The forgotten team member: meeting the needs of oncology support staff

Risk of burnout, psychological growth, longevity of career and making sense of Covid-19 in senior Australian radiation oncologists

INTRODUCTION

Senior radiation oncologists in hospital/organisational settings, are repetitively and vicariously exposed to others' traumatic distress-perpetuating risk of burnout. Little is known of the additional organisational burdens of the Covid-19 pandemic on their mental well-being for career longevity.

METHODS

Using Interpretative Phenomenological Analysis, semi-structured interviews provided positive and negative subjective interpreted data from five senior Australian radiation oncologists during Covid-19 lockdowns.

RESULTS

One superordinate theme, Vicarious risk, hierarchical invalidation, redefining altruistic authenticity, overarched four subordinate themes: (1) Vicarious contamination of caring, (2) The hierarchical squeeze, (3) The heavy burden of me and (4) Growth of authenticity. For these participants, juxtaposed challenges to career longevity and mental well-being were 'self' as empathic carer to vulnerable patients, and ever-increasing burdens of the organisation. Sensing invalidation, they experienced periods of exhaustion and disengagement. However, with experience and seniority, self-care was prioritised and nurtured through intrapersonal honesty, altruism and relational connectedness with patients and mentoring forward junior colleagues. Focusing on mutual well-being, a sense of life beyond radiation oncology became acceptable.

CONCLUSIONS

For these participants, self-care became a relational joining with their patients separate from the lack of systemic support which heralded an early termination to their career for psychological well-being and authenticity.

"More than just cleaning": A qualitative descriptive study of hospital cleaning staff as patient caregivers

Background

Cleaning staff in hospitals can spend an average of 10-20 min per day per patient room. Published literature shows a pattern of interactions between housekeepers and patients, and that they believe themselves to be a part of the patient care team. To date, no study about this phenomenon has been done in the United States or has framed them through the lens of patient care.

Objective

To describe the experiences and perceptions of hospital housekeeping staff in relation to patient care.

Design

Qualitative descriptive.

Setting

A 625-bed tertiary, academic medical center in the United States.

Participants

Eight housekeeping staff participated, ranging from 40 to 62 years old, from diverse cultural and ethnic backgrounds, and worked at the study hospital from 4 months to 20 years. Interviews were conducted between September 2020-October 2020. Participants were recruited through flyers, email, and snowball sampling. Data were collected through semi-structured, in-depth interviews lasting 30 - 60 min. Data were analysed through thematic analysis using a 6-step framework that included data familiarization, generation of initial codes, search for themes, review of data, definition and naming of themes, and generation of a written report. Trustworthiness of the data was established through strategies such as reflective journaling, researcher triangulation and member-checking.

Results

Three themes emerged: 1) "Here to take care of you" 2) Difficulties & Coping: and 3) Perceptions of their role. These three themes provide insight into participants' perceptions of patient interactions and the kind of connections they formed with patients as they went about their duties.

Conclusions

Study findings suggest that there exists among housekeeping staff a respect for the humanity of patients, a duty to protect people from disease, and a longstanding practice of engaging in therapeutic connections with patients. As noted elsewhere, there remains a disparity between the importance of this role and the recognition and dignity afforded it. These results reveal an opportunity to expand our understanding of who we call a caregiver, and to improve how we recognize and support each member of the healthcare team.

"We are all a family" Staff Experiences of Working in Children's Blood and Cancer Centers in New Zealand-A Constructivist Grounded Theory

Background: The purpose of this study is to explore staff experiences of working in a children's blood and cancer center in New Zealand, with a particular focus on how staff maintain resilience in their work and sustain working in this difficult area. Methods: Constructivist grounded theory (GT) methods were used to collect data using focus groups and individual interviews with all staff (nursing, medical, allied health, cleaning, and support staff) working in the area. Data were analyzed using constant comparative analysis, and data collection continued until theoretical saturation was achieved. Results: The GT constructed in this study is being a work family, which includes three core categories: finding attachment, becoming a work family, and having an identity. Discussion: This study found that regardless of profession or discipline, all staff experience similar feelings about their work, and can develop and enhance their resilience by belonging to a "work family." Being socially connected to the work family was recognized as the most supportive intervention, and was identified as being of greater value than the traditional one-on-one support that is currently encouraged.

