Demographic Representation of participant
Table 1, shows the demographics of the participants. The study participants were 14 group of state registered nurses who work at the Pediatric/Hematology Cancer Unit at the Tamale Teaching Hospital, Ghana. These nurses represent the demographic make-up of the region where this study took place. They were between the ages of 29 and 45 years. Three of them of them had master’s certificate on pediatric Nursing and the rest had B.Sc. degrees in Nursing. Among the participants, their years of experiences in pediatric oncology care ranged between two to twelve years.
Table 1
Demographics of Participants
Participants | Gender | Age | Education | Years of Experience |
1 | Male | 29 | B.Sc. Degree | 2 |
2 | Male | 34 | B.Sc. Degree | 6 |
3. | Male | 36 | B.Sc. Degree | 4 |
4 | Male | 40 | B.Sc. Degree | 12 |
5 | Female | 40 | B.Sc. Degree | 11 |
6 | Male | 35 | B.Sc. Degree | 7 |
7 | Female | 36 | Masters | 12 |
8 | Female | 45 | B.Sc. Degree | 9 |
9 | Male | 28 | B.Sc. Degree | 2 |
10 | Male | 36 | B.Sc. Degree | 6 |
11 | Male | 36 | B.Sc. Degree | 6 |
12 | Female | 34 | Masters | 11 |
13 | Female | 36 | Masters | 11 |
14 | Male | 34 | B.Sc. Degree | 9 |
Authors Construct (2020). |
Analysis of the interviews led to identification of eight (8) identified challenges of the pediatric oncology nurses (Sub-categories), these challenges representing a main category termed “Low caring morale”. An overview of the findings is shown in Table 2
Table 2
Sub-Categories, Generic Categories and Main Category of the study
Sub- Categories | Generic-Categories | Main- Category |
⎫ Time-consuming care | Administrative-related constraints | Low caring morale |
⎫ Low Job motivations |
⎫ Inadequate logistics |
⎫ Work stress |
⎫ Reduced labor force |
⎫ Low knowledge level | Personal constraints |
⎫ Absence of team work |
⎫ Perception of contracting cancer |
Authors Construct (2020). |
Low Caring Morale
The participant experienced a work environment that was conceptualized as an environment with low caring moral. Within their stories, participants experiences focused upon “Time-consuming care”, “low Job motivations”, inadequate logistics, “work stress, “Reduced labor force”, “Low knowledge level”, “Absence of team work”, “Perception of contracting cancer”. From the data analysis, it can be saild that the type of environment the nurses worked in, was not an healthy working environment. Low caring Morale in this study, is defined as a health settings (environment) that does not promote good working conditions. A healthy work environment can be defined as a work setting in which nurses are able to both achieve the goals of the organisation and derive personal satisfaction from their work. A healthy work environment fosters a climate in which nurses are challenged to use their expertise, skills and clinical knowledge. It specifically linked the importance of hospital environment and a number of personal constraints and its effect on the concept of morale of nurses. It highlights the concept of the relationship between giving adequate pediatric oncology care and the morale of nurses. Thus, it encompasses a number of administrative work-related issues and personal challenges (Generic-Categories) of this current study.
a.Administrative-related Constraints
Admirative-related constraints in this study refers to challenges in caring for children with cancer that results when the organization did not provide adequate structural and functional logistics to work with, in the hospital environment. Majority of the nurses experienced administration challenges such as: time-consuming care, low job motivation, scarce logistics, reduced labor force and work stress. And this, often leads to physical and psychological burnout for the participants, because of work overload, few supporting staff, coupled with inadequate logistics for caring. These challenges all this contributed to a feeling of work dissatisfaction among the nurse.
1. Time-consuming Care
The participants mentioned about how intense the period used in taking for children with cancer takes. To care for children with cancer. Participants had to sometimes work over time.
A participant narrative concerning time-consuming care is as follow:
“Sometimes, after a night shift a nurse has to overstay till about 12:00 pm because there is no ready nurse to a takeover the next shift. Some other times an off-duty nurse is compelled to report to work due to lack of staff.” (P6)
2. Low Job Motivation
Motivation is a concept used to describe the external state that stimulates a particular behavior and reveal the internal response of that behavior. In an organizational environment, motivation is interpreted as a stimulus to work behavior, which guides the efforts of workers to achieve organizational goals. The motivation of workers in this study, is the result of the interaction between individuals (internal psychological process), their working environment (transaction process) and the fit between these interactions and the social environment. Some participants mentioned that they experienced a low job motivation.
