Stress and death attitudes in nurses

Both qualitative and quantitative methods are used to investigate stress and death attitudes in nurses (n=308) from three clinical areas (palliative, psychiatric and general nursing). The work investigates: the experience of stress (reported sources and levels, coping strategies); fear of death (based on Howells et al., 1986, with nurses' reported fears compared with those reported by a general population sample); coping with death and caring for dying patients (nurses' perceived ability to cope and elements of the experience of patient death which contribute to stress); and perceived effects of working with the dying. Results show differences on fear of death across nursing groups and between nurses and the general population sample, suggesting that nursing work does affect levels of fear of death in some respects. Patient death ranks seventh on a list of 24 sources of stress and appears to be perceived by nurses as a unique stressor. Nurses report a range of coping strategies, most important of which is the use of social support, but often regard their coping strategies as less than effective. Evidence indicates that many nurses perceive their training to have been inadequate to deal with some aspects of caring for the dying, and general nurses report less confidence in their ability to cope with death and dying issues than the other groups. Qualitative accounts emphasise nurses' aims to provide 'good death' for their patients and suggest that failure in that aim increases the nurses' stress and that working with the dying can have a major impact on nurses' lives and relationships with others. It is concluded that some difficult aspects of the experience may not be amenable to change, making adequate and effective coping strategies an important goal for nurses engaged in this work and suggesting implications for training and organisational provision of social support.