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G Ital Med Lav Erg 2017; 39:2, 93-99 © PI-ME, Pavia 2017
ISSN 1592-7830 MEDICINA DEL LAVORO
Rosario Caruso1, Daniela Miazza3, Francesca Gigli Berzolari2, Anna Maria Grugnetti3, Danuta Lichosik4,
Gender differences among cancer nurses’ stress perception
and coping: an Italian single centre observational study
1Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Italy
2Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Italy
3Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Italy
4IEOEDUCATION, School of Robotic Surgery, European Institute of Oncology, Milan, Italy
Nursing is often defined as a stressful profession (1),
due to nurses require to face with different kind of stres-
sors, mainly coming from the delivery of their care, which
have to be emphatic, cultural sensitive and proficient (2),
and from their working environment (3). The literature
shows how cancer nurses are particularly exposed to the
burnout risk (4-6), because they could tend to empathize
with patients’ losses, leading cancer nurses to a feeling of
futility or failure in their care (7). In this context, cancer
nurses’ coping strategies play a paramount role to opti-
mize the nursing answering to the stressors and to improve
their educational needs (8, 9).
Although many studies describe the relationships be-
tween burnout, coping strategies and their working envi-
ronment in the cancer nursing field (2, 3, 5, 6), there is a
shortage of studies aimed to deeply understand the gender
differences related to cancer nurses’coping and stress per-
ception. A clearest understanding related to cancer nurses’
gender differences on how they cope with stressors and
how they percept them, could have a significant influence
to improve stress management education and implementa-
tion (8), especially in the Italian context where the ratio
between male and female nurses is proximally 3:7 (10).
Caring for cancer patients could play as a trigger to de-
velop work related stress, which can result in nurses
burnout (5). According to Maslach, Schaufeli and Leiter,
the burnout is given from an inability to effectively
manage the chronic stress, and it is usually expressed by
three different manifestations: (a) the emotional exhaus-
tion, (b) the depersonalisation, and (c) the reduced per-
sonal accomplishment (11). Researchers have hypothe-
sized that personality traits (12) and self-efficacy (13)
could contribute to burnout, and the same burnout have an
effect on nurses’ behaviours (14, 15). However, burnout is
the edge of a wide range of stressful situations, which is
often considered as the result of a mismatch among the
nurses’ capacity to find internal and external resources and
their stress perception (16).
ABSTRACT. The literature on gender differences in stress
perception and coping has been produced diverse results,
and there is a shortage of studies on this topic among cancer
nurses. For this reason, the aim of this study was to describe
the gender differences related to cancer nurses’ stress perception
and coping. This study had a cross-sectional design, using a
secondary data analysis on dataset (sample = 126 cancer nurses,
74% females). The stress perception and the coping strategies
were assessed using Burnout Potential Inventory (BPI) and
Health Profession Stress and Coping Scale, nurses’ version
(HPSCS). Female cancer nurses perceived more stress from
personal attacks than males. Indeed, female over 45 years had
a significant higher perception of stress, but they used the
request for social support (functional coping) as a coping
strategy more than males. Our results could help to clearly
understand what are the main gender differences in coping
and in perceiving stress among Italian cancer nurses,
and to incentive more research.
Key words: coping, gender difference, oncology, nursing, stress.
RIASSUNTO. La letteratura sulle differenze di genere
nella percezione dello stress e nell’adozione di meccanismi
di coping ha prodotto risultati poco consistenti, inoltre
vi è una lacunosità di studi nell’ambito oncologico.
Per questa ragione, l’obiettivo di questo studio era descrivere
le differenze di genere degli infermieri di oncologia nel
fronteggiare lo stress (coping) e nel percepirlo. Lo studio
aveva un disegno trasversale ed ha usato l’approccio di analisi
secondaria su dataset (campione = 126 infermieri di oncologia;
74% sesso femminile). La percezione dello stress e le strategie
di coping sono state valutate tramite il Burnout Potential
Inventory (BPI) e il questionario Health Profession Stress and
Coping Scale, versione per infermieri (HPSCS). Le infermiere
di oncologia percepiscono maggiore stress rispetto agli uomini
relativamente all’area degli attacchi personali. Inoltre,
le infermiere over-45 anni hanno una percezione di stress
significativamente più alta rispetto agli uomini, ma usano
maggiore richiesta di supporto sociale (coping funzionale)
come strategia di fronteggiamento. I nostri risultati
potrebbero essere utili per comprendere meglio quali siano
le principali differenze di genere degli infermieri di oncologia
italiani nel fronteggiare lo stress e nel percepirlo, oltre che
ad incentivare ulteriori studi.
Parole chiave: coping, differenza di genere, oncologia,
98 G Ital Med Lav Erg 2017; 39:2
emotion exhaustion than men also as a consequence of in-
dividuals stereotypes (30).
The third hypothesis was quite totally confirmed. Fe-
male cancer nurses over 45 years had a higher perception
of nine ‘killer jobs’ situations, and even their overall BPI
score was higher than males. These results suggest to
build up a sound supportive policy to help aging women
to find the right internal and external resources, especially
when their role begin to change within both their family
and society. Another interesting data is that the younger
female nurses perceived more personal attacks than older
colleagues. This aspect should be deeply investigated to
understand what kind of attacks they perceive and by
The results did not confirm the last hypothesis, though
they are interesting due to female nurses seem to better use
the social support coping strategy than males. Social sup-
port should became a real nursing competence (31), due to
it can enhance resilience to stress, help protect against de-
veloping trauma-related psychopathology, and decrease
the functional consequences of trauma-induced disorders
(32). It is reasonable to consider for future researches the
potential role of social support as a positive predictor of
nurses’ self-efficacy (13), behaviours (14, 15), and com-
petence (31, 33).
This study had also some limits. Firstly, the data col-
lection was cross-sectional, for this reason could not have
any information about stability of the investigated phe-
nomena. Secondly, the sample is referred to a single
Italian cancer centre, for this reason the results should be
generalizable with caution. Moreover, the moderate dis-
placement of gender distribution in our sample could have
an influence on the analysis, however it is in line with the
Italian nurses’ gender distribution.
To the best of our knowledge, this was the first study
aimed to describe the gender differences related to
cancer nurses’ stress perception and coping in the Italian
context. The literature on gender differences in stress
perception and coping has been produced diverse results
(29). Our study results could boost some important re-
flections on management, preventing the genesis of mis-
information, or non-evidence-based organisational deci-
Moreover, our results could help to clearly understand
what are the main gender differences in coping and in per-
ceiving stress among cancer nurses. These results should
be used to build up tailored preventive programs for the
stress management, considering the highlighted gender
peculiarities. This topic is strategic even because the
deeper comprehension of those differences in facing with
stressors could help the managers and educators to prevent
the distress situations (e.g. burnout, emotional fatigue),
hypnotizing an effect on nurses’ turnover or intention to
live. Future researches are needed to deeply study the phe-
nomena and to test the effectiveness of the preventive
stress management policy.
The authors would to acknowledge all the nurses who have partici-
pated to this study.
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Correspondence: Dr.ssa Cristina Arrigoni, E-mail: firstname.lastname@example.org