A participant also gave narratives about the low Job motivations by saying:
“when it comes to motivation, we don’t want to even talk about it because it’s not just coming, apart from you getting self-motivated, nothing is forthcoming with regards to the facility, we haven’t seen any support anywhere coming and sometimes apart from the fact that money is key that is not forthcoming.” (P4)
3. Inadequate Logistics
The availability of modern and adequate equipment and a separate structure dedicated to the pediatric cases is one of the essentials of providing useful pediatric oncology care. The lack of equipment can lead to work disruptions, delays and lack of care.
Some participants also gave narratives about inadequate logistics by saying:
“And now we don’t have well-structured unit for oncology patients.” (P1)
“We don’t have the equipment to work with the patient. Like the face masks, gown, apron, wellington boot. Generally, we lack supply of safety gears and protective clothing” (P3)
4. Work Stress
Job satisfaction
is considered a measurement of workers’ contentedness with their
The lack of equipment can lead to lack of care and emotional exhaustion for most nurses, as they had to struggle to thoroughly assess the oncology children condition, give chemotherapies and other routine therapies to the children with cancer and at the same time, listen and take care of the demand of the child’s family members. After wish, they still had to do other administrative work of documenting all care process carried out on the child.
Some participants gave narratives about feeling stressed by saying:
“I will say it’s very laborious and so involving. Take an example like giving chemotherapy to some of patients especially at the time that they are many at the ward, spending about an hour or two on each patient means you have to stand the whole day without rest. After which you are required to do your documentation and monitoring as well. So, it’s so involving and labor-intensive.” (P9)
“It is tough, it is really tough, I don’t even know what to say, I have never pushed a truck, you have seen those truck pushers, pulling and pushing the truck, I can say caring for oncology case is like that. It is difficult.” (P11)
5. Reduced Labor Force
Having sufficient human resources who are available to run shifts is very important because it significantly affect nurse’s morale. Most of the pediatric oncology nurses complained that they are not adequately staffed, this causes loads of work on the few staff in the ward that could contribute to their having a low caring morale.
Some participant spoke about the reduced labor force by saying:
“Because the people in the team are few, we are not many, you can be away and they will be calling you, this child is going for chemotherapy, you have to be around, sometimes they come with problems, it has been hectic.” (P11)
“We don’t have adequate staff.” (P8)
“Most people do not willingly want to become Oncology staff.” (P10)
b. Personal Constraints
Personal constrains of the participants refers to the pediatric oncology care challenges that can be mitigates by to some extent by the nurses themselves. The personal constraint of the clients in this study includes their low level of knowledge, absence of team work and the perceptions of contracting cancer:
6. Low Level Of Knowledge
Having sufficient human resources with high clinical experience and high professional knowledge can be significant in improving the morale of the Nurses.
Some participants gave narratives about Low levels of knowledge by saying:
“Do we have to put pressure on the eye a little bit? So how often are we going to be changing the dressing and how often are we going to be giving the morphine? how to even maintain the dressing was actually a problem.” (P1)
“Not all the staff have the training or the knowledge on the cancer cases.” (P8)
“So, what we do is, we have our number of nurses who have few numbers of workshops on cancer, that with the help of the current pediatric assistant head of department we are able to manage most of the cases, however, this knowledge is not enough.” (P10)
7. Absence Of Team Work
From the nurses’ point of view, team work is a key issue for them in providing care and in some cases, it is not evident in their performance. They noted that having effective team work in caring for children with cancer could partly mirror their professional performance. From the participants view, most of the oncology nurses often do not have the zeal to go and administer the chemotherapy mediations to the children when the children are due to take their routine chemotherapy medications.
A participant also gave narratives about the Absent of team work by saying:
“Pediatric nurses, they don’t have interest in the oncology patient. So, when it happens that some body is in the oncology cubicle and it is time for serving medication, they totally opt-out. They don’t have the zeal” (P10).
8. Perception Of Contracting Cancer
Some nurses in this study also think that they could get cancer as a result of caring in an environment that is not so friendly about putting strategies in place so as to protect them from being exposed.
Some participants gave narratives about their Perception of contracting cancer by saying:
“They say this patient is vomiting and you have to run back to see what is actually happening to that person and that anxiety of thinking that what if the drugs have splashed into your eyes? what is going to happen to you? What if the drugs get in touch with your skin, what will be the side effects and all that?” (P4)
“I personally had medication entering my eyes, I was sad thinking about what the outcome will be in the future, but then I am still moving on, it’s a challenge. if we had a fume chamber where we could do all those, I think all these would not have happened, because it was in the process of mixing the chemotherapy medication that it splashed unto my eye.” (P7)
“So, the challenges are so numerous when it comes to even your colleagues, sometimes assigning colleague nurses, to nurse some oncology cases its interesting you will hear somebody telling you that as for this case I’m scared to go near the person. So, you’ll now ask yourself, if you are scared who should go? So that has been an issue.” (5)