Demographic Representation of participant
Table 1, shows the demographics of the participants. The study participants were 14 groups 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 had master’s certificate in 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.
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 two (2) main category termed “Administrative constraints” and “Personal constraints”. An overview of the findings is shown in Table 2.
1. Administrative Constraints
Administrative 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 administrative challenges such as: Time-consuming care, Lack of teamwork, Inadequate logistics, Work stress and Reduced labor force. 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 contributed to the feeling of work dissatisfaction among the nurses.
The participants mentioned about how intense the period used in taking for children with cancer is. To care for children with cancer. Participants had to sometimes work over time.
A participant narrative concerning time-consuming care is as follow:
“How do I manage my time? The problem is often not me; it relates to the manner of the oncology nursing care too. Many of us had experienced staying at hospital even after our shift ended. I am often compelled to come to the hospital during my day-off. I feel it may be related to the time demanding nature of oncology care. I feel that my colleagues in other hospital wards usually do not experience this problem” (P3).
Lack 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 lack of team work by saying:
“I sometimes do not 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, I sometimes totally opt-out. Because of the lack of the zeal to work with my colleagues” (P10).
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:
“From my opinion, I feel that we don’t have a well-structured unit for oncology patients.” (P1)
“I feel that we do not 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)
“Despite the importance of safety in the oncology ward, it seems that there are some limitations in the aspect of providing protective equipment or even the whole ward structure. On countless occasions, I do prepare chemotherapy medications at that time that the drug mixing chamber does not work, or with absence of face mask or gown. I can’t stop caring (silence). It’s an issue.” (p5)
Job satisfaction is considered a measurement of workers’ contentedness with their psychological, physiological work environmental. 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 that, 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 there are many patients in the ward. I could spend about an hour or two on each patient. That means I have to stand the whole day without rest. After which I am required to do 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)
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:
“We don’t have adequate staff.” (P8)
“I feel that most people do not willingly want to become Oncology staff.” (P10)
“We the nurses are not many, Sometimes I could be away and I will get a phone call from the Ward manager. I was ever called that a child is going for chemotherapy, and I had to return to work because of the reduced staff strength” (P11)
2. 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, perceptions of contracting cancer and Low Job motivations.
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:
“I remembered my first experience with a child who was diagnosed of bleeding Retinoblastoma. I had to battle with lots of thoughts such as: Do I have to put pressure on the eye a little bit? So how often was I going to be changing the dressing and how am I going to be giving the morphine? how to even maintain the dressing was actually a problem.” (P1)
“I feel that to be an oncology nurse, one needs to be a fast learner and be ready to update oneself about new trends with regards to cancer care. Unfortunately, most of us the oncology nurses have many excuses for not been abreast with current happenings about oncology care. I believe that, the consequence is that we do not all have adequate 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 some of the cases, however, this knowledge is not enough.” (P10)
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:
“A patient on chemotherapy was vomiting and I had to run back to see what was actually happening to that patient. Yet, in the mist of caring for the patient, I was also thinking that what if the drugs splashed into my eyes? what is going to happen to me? What if the drugs get in touch with my skin, what will be the side effects and all that?” (P4)
“So, the challenges are so numerous when it comes to even your colleagues, sometimes assigning colleague nurses, to nurse some oncology cases is 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)
“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” (P7)
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:
“Working conditions in an oncological ward needs incorporating supportive organizational system, including flexibility in working hours. However, in this facility, we do not get such extrinsic motivation. I don’t want to even talk about it because it is often not there. I only get Job satisfaction through my intrinsic self-motivating ability. Thus, I am self-motivated” (P4).