Nurses’ perspectives on their communication with patients in busy oncology wards: A qualitative study

Autoři: E. Angela Chan aff001;  Pak Lik Tsang aff001;  Shirley Siu Yin Ching aff001;  F. Y. Wong aff001;  Winsome Lam aff001
Působiště autorů: School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, HKSAR aff001
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224178



Despite an increase in emphasis on psychosocial care in cancer nursing, time constraints and nurses’ lack of knowledge in skilled communication continue to be challenges.


To examine how cancer care nurses view their communication with patients and how they deal with the psychosocial needs of patients in busy wards.


A qualitative interview study.


Focus groups and individual interviews were conducted with eleven hospital-based cancer nurses in Hong Kong from July 2, 2017 to January 2, 2018.


A qualitative thematic analysis of the data identified three themes: 1. Intentional and unintentional psychosocial care that is secondary in focus; 2. Managing an emotionally challenged environment; 3. Mentoring and learning.


Oncology settings are time-constrained, emotionally charged environments for nurses, and providing psychosocial care for patients is a secondary concern. While proactive strategies can be used to avert patient complaints, being open and attending to the individual needs of patients is equally important to avoid blocking in nurse-patient communication. Despite emotional entanglement and tensions, the positive follow-up strategies used by nurses to manage the patients’ emotions and provide psychosocial care reflect good practices. Leadership and support are needed to deal with the nurses’ perception that their communication training has been ineffective and their ability to manage strong emotions deficient. Communication skills, honed by making continuous opportunities to communicate available, as well as an understanding of emotional labour, need to be integrated with mindfulness in the nurses’ care of themselves and their patients. Notwithstanding the importance of experience in oncology care for junior nurses, it is necessary for both junior and senior nurses to learn about and reflect upon the different forms of emotional labour if value-based care is to be provided. In addition, it is essential for junior nurses to receive continuous coaching and mentoring, and to engage in reflective learning from each clinical encounter with oncology patients.

Klíčová slova:

Anxiety – Emotions – Learning – Nurses – Oncology – Patients – Psychological and psychosocial issues – Psychological stress


1. Mahran GK, Taher AM, Saleh NA. Challenges and work crisis facing critical care nurses. Egyptian Nursing Journal. 2017;14(3):235–7.

2. Hospital Authority. HA annual plan 2016–2017. 2017.

3. Association of Hong Kong Nursing Staff. Hong Kong Nurses’ Association’s agenda for the 2017 chief executive election candidates on health and nursing policy 2017.

4. Aiken LH, Sloane DM, Griffiths P, Rafferty AM, Bruyneel L, McHugh MD, et al. Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Quality & Safety. 2017;26(7):559–68.

5. Liang YW, C W.Y., Lee JL, Huang LC. Nurse staffing, direct nursing care hours and patient mortality in Taiwan: the longitudinal analysis of hospital nurse staffing and patient outcome study. BMC Health Service Research. 2012;12(1):44–51.

6. West E, Mays N, Rafferty AM, Rowan K, Sanderson C. Nursing resources and patient outcomes in intensive care: A systematic review of the literature. International Journal of Nursing Studies. 2007;46(7):993–1011. doi: 10.1016/j.ijnurstu.2007.07.011 17964577

7. Güner P, Hiçdurmaz D, Yıldırım NK, İnci F. Psychosocial care from the perspective of nurses working in oncology: A qualitative study. European Journal of Oncology Nursing. 2018;34:68–75. doi: 10.1016/j.ejon.2018.03.005 29784141

8. Engel GL. The need for a new medical model: A challenge for biomedicine. Science. 1977;196:129–36. doi: 10.1126/science.847460 847460

9. King MOB, Gates MF. Perceived barriers to holistic nursing in undergraduate nursing programs. Explore: The Journal of Science and Healing. 2006;2(4):334–8.

10. Pehrson C, Banerjee SC, Manna R, Shen MJ, Hammonds S, Coyle N, et al. Responding empathically to patients: Development, implementation, and evaluation of a communication skills training module for oncology nurses. Patient Education and Counseling. 2016;99(4):610–6. doi: 10.1016/j.pec.2015.11.021 26686992

11. Muzzalti B, Bomben F, Flaiban C, Mella S, Annunziata MA. Psychological distress in cancer patients: From recognition to management. In: Compare A, Elia C, Simonelli AG, editors. Psychological distress. Hauppauge, NY: Nova Science Publishers, Inc.; 2016.

