Professional Quality of Life of Nurses in Palliative Nursing Services
Yenni Ferawati Sitanggang, Devy Ully Manurung, Elly Yunita Puspita, Lawrence Natalia
and Elissa Oktoviani Hutasoit
Faculty of Nursing, Universitas Pelita Harapan, Tangerang, Indonesia
Keywords: Nurses, Palliative Care, Quality of Life.
Abstract: Professional Quality of Life (ProQoL) is the quality of a person perceived in relation to their work as a
helper. ProQoL has two aspects included Compassion Satisfaction (CS) and Compassion Fatigue (CF). CF
has two parts, the first is Burn Out (BO) and the second one is Secondary Traumatic Stress (STS). The aim
of this study was to explore the correlation between nurses’ characteristics (age, gender, work experience,
education and marital status) with ProQoL. This study was a descriptive quantitative study with bivariate
analysis. This study applied a total sampling of 45 nurses who had experienced providing palliative care
services. The study was conducted in one private hospital in Jakarta, Indonesia. This research used ProQoL
questionnaire. The study showed that nurses have experienced both positive and negative aspects of
ProQoL. Most nurses experienced moderate burn out (95.6 %) and more than half nurses (53.3%) have low
secondary traumatic stress. In regards of relationship between nurses’ characteristics with ProQoL (CS, BO
and STS), all results revealed that there was no significant relationship (p value >0.05). It is suggested that
to study more factors that might have any correlation to ProQoL.
1 INTRODUCTION
Palliative care is an “approach that improves the
quality of life of patients and their families facing the
problem associated with life-threatening illness,
through the prevention and relief of suffering by
means of early identification and impeccable
assessment and treatment of pain and other problems,
physical, psychosocial and spiritual” (World Health
Organization, 1990). Moreover, palliative care is a
treatment that helps patients to live a comfortable life
during their terminal disease trajectory (Cancer
Council Australia, 2017). This means that palliative
care does not only focus on pain relief but also
focuses on any symptoms including physical,
psychosocial, spiritual and social aspects.
The need of palliative care around the world
increase overtime following the increase number of
life expectancy. It is said that about 40 million
people need palliative care each year, where 78% of
those are people who live in low – middle income
countries (World Health Organization, 1990). People
who are in needs of palliative care are not only
patients who suffer from cancer, but also people
with chronic illnesses such as cardiovascular
disease, renal failures, stroke, diabetes mellitus and
many more. Providing care to people with chronic
diseases needs an extra attention from nurses to their
patients. Nurses as one of the frontline health care
professionals are demanded to provide a highly
complex care/treatment to patients. In addition,
nurses are not only providing physical care but also
providing support to both patients and families. The
job of caring patients with highly complex treatment
may put nurses in the pressure of performing their
professional work. Therefore, the pressure to
achieve the best quality of nursing care can lead to
psychological problems of the nurses.
This condition possibly leads nurses to
experience compassion fatigue during their works.
Few studies have explored many possibilities of
nurses developing compassion fatigue, especially
nurses who cared for patients with chronic diseases.
As mentioned by Hinderer et al., (2014) that nurses
who work in Intensive Care Units (ICU) may have
higher levels of traumatic stress than those nurses
who work in general or medical wards. This is
because nurses in ICU setting are expected to have a
close supervision, in addition, they have to deliver
complex nursing care to their patients. Heavy
workloads in the ward might cause nurses to feel
burn out (Laschinger and Fida, 2014).
Sitanggang, Y., Manurung, D., Puspita, E., Natalia, L. and Hutasoit, E.
Professional Quality of Life of Nurses in Palliative Nursing Services.