Belastungen, Ressourcen und der berufliche Verbleib von Mitarbeitenden in der spezialisierten ambulanten Palliativversorgung (SAPV) in Bayern

Hintergrund Ziel der Studie ist es, Belastungen und Ressourcen von SAPV-Mitarbeitenden sowie deren Auswirkungen auf die Einschätzung des beruflichen Verbleibs in der SAPV zu untersuchen.

Methode Fragebogenerhebung in 30 SAPV-Teams in Bayern (457 Mitarbeitende) in Kooperation mit dem Landesverband SAPV Bayern e. V. Auswertung: deskriptive Statistik, T-Tests, logistische Regression (IBM SPSS 24).

Ergebnisse Die Rücklaufquote beträgt 53,4 % (n = 244). 64 Befragte (26,2 %) sind bzgl. des beruflichen Verbleibs in der SAPV unsicher. Die höchsten Belastungen werden auf den Skalen »Eigene Betroffenheit« und »Unkontrollierbarkeit« berichtet. Befragte, die höhere Belastung durch »Arbeitszeitorganisation« und »Überlastung« oder geringe »persönliche Ressourcen« berichten, sind eher unsicher bezüglich des beruflichen Verbleibs in der SAPV.

Schlussfolgerungen Es sind nicht Belastungen mit besonderer Relevanz in der SAPV (z. B. Unkontrollierbarkeit), sondern Arbeitszeitorganisation und Überlastung, die im Gesundheitswesen weitverbreitet sind, welche Mitarbeitende bzgl. ihres beruflichen Verbleibs in der SAPV unsicher sein lassen.

Defining the Boundaries of Palliative Care in Pediatric Oncology

CONTEXT

Although palliative care (PC) continues to be integrated into pediatric oncological care, only a minority of patients with cancer receive a formal PC consult.

OBJECTIVES

We sought to describe oncologists' current understanding of PC and how primary PC is provided for children with cancer.

METHODS

This mixed-methods study explored pediatric oncology providers' definitions of PC and self-reported PC practices through semistructured audiotaped interviews. Conventional content analysis was applied to interview transcripts.

RESULTS

Seventy-seven participants with diverse training backgrounds (30 attending physicians, 21 nurses, 18 fellows, five nurse practitioners, and two child life specialists) completed an interview. Approximately 75% provided a modern definition of PC (e.g., not limited to end-of-life care); all participants acknowledged primary PC skills as part of their daily clinical activities. However, participants expressed wide variation in the comfort and time spent performing primary PC tasks (i.e., symptom management, addressing mental health and psychosocial needs) and over half reported that patients' PC needs are not adequately met. In addition, some reported confusion about the benefits of PC consultation, despite acknowledging that PC needs to be better integrated into the care of pediatric oncology patients.

CONCLUSION

Our findings demonstrate that although most pediatric oncologists accept a modern definition of PC in theory, how to integrate PC into pediatric oncology practice is less understood. Formalized training and standardization of practice surrounding identification of PC needs in patients who may require secondary or tertiary PC services may help to overcome current barriers for PC integration in pediatric oncology.

Risky business

Purpose

The purpose of this paper is to describe the experiences of non-clinical staff working in psychiatric settings, particularly in relation to exposure to context-specific hazards, and perceived safety.

Design/methodology/approach

Qualitative interviews with 23 administrative and operational staff were analysed using a framework approach.

Findings

Analysis demonstrated extensive exposure to occupational violence, including assault and verbal abuse within and/or beyond the workplace and concern about infectious disease. Impact of exposure was wide ranging, dependent on type and circumstances of violence and personal resources, with several participants experiencing ongoing psychological distress. Participants employed a range of problem- and emotion-focused strategies, typically seeking support from peers, to manage work-related stress but felt neglected by the organisation. They sought inclusion in or access to processes, such as supervision and debrief, routinely available to clinicians and to information about risk associated with patients.