12. Hogg R, Hanley J, Smith P. Learning lessons from the analysis of patient complaints relating to staff attitudes, behaviour and communication, using the concept of emotional labour. Journal of Clinical Nursing. 2018;27:e1004–e12. doi: 10.1111/jocn.14121 29052343

13. Peterson EB, Calhoun AW, Rider EA. The reliability of a modified Kalamazoo consensus statement checklist for assessing the communication skills of multidisciplinary clinicians in the simulated environment. Patient Education and Counseling. 2014;96:411–8. doi: 10.1016/j.pec.2014.07.013 25103180

14. Wilkinson S. Factors which influence how nurses communicate with cancer patients. Journal of Advanced Nursing. 1991;16(6):677–88. doi: 10.1111/j.1365-2648.1991.tb01726.x 1869716

15. Salmon P, Young B. Creativity in clinical communication: From communication skills to skilled communication. Medical Education. 2011;45(3):217–26. doi: 10.1111/j.1365-2923.2010.03801.x 21299597

16. Banerjee SC, Manna R, Coyle N, Shen MJ, Pehrson C, Zaider T, et al. Oncology nurses’ communication challenges with patients and families: A qualitative study. Nurse Education in Practice. 2016;16(1):193–201. doi: 10.1016/j.nepr.2015.07.007 26278636

17. Lampic C, Sjöden PO. Patient and staff perceptions of cancer patients’ psychological concerns and needs. Acta Oncology. 2000;39(1):9–22.

18. Palos GR, Tortorella FR, Stepen K, Rodriguez MA. A multidisciplinary team approach to improving psychosocial care in patients with cancer. Clinical Journal of Oncology Nursing. 2013;17(5):556–8. doi: 10.1188/13.CJON.556-558 24080057

19. Aldaz BE, Treharne GJ, Knight RG, Conner TS, Perez D. Oncology healthcare professionals’ perspectives on psychosocial support needs of cancer patients during oncology treatments. Journal of Health Psychology. 2017;22(10):1332–44. doi: 10.1177/1359105315626999 26837692

20. Chan EA, Wong F, Cheung MY, Lam W. Patients’ perceptions of their experiences with nurse-patient communication in oncology settings: A focused ethnographic study. Plos One. 2018;13(6):1–17.

21. Brown NM, Lui CW, Robinson PC, Boyle FM. Supportive care needs and preferences of lung cancer patients: A semi-structured qualitative interview study. Supportive Care in Cancer. 2015;23(6):1533–9. doi: 10.1007/s00520-014-2508-5 25394711

22. Adler NE, Page AEK. Cancer care for the whole patient: Meeting psychosocial health needs. Washington, DC: The National Academies Press; 2008.

23. Vinckx MA, Bossuyt I, Dierckx de Casterlé B. Understanding the complexity of working under time pressure in oncology nursing: A grounded theory study. International Journal of Nursing Studies. 2018;87:60–8. doi: 10.1016/j.ijnurstu.2018.07.010 30055374

24. Lambert SD, Loiselle CG. Combining individual interviews and focus groups to enhance data richness. Journal of Advanced Nursing. 2008;62:228–37. doi: 10.1111/j.1365-2648.2007.04559.x 18394035

25. Carey MA. The group effect in focus groups: Planning, implementing, and interpreting focus group research. In: Morse JM, editor. Critical Issues in Qualitative Research Methods. Thousand Oaks, CA: Sage; 1994. p. 225–41.

26. Houghton C, Casey D, Shaw D, Murphy K. Rigour in qualitative case-study research. Nurse Researcher. 2013;20.

27. Guest G, Bunce A, Johnson L. How many interviews are enough?: An experiment with data saturation and variability. Field Methods. 2006;18:59–82.

28. Coenen M, Stamm TA, Stucki G, Cieza A. Individual interviews and focus groups in patients with rheumatoid arthritis: A comparison of two qualitative methods. Quality of Life Research. 2012;21:359–70. doi: 10.1007/s11136-011-9943-2 21706128

29. Dowling M. Approaches to reflexivity in qualitative research. Nurse Researcher. 2006;13:7–21.

30. Rees CE, Ford JE, Sheard CE. Patient information leaflets for prostate cancer: which leaflets should healthcare professionals recommend? Patient Education and Counseling. 2003;49:263–72. doi: 10.1016/s0738-3991(02)00188-x 12642198

31. Taylor B. The experiences of overseas nurses working in the NHS: Results of a qualitative study. Diversity in Health and Social Care. 2005;2:17–27.

32. Pamphilon B. The zoom model: A dynamic framework for the analysis of life histories. Qualitative Inquiry. 1999;5:393–410.

33. Hennink MM, Kaiser BN, Weber MB. What influences saturation? Estimating sample sizes in focus group research. Qualitative Health Research. 2019;29:1483–96. doi: 10.1177/1049732318821692 30628545

34. Moezzi S, editor Combining personal perspectives and women’s knowledge: Combining focus group and semi-structured interviews. 8th International, Interdisciplinary Advances in Qualitative Methods Conference; 2007; Banff, Canada.

35. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77–101.

36. Maguire D, Delahunt B. Doing a thematic analysis: A practice, step-by-step guide for learning and teaching scholars. All Ireland Journal of Teaching and Learning in Higher Education. 2017;3:3351–14.

