Bakgrund Varje år avlider ungefär 1 procent av Sveriges befolkning vilket motsvarar cirka 90 000 personer. Av dessa avlider cirka 36 procent på särskilt boende. Smärta är ett vanligt förekommande symtom hos äldre personer som vårdas i livets slut. Att identifiera smärta och lindra smärta blir således centralt och en viktig del av arbetet för den omvårdnadsansvariga sjuksköterskan. Syfte Syftet är att beskriva sjuksköterskors erfarenheter av att identifiera smärta och använda omvårdnadsåtgärder för att lindra smärta hos den äldre personen boende på särskilt boende i livets slut. Metod Metoden är en kvalitativ intervjustudie med induktiv ansats. Semistrukturerade intervjuer har använts för insamling av data där sjuksköterskor med minst ett års erfarenhet av särskilt boende där personer över 65 vårdas i livets slut inkluderades som informanter. Innehållsanalys gjordes enligt en metod beskriven av Graneheim och Lundman (2004). Resultat Studiens resultat presenteras i fyra kategorier; Relation central vid vård i livets slut, Identifiering av smärta är svårt, Omvårdnadsåtgärder lindrar smärta och Ett kvalificerat team främjar omvårdnaden. Samtliga kategorier presenteras med tillhörande underkategorier. Slutsats Studiens resultat visade på att personkännedom möjliggjorde personcentrerad vård och ökade möjligheten att individanpassa omvårdnadsåtgärder och att enklare identifiera äldre personers smärta. Omvårdnadspersonal saknade kunskap om identifiering av smärta och smärtlindring med omvårdnadsåtgärder. Det var sjuksköterskor som hade ansvar att handleda och kompetensförsörja teamet däremot visar resultatet att sjuksköterskor inte följer riktlinjer gällande användning av skattningsinstrument vid identifiering av smärta och inte heller hade fullgoda kunskaper om de fyra dimensionerna av smärta. / Background Each year approximately 1 percent of Sweden’s population dies, which corresponds to approximately 90 000 people. Of these, about 36 percent dies while living in special housing. Pain is a common symptom in older people receiving end-of-life care. Identifying pain and alleviating pain thus becomes central and an important part of the work of the nurse responsible for care. Aim The aim is to describe nurses’ experiences of identifying pain and using nursing interventions for pain relief in older people living in special housing at the end of life. Method The method used is a qualitative interview study with and inductive approach. Semistructured interviews have been used for the collection of data were nurses with at least one year of experience of working in special housing for people older than 65 years of age in end-of-life care were included as informants. Content analysis was done according to a method described by Graneheim and Lundman (2004). Results The result of the study is presented with four categories; Relationship central for end-oflife care, Identifying pain is difficult, Nursing interventions alleviate pain and A qualified team promotes nursing. All categories are presented with associated subcategories. Conclusions The results of the study show that knowledge of the person made person-centered care possible and increased the possibility to individualize nursing interventions and made it easier to identify pain in older people. Nursing staff lacked knowledge about identifying pain and alleviating pain with nursing interventions. It was nurses who had the responsibility to tutor, and competence supply the team however the results show that nurses does not follow guidelines regarding estimation instruments when identifying pain and neither do they have satisfactory knowledge of the four dimensions of pain.