DOI: 10.5220/0008203500950099
In Proceedings of the 1st International Conference of Indonesian National Nurses Association (ICINNA 2018), pages 95-99
ISBN: 978-989-758-406-0
Copyright
c
 2020 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
95

Austin et al., (2009) in their study interviewed
five nurses who had compassion fatigue. From the
study were discovered; namely nurses who feel
empty, nurses who shielding themselves, nurses who
feel impotent as a nurse, feeling overwhelmed, kind
of nurses they were and trying to survive. It was said
that nurses feel empty because they have nothing to
give emotionally to the patients, shielding
themselves was stated as they kept themselves away
from patients and families and only do their
technical skills, being impotent as a nurse is when
they feel they have not given anything to their
patients as what they wanted to. Moreover, nurses
who feel overwhelmed is the nurses who lost their
balance in life, while a kind of nurse is when they
feel the way they used to and to be empathic. The
last one, there is kind of nurses who try to survive
which means they have not given up this profession
even though they feel compassion fatigue.
Professional Quality of Life (ProQoL) has positive
and negative aspects that someone can feel at their
work as a helper (Stamm, 2015). Positive aspect of
ProQoL is compassion satisfaction, while negative
aspects are Burn Out (BO) and Secondary Trauma
Stress (STS). Stamm (2015) explained CS as the
feeling that someone have after he/she finishes his/her
work well, BO is something related to a feeling of
hopelessness and cannot deal with job effectively,
while STS is a stressful event related to work. Both
BO and STS have usually interconnected each other.
2 METHOD
2.1 Design
This study was a descriptive quantitative study using
cross sectional method.
2.2 Sample
The research was conducted at one private hospital
in Jakarta. Total sampling was used, and 45 nurses
joined the study. All nurses were the one who
worked in the palliative care wards.
2.3 Procedures
Permission to hospital related to the study had
allowed authors to gather all nurses in the palliative
wards. 45 nurses were gathered and was given
explanation of the study. All 45 nurses agreed to join
the study and gave their written consent. Afterwards,
each nurse was given a ProQoL questionnaire to be
filled and was made sure that they completed all the
given question.
2.4 Instrument
ProQoL questionnaire version 5 from Stamm (2010)
was used to measure the nurses’ ProQoL. This
questionnaire had been translated into Bahasa
Indonesia by (Eka and Tahulending, 2018) and was
tested for its validity and its reliability. It was found
that the Crobach alpha was 0.738 which means that
the questionnaire is valid and reliable. The ProQoL
questionnaire consisted of 30 questions.
The ProQoL questionnaire provided likert type
responses ranging from 1-5, 1 (never) and 5 (very
often). This ProQoL assess three subscales: CS, CF
and BO. There were ten questions in each aspect of
ProQoL. Each aspect of Professional quality of life
following category of a score 22 or less indicates
low, a score of 23-41 indicates moderate and a score
of 42 or above indicates high level (Stamm, 2010).
2.5 Ethical Clearance
This study has been approved by Research Ethic and
Committee Faculty of Nursing Universitas Pelita
Harapan and has got permission from the private
hospital itself.
3 RESULT
3.1 Characteristic Respondents
The characteristics of the respondents are described
in Table 1.
Table 1: Distribution of respondents’ characteristics
(n=45).
Category
Frequency
Percentage
Age
28 years
18
40%
28 – 42 years
27
60%
Gender
Female
43
95.6%
Male
2
4.4%
Marital Status
Married
20
44.4%
Not married
24
53.3%
Widow/widowed
1
2.2%
Education
Diploma Nursing
22
48.9%
Bachelor Nursing
23
51.1%
Work Experience
<5 year
35
77.7%
>5 years
10
22.2%
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The participant of this study was mostly female
(95.6%), and age between 22 – 42 years old with
more than half nurses was single (53.3%). In regards
of academic level, 51.1% of the respondents had
Bachelor of Nursing (S1) and the rest had Diploma
nursing. Moreover, majority of nurses (77.7 %) had
less than five years’ experience working in palliative
care services.
Table 2: Distribution of Nurses’ProQoL (n=45).
Category
Mean
Median
SD
CS
41.64
41
4.09
BO
34.16
34
3.81
STS
21.64
22
5.82
The mean score of the study population for the
level of CS, BO and STS among nurses in providing
palliative care were 41.64 (SD=4.09), 34.16
(SD=3.81) and 21.64 (SD=5.82).
