Palliative Care as a Predictor of Professional Stress and Mental Health in Nurses: A Cross-Sectional Study.

Aim: This study aimed to investigate the relationships among palliative care, occupational nursing stress and psychological indices.

Design: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

No patient or public contribution: This study included occupational nurses, not patients, service users, care-givers or members of the public.