Nurses' Awareness of Psychological Distress and Delirium in Cancer Patients and Job Stress

Mi Ae Park; Eunsook Choi

doi:10.5388/aon.2017.17.4.252

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Park and Choi: Nurses' Awareness of Psychological Distress and Delirium in Cancer Patients and Job Stress

Original Article

Asian Oncol Nurs 2017;17(4):252-262.

Published online: 5 December 2017

DOI: https://doi.org/10.5388/aon.2017.17.4.252

Nurses' Awareness of Psychological Distress and Delirium in Cancer Patients and Job Stress

Mi Ae Park, Eunsook Choi

Department of Nursing, National Cancer Center, Goyang, Korea

Address reprint requests to: Park, Mi Ae Department of Nursing, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si Gyeonggi-do 10408, Korea Tel: +82-31-920-2617 Fax: +82-31-920-1908 E-mail: 12125@ncc.re.kr

Received 21 Sep 20178 Dec 2017 Accepted 17 Dec 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose

The purpose of this study was to investigate nurses’ awareness of psychological distress and delirium in cancer patients and job stress.

Methods

The participants were 256 nurses in a cancer general hospital. The nurses’ awareness of psychological distress and delirium was investigated using a self-report questionnaire (1-4 scale) developed by the researcher. Psychological distress was measured by depression, anxiety, and insomnia. Job stress was measured using the Korean version of the Expanded Nursing Stress Scale (1-4 scale).

Results

The analysis of 9 questionnaires about nurses’ awareness was divided into two factors: nurses’ competence and importance. Nurses’ competence results were 2.06 (depression), 2.17 (anxiety), 2.29 (insomnia), and 2.41 (delirium). Importance results were 3.23 (depression), 3.20 (anxiety), 3.15 (insomnia), and 3.37 (delirium). Most nurses have experienced nursing psychological distress and delirium in cancer patients, but only about a quarter have received the relevant education. Job stress was 2.52 and in sub-categories, work load received the highest score 2.92.

Conclusion

Nurses recognize that psychological distress and delirium in cancer patients are very important, but they are less aware of their competence. Therefore, it is suggested to develop an educational program to improve nurses’ competence when dealing with psychological distress and delirium.

Keywords: Stress, Psychological, Delirium, Awareness, Occupational Stress, Nursing

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Fig. 1.

Nurses’ competence and importance of psychological distress and delirium in cancer patients.

Table 1.

Demographic Characteristics and Expanded Nursing Stress Scale (N =256)

Characteristics	Categories	n (%)	M ± SD
Gender	Male	5 (2.0)
Gender	Female	251 (98.0)
Age (year)	≤25	97 (37.9)	28.2 ± 4.76
	26~30	85 (33.2)
	31~35	49 (19.1)
	36~40	19 (7.4)
	≥41	6 (2.3)
Marital status	Not married	199 (77.7)
Marital status	married	57 (22.3)
Nursing degree	Diploma	24 (9.4)
	Bachelor	208 (81.2)
	Master	24 (9.4)
Position	Nurse	240 (93.8)
Position	Chief nurse	16 (6.3)
Clinical experience (year)	≤2	87 (34.0)	5.7 ± 4.67
	3~5	66 (25.8)
	6~10	65 (25.4)
	≥11	38 (14.8)
Unit∗	Center for lung cancer	32 (11.2)
	Center for stomach cancer	30 (10.5)
	Center for prostate cancer	19 (6.7)
	Center for liver cancer	27 (9.5)
	Center for uterus cancer	19 (6.7)
	Center for breast cancer	19 (6.7)
	Center for specific organs cancer	8 (2.8)
	Center for pediatric cancer	15 (5.3)
	Center for hematologic malignancy cancer	18 (6.3)
	Center for colorectum cancer	21 (7.4)
	Center for thyroid cancer	11 (3.9)
	Emergency room	15 (5.3)
	MICU	14 (4.9)
	SICU	24 (8.4)
	Stem cell transplantation ward	7 (2.5)
	Hospice ward	6 (2.1)
Item		M ^± SD	Cronbach's α
Expanded nursing stress scale		2.52 ± 0.55	.96
F1. Death and dying		2.58 ± 0.67	.81
F2. Conflict with physicians		2.71 ± 0.80	.69
F3. Inadequate emotional preparation		2.56 ± 0.58	.73
F4. Problem relating to peers		2.14 ± 0.69	.83
F5. Problem relating to supervisors		2.36 ± 0.72	.84
F6. Work load		2.92 ± 0.62	.79
F7. Uncertainty concerning treatment		2.63 ± 0.62	.80
F8. Patients and their families		2.84 ± 0.67	.85
F9. Discrimination		1.27 ± 0.94	.71

^∗ Unit N= 285 (29 nurses duplicate response)

Table 2.