3.2 Professional Quality of Life of
Nurses
Professional’s quality of life among nurses can be
seen in Table 2. The study revealed that majority of
nurses had moderate level of BO (95.6%), while half
nurses (51.1%) had moderate level of CS and 48.9%
nurses had high CS. Furthermore, for STS level,
nurses were in low level (53.3%) and moderate level
(46.7%).
Table 3: Distribution of ProQoL level (n=45).
Scale
CS (%)
BO (%)
STS (%)
Low
0
0
53.3
Moderate
51.1
95.6
46.7
High
48.9
4.4
0
3.3 Correlation of Nurses’
Characteristics towards BO, CS
and STS
The finding of correlation between nurses’
characteristic and BO, CS, STS can be seen in the
following table 4 to 6.
There were no significant association between
nurses’ characteristics (age, gender, education, work
experience and marital status) and BO. It showed
that there was also no significant difference between
education level and marital status with BO. Though,
there was a significant difference in gender with BO,
this cannot be generalised as the participant primary
female (Table 4).
Table 4: Correlation of nurse’s characteristics with Burn
Out (n=45).
Nurses characteristics
Level BO
P Value
Low
Medium
High
Age
28years
0
16
2
0.30
28years
0
27
0
Gender
Female
0
41
2
1.0
Male
0
2
0
Education
Diploma
Nursing
0
22
0
0.49
Bachelor
Nursing
0
21
2
Work
Experience
<5 years
0
28
2
0.80
5 years
0
15
0
Marital
status
Not
Married
0
22
2
0.40
Married
0
20
0
Widow/
widowed
0
1
0
Table 5: Correlation of nurse’s characteristics with
Compassion Satisfaction (n=45).
Nurses characteristics
Level CS
P Value
Low
Medium
High
Age
28years
0
10
8
0.85
28years
0
13
14
Gender
Female
0
22
21
1.0
Male
0
1
1
Education
Diploma
Nursing
0
10
12
0.66
Bachelor
Nursing
0
13
10
Work
Experience
<5 years
0
15
15
1
5 years
0
8
7
Marital
status
Not
Married
0
14
10
0.29
Married
0
8
12
Widow/
widowed
0
1
0
Table 6: Correlation of nurse’s characteristics with
Secondary Trauma Stress (n=45).
Nurses characteristics
Level STS
P Value
Low
Medium
High
Age
28years
8
10
0
0.50
28years
16
11
0
Gender
Female
22
21
0
0.53
Male
2
0
0
Education
Diploma
Nursing
12
10
0
1
Bachelor
Nursing
12
11
0
Work
Experience
<5 years
16
14
0
1
5 years
8
7
0
Marital
status
Not
Married
10
14
0
0.19
Married
13
7
0
Widow/
widowed
1
0
0
Table 5 showed that there is also no association
Professional Quality of Life of Nurses in Palliative Nursing Services
97

between nurses’ characteristics and CS. There was
almost no difference between age, education level,
and work experience and marital status with CS. But
in the table, nurses who were not married
experienced compassion satisfaction than nurses
who were married.
4 DISCUSSION
4.1 Burn Out
In this study, results indicated that the incidence of
BO occurred to all nurses despite its moderate and
high levels. Hunsaker et al., (2015) revealed in their
study that the older the nurses, the higher the level of
burn out, while the younger the nurses, the higher
the burn out level. In the fact by seeing the result of
this study, the statement from Hunsaker et al.,
(2015) cannot be accepted fully as both age range
from less than 28 years old to more than 28 years old
were in the moderate level of BO. However, the
number of nurses who were above 28 years old (28 –
42 years old) reported a greater number of moderate
BO compared to nurses who were less than 28 years
old.
BO can be the result of personal and
organizational work related. Nurses might feel
exhausted at work, unhappiness and overwhelmed.
Though only two nurses had high burn out, it is
important to be further assessed as it might affect
their performance at work related to patients’
satisfaction. As majority of the respondents were
female nurses, it can be said that female nurses were
the most who experienced burn out with their work
compared to the male nurses. However, this result
cannot be generalized.