Research limitations/implications

Generalisability is constrained by conduct of this study in a particular setting with non-random sample.

Practical implications

The findings of this paper indicate a pressing need for administrators to ensure efforts to address safety encompass all staff, and the need for further research. Particular attention should be given to enabling non-clinical staff to examine ethical questions, ensuring access to support mechanisms and development of an inclusive culture.

Originality/value

While exposure to, and impact of workplace violence on clinical staff have been extensively studied, this paper is the first to qualitatively examine the safety of a commonly forgotten workforce.

Structure, process, and impact of a staff support group in an oncology setting in a developing country

BACKGROUND

Health-care staff working in oncology setting experience excessive stress, which if unrelieved can lead to burnout. Staff support groups have been found beneficial.

AIMS

This study aims to evaluate the structure, process, and impact of a staff support group conducted for field workers involved in cancer screening in an urban tertiary cancer center in a developing country.

SETTINGS AND DESIGN

Retrospective analysis of staff support group conducted in a tertiary care cancer center.

METHODOLOGY

Prospectively maintained data with structured notes for documenting the process of the support group sessions for the field workers was analyzed. Impact was analyzed through a feedback questionnaire designed for the purpose completed by participants at 4 months, 1, and 2 years following session completion.

STATISTICAL ANALYSIS

Descriptive statistics for reporting the overall structure and participants' profile and content analysis for identifying the support group process and themes expressed by the participants were used.

RESULTS

Eleven participants attended the support group consisting of 8 structured sessions. The processes identified were planning, implementation, and supervision of the lead therapist conducting the group. Work overload, target completion, feeling demoralized, interpersonal conflicts, and importance of team support were the main issues identified. Cognitive behavioral approaches were learnt for stress management. Eight, nine, and all 11 participants found the support group moderately to very useful at 4 months, 1 year, and 2 years, respectively.

CONCLUSIONS

The support group followed a planned structure, with good implementation, recording of content and supervision, with both short-term and sustained positive impact.

The Views of Domestic Staff and Porters when Supporting Patients with Dementia in the Acute Hospital: An Exploratory Qualitative Study

There is increasing recognition that very many hospital patients have dementia but there are many concerns about the quality of care and support they receive. Consequently there have been numerous calls for hospital staff to have dementia training. While cleaning or domestic staff and porters form considerable parts of the hospital workforce they are infrequently considered in discussions of dementia care training and practice. This exploratory study aimed to investigate the experiences of domestic staff and porters working in an acute hospital setting who are in contact regularly with patients with dementia. Semi-structured interviews were undertaken in 2016 with seven domestic staff and five porters in one English acute hospital to investigate their views and experiences. Data were analysed thematically by constant comparison technique and theoretical sampling. Themes were identified and realistic concepts developed. Participants observed that caring attitudes and behaviour in their encounters with patients with dementia are important but challenging to put into practice. Several would have valued more information about dementia. Some noted situations in the hospital stay that seemed particularly difficult for patients with dementia such as travelling to different parts of the hospital for treatments. The study suggests the need for improving the dementia-related knowledge and skills of all non-clinical staff especially those new to the NHS. The impact of witnessing dementia symptoms and distress on emotional well-being requires further research so that ancillary staff can improve the hospital stay of patients with dementia.

Oncologists' negative attitudes towards expressing emotion over patient death and burnout

PURPOSE

The aims of this study were to examine the relationship between negative attitudes towards expressing emotion following patient death and burnout in oncologists and to explore oncologists' preferences for institutional interventions to deal with patient death.

METHODS

The participants included a convenience sample of 177 oncologists from Israel and Canada. Oncologists completed a questionnaire package that included a sociodemographic survey, a burnout measure, a survey assessing negative attitudes towards expressing emotion, and a survey assessing desired interventions to cope with patient death. To examine the association between burnout and negative attitudes while controlling for the effect of sociodemographic variables, a hierarchical linear regression was computed.

