The aim of the study is, based on the staff’s perspective, to describe and analyse the existential needs of elderly in end-of-life living in nursing homes. The aim was also to examine how the staff perceive working with elderly in end-of-life care. Three qualitative focus groups were conducted by interviewing nursing home staff. The analysis is based on Weisman’s the appropriate death, Tornstam’s gerotranscendence and Hasenfeld’s human service organizations. The main findings were that the term ‘existential needs’ is described as wide and hard to define. Uneasiness and anxiety were common in the end-of-life and it was hard for the staff to meet the existential needs. The staff also described that the “little things” matter, such as holding one’s hand, as well as being present with the elderly. The relationship between the elderly and the staff was vital in order for the elderly to have as good an end-of-life and death experience as possible. The staff felt sorrow when the elderly had passed away and had little time to grieve. In difference to earlier research the staff did not request further education nor tutoring, however they wanted more time to grieve and process the deaths of the elderly.

I vårt arbete med palliativa patienter har vi sett en kunskapsbrist i hur patienters existentiella behov bemöts. Det saknas tid för att lyssna på patienterna och tillgodose de existentiella behoven. Det finns en risk att medikalisera de existentiella behoven istället för att bemöta dem. Uppsatsens syfte var att, baserat på självbiografier, belysa patienters existentiella behov i livets slut. En självbiografistudie genomfördes för att få belyst vilka de existentiella behoven var. En narrativ analysmetod användes. Fyra huvudkategorier framträdde; Behov av att känna tillit, behov av att ha en tro på något, behov av att få leva ett vardagsliv och behov av livet som går vidare. Familjen, de nära vännerna och att ges möjlighet att leva vardagsliv var det mest framträdande. Även tillit till personalen var viktigt. Patienter som hade en tro behöll denna till slutet, trots att inga under skedde. Vardagslivet tillsammans med familj och vänner var det som uppskattades mest och som gav störst tillfredsställelse vid livets slut. / In our work with patients in end of life we have seen a lack of knowledge in how we respond to the existential needs. Also there is a lack of time in listening to the patients when they want to express their existential needs. It is so much easier to give sedatives to comfort the patients instead of taking the time and effort to listen to the extential needs. The aim of this study was, based on autobiographies, to examine patients existential needs in end-of-life. In order to find out what needs they had we read autobiographies. The analysis was performed with a narrative method. Four main-categories were found; Need of confidence, need to have a faith in something, need to live a everyday-life and need of life that goes on. The family, close friends and the everyday-life was very important. Also the confidence for the caregivers was of significance. Patients who had a faith kept their faith to the end of life, inspite that there was no miracle. Everyday-life with family and friends at home was the most appreciated in end-of-life.

Bakgrund: Majoriteten av alla sjuksköterskor arbetar någon gång under sitt yrkesverksamma liv direkt, eller indirekt, med vård i livets slutskede. Det är viktigt att alla sjuksköterskor har förståelse för den typen av vård. Att vara vårdare under människans sista tid i livet är ett stort ansvar, för vårdteamet, patienten och anhöriga. Syfte: Att beskriva sjuksköterskors erfarenheter av att vårda patienter i livets slutskede. Metod: En allmän litteraturöversikt där tolv vetenskapliga artiklar med kvalitativ ansats samt två artiklar med kvantitativ ansats analyserades. Artiklarna analyserades i fyra steg utifrån Friberg. Resultat: Genom litteraturöversikten identifierades fyra teman. Dessa är sjuksköterskors erfarenheter av maktlöshet, stöd av team, funderingar kring egen dödlighet och utbildningsbehov. Slutsats: Vård i livets slutskede för med sig mycket frustration och ofta en känsla av maktlöshet och otillräcklighet. De som ofta möter döden i arbetet får ofta egna existentiella tankar. I välfungerande palliativa team skapas möjligheter för sjuksköterskor att få stöd inom teamet och då blir de också kapabla att räcka till för patienterna, deras anhöriga och för övriga teammedlemmar. För att kunna genomföra en god vård i livets slutskede för patienten och anhöriga behövs ett välfungerande team där alla har en grundutbildning inom palliativ vård. / Background: Most of all nurses will at some point during their working life directly, or indirectly, work with end-of-life care. It is important that all nurses understand that type of care. Being a caregiver during a person's last period of life is a great responsibility, for the care team, the patient, and relatives. Aim: To describe nurses' experiences of caring for patients at the end of life. Method: A general literature review in which twelve scientific articles with a qualitative approach and two articles with a quantitative approach were analyzed. The articles were analyzed in four steps based on Friberg. Results: Four themes were identified through the literature review. These are the nurse's experience of powerlessness, support from teams, thoughts about own mortality and educational needs. Conclusion: End-of-life care brings a lot of frustration and often a feeling of powerlessness and inadequacy. Those who often face death at work often have existential thoughts of their own. In well-functioning palliative care teams, opportunities are created for nurses to receive support within the team and then they also become capable of being enough for the patients, their relatives and other team members. To be able to carry out good end-of-life care for the patient and relatives, a well-functioning team is needed where everyone has a basic education in palliative care.

Through the lenses of religion’s role in society, the purpose of this thesis is to examine, the role of the Church of Sweden in providing support to people at the end of life. Questions asked are:  "What types of spiritual support is offered by the Church of Sweden during terminal care provided in patients' homes and how is this support expressed in church orders, assembly instructions, plans of operations and congregation letters?" and " How can the work of the Church of Sweden be understood, based on theories of religion's role in society? The method used is a content analysis of the Church Order, assembly instructions, plans of operations and congregation letters in 17 different congregations within the diocese of Lund. I then engage in a discussion with theories on differentiation and the privatization of religion as a means to interpret my results. My conclusion is that the investigated parishes in the diocese of Lund do not have any specific goals or targets documented for spiritual support to people who are at life’s end cared in their homes. This can be understood based on theories of differentiation. The privatization of religion may explain the phenomenon that people's religious needs are not linked to the collective institutional religion of the Church of Sweden.  This is despite of the fact that a large proportion of the Swedish population belongs to the Church of Sweden. The de-privatization of religion, at a societal level can explain the reason why these concerns are attracting an increased interest from the healthcare services as people's need of spiritual support are discussed. The question of who should meet the patients' needs for spiritual support is unclear.

This diploma thesis deals with clients suffering from mental and sense disease staying in hospices in the Czech Republic. The first chapter is aimed to the history and the present of hospice and palliative care. The second chapter presents specifics of communication and approach to the clients with mental and sense disease. The third chapter deals with professional qualification of the staff working in hospices with such clients. The fourth chapter is aimed to satisfying of existence and existential needs of clients with mental and sense disease. This chapter also indicates some differences in the ways of satisfying these needs in relation to other dying people. The last part of this diploma thesis presents research project which deals with mapping of experiences of hospice staff with clients with mental and sense disease. The research also identifies the specificity of care provided to these clients and describes how the existence and existential needs of these clients are satisfied. It tries to understand how the hospice workers are given their professional competence. Qualitative type of research was used for the project; quantitative part includes semistructured dialogues and group discussion. The research part is based on analysis of seven dialogues and three group discussions with hospice...