In connection with BO occurrence, Chang and
Chan (2015) in their study mentioned that nurses
who have high level of optimism and positive
coping tend to have low level of burn out. The
authors explored that nurses who are optimistic
usually think positively although they face work
related obstacles. Therefore, optimistic people are
good in dealing with any stressors. Timmermann,
Naziri and Etienne, (2018), also added that coping
control and social support are one example of coping
strategies to deal with burn out. In line with those
results, it is important for nurses to have a positive
coping mechanism to be able to face challenges and
obstacles during their work and services. However,
in this study, level of optimism and coping were not
studied.
4.2 Compassion Satisfaction
Hinderer et al., (2014) discovered that nurses who
had higher level of CS had lower STS. This study’s
result in line with the result by Hinderer et al.,
(2014) that showed by 51.1% CS in moderate level
had also moderate level of STS which almost half
nurses (46.7%) while high level of CS (48.9%) had
not showing any high level of STS.
However, Hunsaker et al., (2015) investigated
the comparison between male and female nurses test
and showed that there is no statistical significance of
CS, CF and Burn out level between male and female
nurses.
4.3 Secondary Trauma Stress
Many resources mentioned that healthcare workers
are suffer from work related stress (Najjar et al.,
2009); Mchugh et al., (2011). Mchugh et al., (2011)
in their study mentioned that nurses who provide
direct care to their patients in nursing home have the
highest degree of dissatisfaction, followed by nurses
who give direct care but in other setting such as
hospital. These nurses in this study were giving their
direct patient care to patients with cancer and
chronic diseases in the hospital. In addition, nurses
provide a holistic care to the patients who were in
irreversible condition because of their diseases. As a
result, these reasons might develop a trauma stress
within them. In line with this is a study carried out
by Najjar et al., (2009) which highlighted that nurses
who are in oncology wards face challenges while
providing care to patients who are approaching
death.
Hinderer et al., (2014) stated that nurses who had
high level of burn out is more likely to have a higher
level of secondary trauma stress. However, in this
study, with the majority number of moderate burns
out of 43 nurses (95.6%), it cannot be proved that
the nurses experienced a higher number of traumatic
stress. In the fact, there were more than half nurses
was actually showed a low level of traumatic stress
(53.3%) and moderate level (46.7%). Melvin, Wald
and Saunders, (2012) stated that compassion fatigue
does exist among nurses who work in palliative care
wards and hospice. It further said that by providing
this care, it is possibly that nurses develop a negative
physical and emotional effects. Therefore, this study
might need to explore more on possibility of
physical and emotional effect that may cause by
traumatic stress.
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5 LIMITATIONS
Apart from the results, there are several limitations
of this study such as all participants were mostly
women which makes the results cannot be
generalized. Moreover, this study only describes the
nurses’ ProQoL with a minimum sample and explore
the relationship between each aspect of ProQoL
(BO, STS and CS) with nurses’ characteristics (age,
marital status, and work experience, gender and
education level). The result showed there were no
significant correlation found between nurses’
characteristics with each aspect of ProQoL.
Therefore, further study related to other factors
might be beneficial to be studied. Some resources
mention that there are so many factors that might
impact on someone’s professional quality of life that
might be interesting to be studied in the future
research.
6 CONCLUSIONS
To conclude, it is crucial to assess the three aspects
of professional quality of life of nurses who
especially provide a palliative care. As it was
mention that nurses who provide care to those
palliative patients may develop the three aspects of
ProQoL. However, more training and professional
development for nurses may help nurses to be able
to cope with any possibility of compassion fatigue
incidence. Moreover, it is important for further study
to assess the relationship between each aspect in
professional’s quality of life of nurses, the
connection of compassion fatigue, burn out and
secondary traumatic stress. It would be beneficial for
the next researchers to assess factors that may cause
the occurrence of compassion fatigue to nurses
providing the palliative care.
ACKNOWLEDGEMENTS
The authors would like to thank Faculty of nursing
Universitas Pelita Harapan for an ethical clearance
approval and to all nurses who participated in this
study. Moreover, we would like to show our
gratitude to Ni Gusti Ayu Eka who has given us
permission to use The ProQoL questionnaire in
Indonesian version. We are also thanking Dwi
Yulianto who has given his time to proofreading this
manuscript and made some comments and
suggestions.
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