Nursing Experience, Educational Experience, Educational Place of Psychological Distress and Delirium in Cancer Patient (N =256)

Variables	Depression (%)	Anxiety (%)	Insomnia (%)	Delirium (%)
Nursing experience (n=256)
Yes	89.1	91.8	94.1	95.3
No	5.9	4.7	3.1	3.9
Don't know	5.1	3.5	2.7	0.8
Educational experience (n=256)
Yes	27.3	22.7	21.5	28.9
No	59.8	63.7	66.8	59.4
Don't know	12.9	13.7	11.7	11.7
Place of education∗	(n=74)	(n=62)	(n=59)	(n=85)
Continuing education	24.3	22.6	16.9	20.0
Job training	24.3	22.6	30.5	18.8
Conference	5.4	11.3	8.5	14.1
Etc.	45.9	43.5	44.1	47.1

^∗ Duplicate response.

Table 3.

Comparison of Nurses'Awareness of Psychological Distress and Delirium in Cancer Patients according to Nurse Characteristics

Variables		Competence								Importance								Job stress
		Depression		Anxiety		Insomnia		Delirium		Depression		Anxiety		Insomnia		Delirium		Job stress
		M ± SD	t or F (p)	M ± SD	t or F (p)	M ± SD	t or F (p)	M ± SD	t or F (p)	M ± SD	t or F (p)	M ± SD	t or F (p)	M ± SD	t or F (p)	M ± SD	t or F (p)	M ± SD	t or F (p)
Gender	Male	1.50 ± 0.41	-2.60	2.00 ± 0.61	-0.75	1.73 ± 0.38	-2.39	2.73 ± 0.69	1.36	2.93 ± 0.64	-1.29	3.07 ± 0.64	-0.56	2.87 ± 1.17	-0.55	3.33 ± 0.62	-0.16	2.45 ± 0.71	-0.31
Gender	Female	2.07 ± 0.48	(.010)	2.17 ± 0.51	(.456)	2.31 ± 0.53	(.018)	2.41 ± 0.53	(.176)	3.23 ± 0.51	(.199)	3.21 ± 0.54	(.573)	3.15 ± 0.58	(.614)	3.37 ± 0.53	(.873)	2.53 ± 0.55	(.761)
Age (year)	≤25^a	2.12 ± 0.45	1.08	2.24 ± 0.47	0.94	2.31 ± 0.48	0.09	2.40 ± 0.50	1.03	3.13 ± 0.45	2.88	3.09 ± 0.48	2.80	2.99 ± 0.53	3.73	3.26 ± 0.50	1.69	2.43 ± 0.52	2.07
	26~30^b	1.99 ± 0.51	(.365)	2.12 ± 0.51	(.444)	2.28 ± 0.57	(.984)	2.47 ± 0.54	(.395)	3.21 ± 0.55	(.023)	3.20 ± 0.57	(.026)	3.18 ± 0.60	(.006)	3.42 ± 0.50	(.154)	2.62 ± 0.55	(.086)
	31~35^c	2.06 ± 0.50		2.13 ± 0.53		2.28 ± 0.58		2.41 ± 0.58		3.39 ± 0.51	a＜ c	3.33 ± 0.54	a＜ d	3.24 ± 0.62	a＜ c	3.46 ± 0.60		2.56 ± 0.60
	36~40^d	2.08 ± 0.52		2.18 ± 0.60		2.26 ± 0.50		2.32 ± 0.60		3.42 ± 0.66	a＜ d	3.44 ± 0.66		3.42 ± 0.60	a＜ d	3.46 ± 0.63		2.64 ± 0.55