RESULTS

Higher burnout scores were related to higher negative attitudes towards perceived expressed emotion (partial r = .25, p < .01) of those who viewed this affect as a weakness and as a sign of unprofessionalism. Approximately half of the oncologists found each of the five categories of institutional interventions (pedagogical strategies, emotional support, group/peer support, taking time off, and research and training) helpful in coping with patient death.

CONCLUSIONS

Our findings suggest that high burnout scores are associated with negative attitudes towards expressing emotion and that there is a wide variation in oncologist preferences in coping with patient death. Institutions should promote interventions that are varied and that focus on the needs of oncologists in order to reduce burnout. Interventions that legitimize expression of emotion about patient death may be useful. Another way to reduce stigma would be to require oncologists to "opt out" rather than "opt in" to accessing a selection of social and/or individual interventions.

Tidying rooms and tending hearts: An explorative, mixed-methods study of hospital cleaning staff's experiences with seriously ill and dying patients

BACKGROUND/AIM

Palliative care is based on multi-professional team work. In this study, we investigated how cleaning staff communicate and interact with seriously ill and dying patients as well as how cleaning staff cope with the situation of death and dying.

DESIGN

Sequential mixed methods, consisting of semi-structured interviews, focus groups, and a questionnaire. Interviews and focus group discussions were content analyzed and results were used to create a questionnaire. Quantitative data were submitted to descriptive analysis.

SETTING

Large university clinic in southern Germany.

PARTICIPANTS

A total of 10 cleaning staff participated in the interviews and 6 cleaning staff took part in the focus group discussion. In addition, three managerial cleaning staff participated in a separate focus group. Questionnaires were given to all cleaning staff ( n = 240) working at the clinic in September 2008, and response rate was 52% (125/240).

RESULTS

Cleaning staff described interactions with patients as an important and fulfilling aspect of their work. About half of participants indicated that patients talk with them every day, on average for 1-3 min. Conversations often revolved around casual topics such as weather and family, but patients also discussed their illness and, occasionally, thoughts regarding death with cleaning staff. When patients addressed illness and death, cleaning staff often felt uncomfortable and helpless.

CONCLUSION

Cleaning staff perceive that they have an important role in the clinic-not only cleaning but also supporting patients. Likewise, patients appreciate being able to speak openly with cleaning staff. Still, it appears that cleaning staff may benefit from additional training in communication about sensitive issues such as illness and death.

Reflective case study on end of life care in post anaesthesia

Operating department practitioners (ODPs) are well known for their technical abilities within the perioperative environment and are passionate about the care they deliver. This article will critically reflect on the post anaesthetic care of a dying patient, the challenges of having relatives present, the importance of having a good student/mentor relationship, and will show that student ODPs can deliver compassionate and personalised care.

The prevalence of burnout among oncology professionals: oncologists are at risk of developing burnout

OBJECTIVE

International research shows that oncology staff suffers more from burnout than other healthcare professionals. Burnout is common among oncologists. The prevalence of emotional exhaustion, depersonalization, and low personal accomplishment appears to be significantly higher among physicians. Detecting burnout is highly relevant, because it affects the personal well-being and quality of life of the healthcare professional. A national study on the prevalence of burnout in oncology was never conducted in Flanders (Dutch-speaking part of Belgium).

METHODS

The Cédric Hèle institute spread anonymous questionnaires among 923 healthcare workers in oncology (physicians, social workers, psychologists, nurses, and specialist-nurses) in Flanders. The questionnaire consisted of two parts. The first part contained questions concerning demographic and job features. The second part included the Dutch version of the Maslach Burnout Inventory.

RESULTS

Five hundred and fifty subjects participated in the survey (response rate of 59.5%). Of the medical oncologists, 51.2% suffered from emotional exhaustion, 31.8% from depersonalization, and 6.8% from a lack of personal accomplishment. Multivariate analysis of variance suggested a significantly elevated level of emotional exhaustion and depersonalization in oncologists compared with other professionals. Logistic regression indicated that the following variables have predictive value on risk of burnout: gender, profession, and combining work in a university hospital with work in a private hospital.

