An investigation into the relationship between caring, death anxiety and the burnout syndrome among palliative care nurses.

Introduction The concept of “Death Anxiety" has been used to denote the apprehension often created by human awareness o f the possibility of death and dying. For example, humans are unique in the sense that they must learn to live with and adapt to the awareness o f their own ephemeral existence. Similarly, confronting the inevitability of death and its related anxiety is a universal psychological problem faced by most human beings. For nurses working in palliative care, death is an unmistakable reality regardless of experience and understanding. This means that within the process of helping individual patients and their families cope with death and dying these nurses have a central responsibility for providing emotional and social support for the very phenomenon that most threatens their own ephemeral existence. Given the universality o f death anxiety, it is academically both interesting and most challenging to investigate how death anxiety might interact with such other variables as burnout and aspects o f caring. It is also interesting to note that to date there are no studies that specifically look at possible cause and effect or association between death anxiety, caring and burnout. Aim This thesis investigates the relationship between caring, death anxiety and burnout among palliative care nurses with a view to understanding the possible interaction of these three variables. Methodology A correlational survey design was used to look for relationships between death anxiety and burnout among palliative care nurses working in hospice, hospital and community settings. A total of 213 nurses completed the 25 item Templer’s Revised Death Anxiety Scale, the 22 item Maslach Burnout Inventory, the 5 item Social Support Scale and the 13 item Sources of Pressure Measurement Scales. Spearman’s rho correlation was used to establish associations between variables of interest, and multiple regression to determine significant predictor variables of burnout. The Kruskal-Wallis test, tested for significant differences in the mean scores of death anxiety and measures of burnout. Results The results show a positive and moderate correlation between death anxiety and burnout. No correlation was found between death anxiety and age/gender. No correlation was found between burnout and age/gender. Social support was negatively correlated with emotional exhaustion (the first stage of burnout) that is, the more social support nurses received, the less emotional exhaustion they felt and the need to depersonalise their care was minimal. Caring shows as a unique statistically significant predictor of emotional exhaustion. The more nurses felt unable to control psychological pain and other symptoms, the more their death anxiety and burnout levels increased. Of the 98 hospice nurses, 91% showed moderate levels of death anxiety, while 8% showed high levels. O f the 78 hospital nurses, 92% showed moderate levels of death anxiety, while 6% showed high levels. Of the 31 nurses from the community, 87% showed moderate levels o f death anxiety, while 13% showed high levels. Of the 98 hospice nurses, 35% showed moderate levels of Emotional Exhaustion (EE), while 20% showed high levels. Of the 78 hospital nurses, 30% showed moderate levels o f EE, while 22% showed high levels. The 31 nurses from the community, 45% showed moderate levels of EE, while 23% showed high levels. Discussion These results are consistent with previous studies particularly from North America. High levels of death anxiety and burnout may interfere with nurses’ ability to provide high quality care or engage in reflective practice. Implications of these findings for clinical practice and future research are discussed. These findings are timely for managers, educators and policy makers in devising ways of supporting palliative care nurses if they are to continue caring for dying patients effectively, and without the danger of developing burnout and death anxiety.