	≥41^e	1.86 ± 0.54		2.00 ± 0.54		2.39 ± 0.81		2.08 ± 0.47		3.17 ± 0.28		3.33 ± 0.42		3.50 ± 0.46	a＜ e	3.33 ± 0.47		2.20 ± 0.43
Marital status	Not Ma.	2.07 ± 0.49	0.98	2.18 ± 0.50	0.38	2.30 ± 0.52	0.45	2.43 ± 0.53	1.20	3.21 ± 0.51	-1.26	3.17 ± 0.54	-1.59	3.11 ± 0.59	-1.86	3.35 ± 0.51	-0.99	2.52 ± 0.56	-0.62
Marital status	Married	2.00 ± 0.49	(.327)	2.15 ± 0.54	(.707)	2.27 ± 0.60	(.653)	2.34 ± 0.57	(.231)	3.30 ± 0.54	(.207)	3.30 ± 0.57	(.113)	3.27 ± 0.59	(.064)	3.42 ± 0.59	(.322)	2.57 ± 0.52	(.534)
Nursing degree	Diploma^a	2.12 ± 0.49	1.29	2.28 ± 0.47	0.93	2.39 ± 0.54	1.72	2.58 ± 0.52	1.27	3.18 ± 0.67	2.70	3.11 ± 0.61	3.47	3.00 ± 0.62	5.37	3.39 ± 0.63	1.21	2.59 ± 0.44	0.19
	Bachelor^b	2.03 ± 0.49	(.278)	2.15 ± 0.51	(.397)	2.27 ± 0.52	(.181)	2.39 ± 0.54	(.284)	3.21 ± 0.50	(.070)	3.18 ± 0.53	(.032)	3.12 ± 0.58	(.005)	3.35 ± 0.53	(.301)	2.52 ± 0.55	(.827)
	Master^c	2.19 ± 0.47		2.24 ± 0.56		2.45 ± 0.64		2.41 ± 0.55		3.46 ± 0.49		3.47 ± 0.55	a＜ c	3.50 ± 0.51	a＜ c	3.53 ± 0.48		2.55 ± 0.62
													b＜ c		b＜ c
Position	Nurse	2.05 ± 0.49	-1.03	2.17 ± 0.51	-0.41	2.29 ± 0.52	-0.70	2.42 ± 0.53	1.16	3.22 ± 0.52	-0.84	3.19 ± 0.54	-1.62	3.13 ± 0.58	-2.04	3.37 ± 0.53	-0.35	2.52 ± 0.55	-1.16
Position	Chief N.	2.18 ± 0.43	(.306)	2.22 ± 0.51	(.685)	2.39 ± 0.71	(.483)	2.26 ± 0.59	(.246)	3.33 ± 0.52	(.400)	3.42 ± 0.61	(.106)	3.44 ± 0.65	(.042)	3.42 ± 0.64	(.724)	2.68 ± 0.50	(.248)
Clinical ex. (year)	≤2^a	2.11 ± 0.48	0.73	2.24 ± 0.51	1.13	2.31 ± 0.52	0.54	2.40 ± 0.53	0.02	3.12 ± 0.47	5.56	3.10 ± 0.49	5.92	3.01 ± 0.56	4.94	3.27 ± 0.47	3.97	2.44 ± 0.53	1.51
	3~5^b	2.03 ± 0.47	(.534)	2.14 ± 0.46	(.338)	2.28 ± 0.49	(.658)	2.41 ± 0.50	(.997)	3.13 ± 0.52	(.001)	3.07 ± 0.55	(.001)	3.07 ± 0.60	(.002)	3.29 ± 0.53	(.009)	2.55 ± 0.56	(.212)
	6~10^c	2.00 ± 0.50		2.09 ± 0.49		2.24 ± 0.56		2.42 ± 0.56		3.41 ± 0.50	a＜ c	3.36 ± 0.53	a,b＜ c	3.28 ± 0.59	a＜ c,d	3.51 ± 0.57	a,b＜ c	2.55 ± 0.52
	≥11^d	2.08 ± 0.53		2.18 ± 0.63		2.37 ± 0.61		2.42 ± 0.60		3.33 ± 0.55	b＜ c	3.39 ± 0.59	a,b＜ d	3.37 ± 0.57	b＜ d	3.51 ± 0.54	a,b＜ d	2.65 ± 0.61

Not Ma.= Not married; Chief N.= Chief nurse; Clinical ex.= Clinical experience.