CONCLUSION

The CHi research showed a significantly increased level of burnout-components in professionals working in oncology, especially in medical oncologists. These results should have an impact on the daily clinic of oncology, and could be guidance for further research.

Pediatric oncology providers' perceptions of barriers and facilitators to early integration of pediatric palliative care

BACKGROUND

Pediatric patients experience significant symptoms during cancer treatment. Symptom management is frequently inadequate. We studied perceptions of pediatric oncology care providers regarding early integration of palliative care (PC) for pediatric patients to identify barriers and facilitators that might assist in understanding how care could be improved.

PROCEDURES

Pediatric oncology providers were recruited to participate in four focus groups. A proposal for early integration of a pediatric palliative care team (PPCT) was presented and followed by a facilitated discussion. Data were analytically categorized into themes by three independent coders using constant comparative analysis and crystallization techniques. A consensus approach was used to identify final themes.

RESULTS

Barriers to the proposed care model of early integration of a PPCT included provider role, conflicting philosophy, patient readiness, and emotional influence and were more prevalent in the physician participants compared to nurse practitioner, nursing, and social work participants. Facilitators included patient eligibility, improved patient care, education, and evidence-based medicine. Though all participants were invested in providing optimal patient care, physician participants believed the current standard of care model is meeting the needs of patients and family, while the nurse practitioner, nursing, and social work participants working on the same healthcare team believed the proposed care model would improve the overall care of children diagnosed with cancer.

CONCLUSIONS

Differing perceptions among healthcare providers regarding the care of children with cancer suggest that team functioning could be improved. Avenues for pilot testing early integration of PC could provide useful information for a next study.

Development and validation of the Work Stressor Inventory for Nurses in Oncology: preliminary findings

AIM

This study is a report of the development and testing of the Work Stressor Inventory for Nurses in Oncology.

BACKGROUND

Stressors in oncology nursing are generally assessed using generic stress scales like the Nursing Stress Scale or the Health Professions Stress Inventory. However, qualitative investigations have highlighted the specific nature of the stress to which nurses are exposed.

DESIGN

The Work Stressor Inventory for Nurses in Oncology was developed using both qualitative and quantitative methodologies.

METHOD

For the item generation phase, a semi-structured interview was conducted with 59 nurses working in oncology units during 2007. A total of 51 work-related items were retained for the final survey. A convenience sample of 582 nurses working in oncology completed the survey between January 2008-June 2008. They also completed the General Health Questionnaire and the Maslach Burnout Inventory. The Work Stressor Inventory for Nurses in Oncology was further tested for theoretically supported constructs, internal consistency reliability and concurrent validity.

FINDINGS

The exploratory results revealed five factors: workload, dealing with death and dying, dealing with suffering, interpersonal conflicts, dealing with patients and relatives. The internal consistency of the five subscales was satisfactory. Correlation patterns between the Work Stressor Inventory for Nurses in Oncology dimensions and both mental health and burnout variables support the criterion-related validity of the scale.

CONCLUSION

Future quantitative or qualitative studies using this scale could add knowledge about the experiences of emotional and organizational stressors related to this area of nursing.

Social work in oncology-managing vicarious trauma-the positive impact of professional supervision

This exploratory study focused on the experience and management of vicarious trauma in a team of social workers (N = 16) at a specialist cancer hospital in Melbourne. Respondents completed the Traumatic Stress Institute Belief Scale (TSIBS), the Professional Quality of Life Scale (ProQOL), and participated in four focus groups. The results from the TSIBS and the ProQol scales confirm that there is a stress associated with the social work role within a cancer service, as demonstrated by the high scores related to stress. However at the same time the results indicated a high level of satisfaction which acted as a mitigating factor. The study also highlighted the importance of supervision and management support. A model for clinical social work supervision is proposed to reduce the risks associated with vicarious trauma.

