distress, health care professionals, Grounded Theory, moral distress, palliative care, qualitative, risk and protective factors



  1. Maffoni, Marina MPsych
  2. Argentero, Piergiorgio MPsych
  3. Giorgi, Ines MPsych
  4. Giardini, Anna MPsych


Palliative care practice is associated with risk factors linked to end-of-life, chronicity, personal, interpersonal, and work characteristics, as well as with protective factors, but how these are perceived by the health care providers themselves is not clear. This article aims to elaborate a theoretical framework explaining the risk and protective factors for palliative care providers in their daily practice. Nineteen providers (16 nurses, 3 physicians) working in a palliative care unit of a clinical-research institute in Northern Italy were interviewed. A Grounded Theory qualitative approach guided the data collection and analysis. From the interviews, 28 codes, subsequently organized into 11 interconnected categories, emerged. They described both stressors (emotion management regarding death/dying, conflicts, communication and relationship with patients/caregivers, discrepancies between patients' and caregivers' needs, communication of poor diagnosis/prognosis, decision making about treatment, and real-life and work interference) and protective factors (social support, positive approach and value of past experience, recognized value of/passion toward professional work, work-family balance). Experiencing these elements as positive or negative depends on the professionals' point of view, as well as their past and present experience.


Understanding what dealing with life-limiting illnesses means may suggest tailored interventions to improve professionals' well-being by fostering the protective elements and combatting the risk factors.