Table 4.

Correlation between Nurses’ Awareness of Psychological Distress and Delirium in Cancer Patients and Job Stress (N =256)

Variable	Depression		Anxiety		Insomnia		Delirium
Variable	Competence	Importance	Competence	Importance	Competence	Importance	Competence	Importance
	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)
Job stress	-.13 (.040)	-.02 (.709)	-.10 (.103)	-.03 (.609)	-.08 (.217)	-.01 (.931)	-.06 (.305)	.07 (.235)

Appendix 1.

암 환자의 심리적 디스트레스와 섬망에 대한 간호사의 인식

다음은 암 환자의 우울 (불안,불면,섬망)에 대한 간호사의 인식 정도를 조사하는 내용입니다. 내용을 읽으신 후 해당란에 √ 표를 체크해주십시오.
간호사의 인식	전혀 그렇지 않다 (1)	어느 정도 그렇다 (2)	대체로 그렇다 (3)	매우 그렇다 (4)
암 환자의 우울 (불안,불면,섬망)을 간호하는 것은 중요하다
나는 우울 (불안,불면,섬망)에 대한 지식을 가지고 있다
나는 우울 (불안,불면,섬망) 증상과 관련하여 적절한 사정도구를 사용할 수 있다
나는 우울 (불안,불면,섬망) 환자에 대한 간호중재를 적용할 수 있다
나는 우울 (불안,불면,섬망) 환자를 간호할 수 있는 능력을 가지고 있다
나는 우울 (불안,불면,섬망) 환자를 간호하는 데 있어서 자신감을 가지고 있다
나는 환자 (보호자)에게 우울 (불안,불면,섬망)에 대해 설명할 수 있다
암 환자를 돌보는 간호사에게 우울 (불안,불면,섬망)에 대한 전문적인 교육이 필요하다
우울 (불안,불면,섬망)과 관련된 교육이 있다면 참여할 생각이 있다
	없다	있	다	모르겠다
나는 우울 (불안,불면,섬망) 환자를 간호한 경험이 있다
나는 우울 (불안,불면,섬망)과 관련된 교육을 받은 적이 있다
교육을 받았다면 어디에서 받으셨습니까?	보수교육	직무교육	학술대회	기타
교육을 받았다면 어디에서 받으셨습니까?

Appendix 2.

암환자의 심리적 디스트레스와 섬망에 대한 간호사의 인식 중 9문항에 대한 요인 분석

Item	Rotated Component Matrixa
	Depression		Anxiety		Insomnia		Delirium
	Factor 1	Factor 2	Factor 1	Factor 2	Factor 1	Factor 2	Factor 1	Factor 2
Q1. It is important for nurses to care patients with depression (anxiety/insomnia/delirium)	.074	.602	.054	.656	.118	.707	.098	.697
Q2. I have knowledge of depression (anxiety/insomnia/delirium)	.667	.087	.741	-.022	.755	.120	.781	.140
Q3. I can use appropriate assessment tools for depression (anxiety/insomnia/delirium)	.722	-.069	.697	-.067	.749	-.019	.728	.072
Q4. I can apply nursing interventions to patients with depression (anxiety/insomnia/delirium)	.791	.147	.851	.054	.866	.110	.853	.152
Q5. I have the ability to care for patients with depression (anxiety/insomnia/delirium)	.800	.172	.845	.088	.863	.184	.847	.039
Q6. I have confidence in nursing in patients with depression (anxiety/insomnia/delirium)	.812	.056	.790	.114	.829	.116	.791	-.044
Q7. I can explain the depression to the patient or caregiver (anxiety/insomnia/delirium)	.787	.139	.838	.053	.803	.114	.827	.146
Q8. Professional education on depression is needed (anxiety/insomnia/delirium)	.070	.877	-.032	.879	.084	.914	.085	.882
Q9. I am willing to participate in education about depression (anxiety/insomnia/delirium)	.101	.832	.065	.861	.096	.875	.054	.870
Cronbach's α	.866	.686	.881	.743	.895	.799	.887	.777
% variances	42.08	18.77	42.93	21.86	47.11	21.15	45.38	21.53
Cumulative %	.60.86		64.80		68.26		66.91
Extraction Method: Principal Component
Analysis. Rotation Method: Varimax with Kaiser Normalization.

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