nursing care is related to occupational stress.
Providing palliative nursing care was associated with higher levels of occupational stress. Stress may trigger adverse health consequences such as the development of anxiety, depression and other chronic non-communicable diseases. Support programs are indispensable for strengthening nurses' skills and reducing occupational stress to maintain their health and ensure high-quality patient care.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: A non-probabilistic convenience sample of nurses was the subject of a cross-sectional study to assess the level of occupational stress of nurses who provide palliative nursing care and its impact on nurses' mental health. Occupational stress in palliative care can have negative health consequences for nurses, including the development of anxiety, depression and other chronic non-communicable diseases. Consequently, the quality of nursing care may be adversely affected. Palliative patients, especially at the end of life, are at risk of lower quality of healthcare, which can deteriorate care outcomes and patient satisfaction.
This study included occupational nurses, not patients, service users, care-givers or members of the public.
本研究旨在调查姑息治疗、职业护理压力和心理指标之间的关系。
这项横断面研究纳入了克罗地亚扎达尔县医疗保健机构（初级卫生保健机构、门诊诊所、医院、老年机构和家庭护理机构）雇佣的180名护士。
我们纳入了两组护士：提供姑息治疗的护士（N = 94）和不提供姑息治疗的护士（N = 86）。还收集了社会人口学特征、性格类型、自尊、焦虑、抑郁、嗜睡、心理弹性和职业护理压力的数据。使用多元线性回归模型来确定姑息治疗、职业护理压力、心理弹性、嗜睡、焦虑、抑郁、自尊和性格特征之间的关联。
姑息治疗与护理压力（β = 0.36；p < 0.001）、死亡与濒死（β = 0.28；p < 0.001）、准备不足（β = 0.14；p = 0.022）和嗜睡（β = -0.19；p = 0.021）相关。提供姑息治疗的护士报告缺乏支持（β = -0.14；p = 0.028），这与工作量（β = 0.44）和患者护理的不确定性（β = 0.41）相关，两者p均< 0.001。护士与医生之间的冲突增加了护士之间的冲突（β = 0.49；p < 0.001）和治疗的不确定性（β = 0.35；p < 0.001）。死亡与濒死导致工作量（β = 0.23；p = 0.006）和治疗的不确定性（β = 0.23；p = 0.014）。护理压力导致抑郁（β = 0.16；p = 0.009）和焦虑（β = 0.12；p = 0.043），反之亦然。这些结果支持了姑息护理与职业压力相关的假设。
提供姑息护理与更高水平的职业压力相关。压力可能引发不良健康后果，如焦虑、抑郁和其他慢性非传染性疾病的发生。支持项目对于增强护士技能和减少职业压力以维持其健康并确保高质量患者护理是必不可少的。
对专业和/或患者护理的启示：一项横断面研究以非概率便利抽样的护士为对象，评估提供姑息护理的护士的职业压力水平及其对护士心理健康的影响。姑息治疗中的职业压力可能对护士产生负面健康后果，包括焦虑、抑郁和其他慢性非传染性疾病的发生。因此，护理质量可能受到不利影响。姑息患者，尤其是在生命末期，面临医疗保健质量较低的风险，这可能会使护理结果和患者满意度恶化。
本研究纳入的是职业护士，而非患者、服务使用者、护理人员或公众成员。
