Independent Study Module
Learning Contract
97181835

QUEEN MARGARET UNIVERSITY – INDEPENDENT STUDY MODULE
LEARNING CONTRACT________________________________________________________

NAME: Julie Young
PROGRAMME: MSc Palliative Care
AREAS OF INTEREST: Stress in Palliative Care
RATIONALE FOR CHOICE: Over the past two years, the student’s organisation (a Hospice Unit) has undergone many changes, particularly at ward level: a change in environment (a temporary change of building and location in a non-purpose built building), the loss of staff members, a reduction in staff/patient ratios and an increase in the number of beds.
During this period of change and increasing demands, the student, a Staff Nurse on the hospice ward, has observed a general increase in ‘stress’ levels of the ward staff. Rising levels of exhaustion and staff frustration are apparent, along with a general feeling of ‘no longer feeling valued’. The student has observed, over time, signs of apathy in colleagues’ daily behaviour.
Nursing ranks highly in occupations to experience stress according to the Health and Safety Executive (2005). A postal survey to 6000 general nurses, undertaken by the Royal College of Nursing (2006) in the UK, assessed respondents against 6 domains. Nurses scored higher on the domains of demands, control, roles and relationships compared with other occupations indicating greater levels of stress. Similar stressors have also been reported for nurses working in adult palliative care settings (Newton and Waters 2001).
Caring for the terminally ill is a demanding, but rewarding area (Slocum-Gori et al 2013) of health care, stressors unique to this working environment – dealing with patient death rather than cure, and supporting entire family units, for example – putting caregivers at risk from stress related illness (Hulbert and Morrison 2006). Prolonged exposure to ‘job stressors’ leads to the psychological syndrome ‘Burnout’ (Masalach 2006).
Burnout refers to a loss of energy, which usually happens when persons feel ‘burned’ in both physical and psychological terms (Perieira et al 2011). A burnt out person shows signs of distress in their daily behaviour and feel that it is almost impossible for them to perform normally because of exhaustion (Perieira et al 2012).
Burnout is associated with risk factors stemming from a professional environment (Perieira et al 2011). Palliative care is provided in a challenging environment, where work is characterised by the development, over time of intense professional relationships with patients and families (Michael et al 2004) and protracted exposure to suffering and death (Medland et al 2004).
Caring for dying patients involves high levels of emotional engagement and personal commitment (Meier and Beresford 2006). Stress is a topic close to the student’s heart. Having struggled with the effects of stress throughout her life, the student feels it is now well managed but remains unable to entirely avoid feeling stressed. For this reason the student aims to, by answering the following questions, learn about the effects of stress on health professionals working in palliative care.

What are the degrees of stress?
Are there particular sources of stress in the palliative care setting?
Moreover, are palliative care health professionals at risk of burnout?
Are there coping strategies palliative care health professionals can use to alleviate stress/avoid burnout?

ACADEMIC SUPERVISOR: Janice Logan
LEARNING OBJECTIVES
1. General Aim: I would like to learn about the effects of stress in health professionals working in palliative care.
2. Specific Outcomes:
1. Negotiate an individual learning contract with supervision that helps to guide and structure my work.
2. Formulate a search strategy in relation to stress in palliative care.
3. Through in-depth appraisal, synthesise and critically analyse the literature on stress in palliative care.
4. Evaluate the relevance of the