Hospital administration team development and support in a children's cancer service

The administration team in the Queensland Children's Cancer Centre at the Royal Children's Hospital, Brisbane, included a team of 16 administration staff supporting the service and the state-wide clinical network. Shortly after the creation of a new expanded service, issues became apparent in administration team morale, relationships, communication, processes, leadership, support and training. The analysis of these issues included team interviews and surveys, consultation with senior administration staff and monthly sick leave monitoring. Strategies implemented included providing information; the joint development of a team business plan and individual performance plans; a review of the team's structure, workload and business processes; engaging staff in quality improvements; and the development of relationships and leadership. As a result, the team reported being more comfortable and supported in their roles, had improved morale and worked better together with more consistent and improving business processes. They had clear purpose and expectations of their roles, displayed better customer service and had reduced sick leave. The study shows that in a high stress environment, such as a children's cancer centre, attention to the team's culture, vision and purpose, providing information and improving communication and relationships, when combined with a team's enthusiasm, will improve the team's growth, cooperation and work outcomes.

Digestive oncologist in the gastroenterology training curriculum

Until the late 1980s, gastroenterology (GE) was considered a subspecialty of Internal Medicine. Today, GE also incorporates Hepatology. However, Digestive Oncology training is poorly defined in the Hepatogastroenterology (HGE)-curriculum. Therefore, a Digestive Oncology curriculum should be developed and this document might be a starting point for such a curriculum. HGE-specialists are increasingly resisting the paradigm in which they play only a diagnostic and technical role in the management of digestive tumors. We suggest minimum end-points in the standard HGE-curriculum for oncology, and recommend a focus year in the Netherlands for Digestive Oncology in the HGE-curriculum. To produce well-trained digestive oncologists, an advanced Digestive Oncology training program with specific qualifications in Digestive Oncology (2 years) has been developed. The schedule in Belgium includes a period of at least 6 mo to be spent in a medical oncology department. The goal of these programs remains the production of well-trained digestive oncologists. HGE specialists are part of the multidisciplinary oncological teams, and some have been administering chemotherapy in their countries for years. In this article, we provide a road map for the organization of a proper training in Digestive Oncology. We hope that the World Gastroenterology Organisation and other (inter)national societies will support the necessary certifications for this specific training in the HGE-curriculum.

Where do nurses go for help? A qualitative study of coping with death and dying

As end-of-life care becomes a more prominent issue in health care, it is important to address the experience from the caregivers' perspective. In order to cope with the stressful experience of caring for a dying patient, nurses need programmes that both help them develop coping strategies and prepare them for caring for dying patients as well as resources to help them cope with the experience once it has happened. Because little is known about the coping habits of nurses facing the death of a patient, research is needed that examines their coping responses to develop more effective resources. This research examines the resources that nurses use when coping with the death of a patient. The results of this research indicate that communication with patients and their families, as well as coworkers, is an integral part of that process.

Integrative Oncology for the Whole Person: A Multidimensional Approach to Cancer Care

Today, more than ever before, millions of people are seeking an approach to medicine and health care that is more comprehensive, more holistic and integrative, and more compassionate and sensitive to their needs as a whole person. This is particularly true for those dealing with cancer. Changing patient demographics, heightened consumer demand for complementary and alternative medicine (CAM) products and services, advances in medical science and technology, expanding access to the Internet and health information, and other factors have contributed to a wave of transformation that is unprecedented in its impact on the entire health care system. These trends have fueled the emerging fields of integrative medicine and oncology, which are growing rapidly. As these fields continue to evolve, they will move beyond the present integrative model to a broader vision of whole-person, multidimensional care that will more fully and coherently address and embrace all dimensions of the human experience. This article describes 6 major driving forces behind the wave of transformation presently under way in medicine and health care. It provides a brief, historical overview of integrative medicine and oncology and summarizes the present status of these emerging fields. It discusses the future of integrative medicine and oncology, including a multidimensional approach to care, and highlights 5 key elements that underlie this approach. Finally, it describes The Seven Levels of Healing — a model of multidimensional care—and concludes with a discussion of 3 important challenges and opportunities for medicine and health care that lie on the horizon.