Syftet med denna studie är att undersöka om det finns en stereotyp av den äldre som får bifall på sin överklagan till särskilt boende. Detta kommer undersökas med hjälp av en riktad kvalitativ innehållsanalys där de texter som kommer analyseras är domar ifrån förvaltningsrätten där äldre personer överklagat sitt biståndsbeslut. Genom att använda teorier om att göra ålder och perspektiv på makt, analyserades och tolkades utvalt empiriskt material. Analysen utfördes genom att söka efter meningsbärande delar av texten, meningar som innehåller relevant information för att kunna svara på studiens syfte. Den relevanta informationen kodades för att sedan kategoriseras, och separerades i olika teman som slutligen analyserats med teori och tidigare forskning. Studien visar att det är svårt att urskilja en stereotyp av den äldre som får bifall på sin överklagan. Denna slutsats tas då det inom kategorierna verkar skilja sig åt både mellan de olika bifallen och de olika avslagen, men även mellan avslag och bifall. Utifrån det resultatet så verkade det inte vara några vissa egenskaper som den äldre ska, eller inte ska ha för att beviljas insatsen. Slutsatsen innebär inte att en stereotyp nödvändigtvis inte existerar, men den har inte kunnat urskiljas i det empiriska materialet. Utifrån de teoretiska begrepp och den forskning som använts i studien är en trolig slutsats i stället att biståndshandläggarna tar godtyckliga beslut utifrån de givna ramar som organisationen utformat i form av kommunala riktlinjer och rådande lagstiftning. Den utredning som biståndshandläggarna skriver om den äldre, utgör sedan en del av underlaget i förvaltningsrättens dom, och det är denna del som är av intresse för denna studie. / The purpose of this study is to investigate whether there is a stereotype of the elderly being granted their appeal to retirement homes. This will be conducted with the help of a targeted qualitative content analysis where the texts that will be analyzed are verdicts from the Administrative Court where older people have appealed their denied request for assistance. Based on theories on “making age” and perspectives on power, empirical material was analyzed. The analysis was conducted by searching for meaning-bearing parts of the text, sentences that contain relevant information to be able to answer the purpose of the study. These codes were then divided into categories, to be further divided into different themes that were finally analyzed through theory and with previous research. The study reveals that it is in fact difficult to discern a stereotype of the elderly who gets approval of their appeal. This conclusion is drawn due to categories that seems to differ both between different approvals and different refusals, but also between rejection and approval. Based on this, it did not seem to be any certain characteristics that the elder should, or should not have in order to be granted approval of special housing. This does not necessarily mean that this stereotype does not exist, it simply means that it has not been discernible in the empirical material used in this essay. Based on the theoretical concepts and the research used in the study, a plausible conclusion is instead that the development assistance administrators make arbitrary decisions based on the framework that is set by the organization in the form of municipal guidelines and current legislation. The investigation that the social workers write about the elderly then forms part of the basis in the Administrative Courts judgement, and it is this part that is of interest for this study.

Heart failure is a growing public health problem associated with significant morbidity and mortality. Family support positively affects outcomes for the person with heart failure while also leading to caregiver burden. Registered nurses have a key role in supporting and meeting the needs of family caregivers. The overall aim was to explore the situation and needs of family caregivers to a person with heart failure, and explore requisites and ways of supporting and involving family caregivers in heart failure nursing care. Two interview studies, one web survey study and one intervention study were conducted between 2012 and 2017. A total of 22 family caregivers, eight persons with heart failure and 331 registered nurses participated in the studies. Family caregivers' daily life was characterized by worry, uncertainty and relational incongruence but salutogenic behaviours restored new strength and motivation to care. Family caregivers experienced that their caregiving was taken for granted by health care professionals. Family caregivers expressed a need for a permanent health care contact and more involvement in the planning and implementation of their near one’s health care together with health care professionals. Registered nurses acknowledged family caregivers’ burden, lack of knowledge and relational incongruence. A registered nurse was suggested as a permanent health care contact to improve continuity and security. Registered nurses neither acknowledged family caregivers as a resource nor their need for involvement. Registered nurses working in primary health care centres, in nurse-led heart failure clinics, with district nurse specialization, with education in cardiac nursing care held the most supportive attitudes toward family involvement in heart failure nursing care. Family health conversations via telephone in nurse-led heart failure clinics were found to successfully support and involve families. The conversations enhanced nurse-family relationship and relations within the family. They also provided registered nurses with new, relevant knowledge and understanding about the family as a whole. Family health conversations via telephone were feasible to both families and registered nurses, although fewer and shorter conversations were preferred by registered nurses. This thesis highlights the divergence between family caregivers’ experiences and needs, and registered nurses’ perceptions about family caregivers’ situation and attitudes toward the importance of family involvement. It adds to the knowledge on the importance to acknowledge family caregivers as a resource and to support and involve them in heart failure nursing care. One feasible and successful way is to conduct Family health conversations via telephone in nurse-led heart failure clinics.