Prior research has suggested that nurses, regardless of workplace or culture, are confronted with a variety of stressors. As the worldwide nursing shortage increases, the aged population becomes larger, there is an increase in the incidence of chronic illnesses and technology continues to advance, nurses continually will be faced with numerous workplace stressors. Thus, nurses, especially palliative care nurses, need to learn how to identify their workplace stressors and to cope effectively with these stressors to attain and maintain both their physical and mental health. This article describes workplace stressors and coping strategies, compares and contrasts cross-cultural literature on nurses' workplace stressors and coping strategies, and delineates a variety of stress management activities that could prove helpful for contending with stressors in the workplace.

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The work environment significantly affects the physical, psychological, emotional and/or spiritual wellbeing of individuals is unquestionable. Adverse effects have been noted among healthcare professionals working with clients experiencing pain and suffering often associated with cancer, palliative or end-of-life care; however, little is known about how or in which manner the nurse-patient-family relationship may affect the psychosocial health and wellbeing of nurses working in these areas. Three concepts have been highlighted as most frequently associated with the adverse consequences of caring work: these are compassion fatigue (secondary traumatic stress), burnout and vicarious traumatization. The following discussion investigates these concepts and their implications on palliative and hematological cancer nursing practice.

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This article explores the emotional labor involved for nurses providing palliative care for children/young people living with life-limiting illnesses/conditions, and their families. It highlights the challenges nurses face in managing their emotion when caring for children/young people and their families, and explores strategies to enable nurses to cope with this aspect of their role without compromising their personal wellbeing. It suggests that emotional labor within nursing goes largely unrecorded, and remains undervalued by managers and health care services.

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This article explores the issues of hospice palliative care volunteer attrition and retention (i.e., why volunteers leave and how to keep them interested). In addition, common sources of stress for volunteers will be identified and suggestions for alleviating stress will be offered. Volunteers are special people; patients and families greatly appreciate the care and support they provide and the other staff members' (e.g., nurses) jobs are often made easier because of them. Thus, maintaining a committed group of volunteers is an extremely important task for volunteer coordinators. The literature reviewed in this article focused mostly on North American studies and was limited to research that specifically involved hospice palliative care volunteers as participants.

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Children with advanced, life-limiting illness have unique needs which are different from those of adults. Pediatric palliative care is an under developed specialty. Aims : To identify concerns of parents of children with advanced, incurable cancers, and to elicit their attitudes toward revealing the diagnosis and prognosis to the sick child. Method : This study was carried out in a large tertiary cancer center in India. Parents of 20 pediatric palliative care patients attending the outpatient department were interviewed and emerging themes identified. Results : Parents showed varying degrees of anticipatory grief. Most families were financially strained. Most parents were reluctant to discuss disease and dying with the child. Siblings were rarely told or directly involved in care. There was resistance to allowing the palliative care team to communicate with the patient. Patients did not receive any formal support. Parents identified family and neighbors as the main sources of support. Conclusions : Parental attitudes hinder open communication with dying children in India. There is a need for research to explore the concerns of families of children with fatal illness. Specialist training is required for professionals working in pediatric palliative care to address this issue.

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Metastatic bone pain is acommonly encountered clinical condition seen in oncology clinical practice. About 50% of all cancer patients develop metastases in their lifetime and half of them develop skeletal metastases. Despite its importance, no specific therapeutic strategy, to prevent or treat this complication of cancer has been demonstrated. This study comparing two radiotherapy regimens was conducted at a cancer center in New Delhi, India. Patients with confirmed bone metastases were randomized into two treatment arms, Group A (single fraction) and Group B (multiple fractions). Patients were followed up for 12 weeks. Pain relief was the primary endpoint of the treatment. Other parameters were improvement in analgesic score, performance status, and acute side effects like nausea, vomiting, tiredness, and lassitude. Fifty patients were evaluated at the end of the study. Overall response rate was seen in 86% of cases, whereas complete response was seen in 36% of cases. The two treatment regimens were found to be comparable with respect to other endpoints. Hence, a single fraction treatment, which is more convenient and cost effective, is a more logical approach in the Indian scenario in selected cases.

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Objective : To investigate the palliative care needs of patients with stage 3 and 4 HIV infection in Settlers Hospital, Grahamstown. Design : Observational study done by patient interviews. Setting : A district hospital in a small town in South Africa. Participants : A total of 50 patients admitted to the medical ward of the hospital with stage 3 and 4 HIV infection who were well enough to be interviewed and who consented. Interventions : All the patients were interviewed by a team comprising an Honors student in psychology and a nurse or a medical doctor (CJ) and a nurse. Main outcome measures : The self-reported needs of these patients as identified by an interview. Results : A total of 55 patients admitted to the ward between February and May 2005 were identified as fulfilling the criteria of having stage 3 and 4 HIV infection. Of these patients, three were too ill and two refused consent to be interviewed. Ninety-four percent of the patients had unresolved medical problems and needed symptom relief. All the patients had some socioeconomic problems and 56% had no income. Poor housing (50%) and no access to electricity (28%), or running water (48%) were also major problems. As were lack of transport (96%) and worries about the future of children left behind (72%). Surprisingly psycho spiritual issues were not a major problem with 80% having spiritual and family support. Conclusions : Medical problems with poor symptom control were the commonest problems, followed by socioeconomic issues related to no income, poor living conditions and fears for the future of their children. Spiritual and psychological issues were surprisingly less of a problem possibly because the immediacy and severity of the demands of day-to-day survival. As a result of the needs identified among these patients, it became apparent that a palliative care ward catering to these needs was needed. The guiding principles in the development of this ward were the need for privacy, for a teamwork approach and for meticulous medical care, all of which underpin good palliative care.

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