37. Taylor SJ, Bogdan R. Introduction to qualitative research methods: A guidebook and resource NY: Wiley; 1998.

38. Hochschild AR. The managed heart: The commercialisation of human feeling. Berkeley, CA: University of California Press; 1983.

39. Freshwater D, Stickley T. The heart of the art: emotional intelligence in nurse education. Nursing Inquiry. 2004;11:91–8. doi: 10.1111/j.1440-1800.2004.00198.x 15154888

40. Henderson A. Emotional labor and nursing: An under-appreciated aspect of caring work. Nursing Inquiry. 2001;8:130–8. 11882211

41. Carmack BJ. Balancing engagement and detachment in caregiving. Image: The Journal of Nursing Scholarship. 1997;29:139–43.

42. Sheldon LK, Barrett R, Ellington L. Difficult communication in nursing. Journal of Nursing Scholarship. 2006;38(2):141–7. 16773917

43. Weis J. Psychosocial care for cancer patients. Breast Care. 2015;10:84–6. doi: 10.1159/000381969 26195935

44. Angel S, Vatne S. Vulnerability in patients and nurses and the mutual vulnerability in the patient-nurse relationship. Journal of Clinical Nursing. 2016;26:1428–37.

45. Wilkinson S, Perry R, Blanchard K, Linsell L. Effectiveness of a three-day communication skills course in changing nurses’ communication skills with cancer/palliative care patients: A randomised controlled trial. Palliative Medicine. 2008;22:365–75. doi: 10.1177/0269216308090770 18541641

46. Watts R, Botti M, Hunter M. Nurses’ perspectives on the care provided to cancer patients. Cancer Nursing. 2010;33(2):E1–E8. doi: 10.1097/NCC.0b013e3181b5575a 20142746

47. Kennedy-Sheldon L, Barrett R, Ellington L. Difficult communication in nursing. Journal of Nursing Scholarship. 2006;38(2):141–7. 16773917

48. Mann S. A health-care model of emotional labour: An evaluation of the literature and development of a model. Journal of Health Organization and Management. 2005;19:304–17. doi: 10.1108/14777260510615369 16206916

49. Huynh T, Alderson M, Thompson M. Emotional labour underlying caring: An evolutionary concept analysis. Journal of Advanced Nursing. 2008;64:195–208. doi: 10.1111/j.1365-2648.2008.04780.x 18990101

50. Smith P. The emotional labour of nursing revisited: Can nurses still care? 2nd ed. Basingstoke, UK: Macmillan International Higher Education; 2011.

51. Msiska G, Smith P, Fawcett T. Exposing emotional labour experienced by nursing students during their clinical learning experience: A Malawian perspective. International Journal of Africa Nursing Sciences. 2014;1:43–50.

52. Theodosius C. Emotional labour in health care: The unmanaged heart of nursing. London: Routledge; 2008.

53. Karimi L, Leggat SG, Donohue L, Farrell G, Couper GE. Emotional rescue: The role of emotional intelligence and emotional labour on well-being and job-stress among community nurses. Journal of Advanced Nursing. 2014;70:176–86. doi: 10.1111/jan.12185 23763612

54. Smith P, Cowie H. Perspectives on emotional labour and bullying: Reviewing the role of emotions in nursing and healthcare. International Journal of Work Organisation and Emotion. 2010;3:227–36.

55. Mayer D, Salovey P. The intelligence of emotional intelligence. Intelligence. 1993;17:433–42.

56. Snowden A, Stenhouse R, Young J, Carver H, Carver F, Brown N. The relationship between emotional intelligence, previous caring experience and mindfulness in student nurses and midwives: A cross sectional analysis. Nurse Education Today. 2015;35:152–8. doi: 10.1016/j.nedt.2014.09.004 25282342

57. Chou HY, Hecker ROB, Martin A. Predicting nurses’ well-being from job demands and resources: A cross-sectional study of emotional labour. Journal of Nursing Management. 2012;20:502–11. doi: 10.1111/j.1365-2834.2011.01305.x 22591152

58. Brereton ML. Communication in nursing: The theory-practice relationship. Journal of Advanced Nursing. 1995;21(2):314–24. doi: 10.1111/j.1365-2648.1995.tb02528.x 7714289

59. Eisner EW. Artistry in education. Scandinavian Journal of Educational Research. 2003;47:373–84.

60. Dilworth S, Higgins I, Parker V, Kelly B, Turner J. Patient and health professional’s perceived barriers to the delivery of psychosocial care to adults with cancer: A systematic review. Psycho-Oncology. 2014;23(6):601–2. doi: 10.1002/pon.3474 24519814

61. Prince-Paul M, Kelley C. Mindful communication: Being present. Seminars in Oncology Nursing. 2017;33(5):475–82. doi: 10.1016/j.soncn.2017.09.004 29107525

62. Kolb DA. Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice-Hall; 1984.

63. Reed E. The necessity of experience. New Haven, CT: Yale University Press; 1996.

Článek vyšel v časopise


2019 Číslo 10