Institutionen för vårdvetenskap, 2024.Bakgrund: Forskning visar att patienter föredrar att vårdas och dö i det egna hemmet. Att vårda patienter i livets slutskede inom ordinärt boende ställer höga krav på sjuksköterskans kunskap och kompetens inom ordinärt boende för att kunna hantera komplexa medicinska och psykosociala utmaningar. Syfte: Syftet med litteraturstudien var att beskriva sjuksköterskans upplevelse av att vårda patienter i livets slutskede i ordinärt boende. Metod: Litteraturstudien baseras på resultaten från tio vetenskapliga artiklar med kvalitativ ansats. Databaserna PubMed och Cinahl har använts för att identifiera artiklar av relevans för syftet. De tio artiklarna kvalitetsgranskades utifrån SBU:s mall, och analyserades utifrån Popenoes principer för dataanalys. Resultat: Två kategorier identifierades: Utmaningar i arbetet och Betydelsen av en välfungerande verksamhet. Sex subkategorier identifierades och de var följande: Känsla av maktlöshet, Känsla av otillräcklighet, Känslomässig och existentiell påfrestning, Svårigheter i samverkan inom teamet, Betydelsen av en välfungerande verksamhet, Vikten av goda relationer till patienter och närstående samt Vikten av stöd och struktur i arbetet. Konklusion: Studiens resultat tyder på att sjuksköterskor står inför en mångfald av utmaningar när det gäller att vårda patienter i livets slutskede i hemmet. Det fanns exempelvis stress på arbetsplatsen, höga krav, brist på kontroll över arbetsuppgifter, att inte ha blivit sedd, hörd samt respekterad vilket kunde leda till känslor av otillräcklighet och svårigheter i samverkan inom teamet. För att kunna erbjuda en god vård till patienter i livets slutskede inom ordinärt boende är det viktigt att sjuksköterskan får ett gott stöd, både från verksamheten och kollegor. / Background: Research shows that patients prefer to be cared for and die at home. Caring for patients at the end of life in community settings places high demands on the knowledge and skills of community nurses to deal with complex medical and psychosocial challenges. Aim: The purpose of the literature review was to describe the nurse's experience of providing home-based end-of-life palliative care. Method: The literature review was based on the results of ten scientific articles with qualitative approaches. The databases PubMed and Cinahl were used to identify articles that met the study's inclusion criteria. The SBU template was used to review the articles. Results: Two categories were identified: Challenges at work, and Importance of a well-functioning organization. Six subcategories were identified and they were as follows: Feeling powerless, Feeling inadequate, Emotional and existential stress, Difficulties in collaboration within the team, The importance of a well-functioning organization, The importance of good relations with patients and relatives and the importance of support and structure in the work.Conclusion: The study findings suggest that nurses face a variety of challenges in caring for patients at the end of life at home. These included workplace stress, high demands, lack of control over tasks, not being seen, heard and respected, which could lead to feelings of inadequacy and difficulties in team collaboration. In order to offer good care to patients at the end of life in ordinary housing, it is important that the nurse receives good support, both from the organization and colleagues.

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Palliativ vård infaller då en patient är obotligt sjuk och närmar sig livets slutskede. Vården bör vara inriktad på att främja livskvalitet och lindra patientens mångsidiga lidande. Barn som vårdas för obotlig sjukdom kräver personcentrerad vård där föräldrar och anhöriga inkluderas och blir delaktiga. Sjuksköterskan bör vidare bemöta patientens och anhörigas unika livsvärld för att skapa möjlighet till vårdande möten. Att vårda ett döende barn i hemmiljö avviker från den naturliga vårdrelationen som sjuksköterskan har med patienten och är mycket komplext för sjuksköterskan. Syftet med litteraturöversikten är att belysa sjuksköterskans upplevelse av att vårda barn i ett palliativt skede i hemmiljö. Litteraturöversikten utgår från kvalitativa och kvantitativa artiklar och dess analys samt kvalitetsgranskning grundar sig på Fribergs analysprocess. Studiens resultat har genererat fyra teman som tillsammans sammanfattar sjuksköterskans erfarenheter av att vårda palliativt sjuka barn i hemmiljö: förtroendefulla relationer, emotionella reaktioner, etiska och moraliska dilemman samt utmaningar och strategier. Resultatet speglar vikten av betydelsefulla relationer, vilka komplexa emotionella reaktioner som uppstår hos sjuksköterskan samt mängden av upplevda etiska och moraliska dilemman vid pediatrisk palliativ vård i hemmiljö. Vidare visar resultaten att sjuksköterskor identifierat många brister i hälso- och sjukvårdens resurser men att sjuksköterskor trots det hittar styrka och finner mening i arbetet. Genom kontinuerliga utbildningar och tillgång till rätt resurser skapas grundläggande förutsättningar för sjuksköterskan gällande pediatrisk palliativ vård i hemmiljö. Genom att belysa de komplexa situationer sjuksköterskan erfar i pediatrisk palliativ vård kan förbättringsområden identifieras. / Palliative care occurs when a patient is terminally ill and approaching the end of life. Care should be aimed at promoting quality of life and alleviating the patient's multifaceted suffering. Children who are treated for an incurable disease require person-centered care where parents and relatives are included and become participants. The nurse should also respond to the unique life situation of the patient and relatives in order to create opportunities for caring encounters. Caring for a terminally ill child deviates from the natural care relationship that the nurse has with the patient. The purpose of the literature review is to shed light on nurses' experiences of caring for children in a palliative stage in a home environment. The literature review is based on qualitative and quantitative research and the analysis and quality review is based on Friberg's analysis process. The results of the study have generated four themes that together summarize nurses' experiences of caring for terminally ill children in the home environment: trusting relationships, emotional reactions, ethical and moral dilemmas as well as challenges and strategies. The result reflects the importance of significant relationships, the complex emotional reactions that arise in the nurse, and the amount of perceived ethical and moral dilemmas in pediatric palliative care in the home environment. Furthermore, the results show that nurses have identified many shortcomings in health care resources, but that despite this, nurses find strength and meaning in their work. Through continuous training and access to the right resources, basic prerequisites are created for the nurse regarding pediatric palliative care in a home environment. By highlighting the complex situation the nurse experiences in pediatric palliative care, areas for improvement can be identified.

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Aim: The aim of this study was to investigate the frequency of and the gender differences in the use of professional home care in Germany. Methods: We used harmonized data from three large cohort studies from Germany (“Healthy Aging: Gender-specific trajectories into the latest life”; AgeDifferent.de Platform). Data were available for 5,393 older individuals (75 years and older). Mean age was 80.2 years (SD: 4.1 years), 66.6% were female. Professional homecare outcome variables were use of outpatient nursing care, paid household assistance, and meals on wheels’ services. Logistic regression models were used, adjusting for important sociodemographic variables. Results: Altogether 5.2% of older individuals used outpatient nursing care (6.2% women and 3.2% men; p < 0.001), 24.2% used paid household assistance (26.1% women and 20.5% men; p < 0.001) and 4.4% used meals on wheels’ services (4.5% women and 4.0% men; p = 0.49). Regression analysis revealed that women had higher odds of using paid household assistance than men (OR = 1.48, 95% CI: [1.24–1.76]; p < 0.001), whereas they had lower odds of using meals on wheels’ services (OR = 0.64, 95% CI: [0.42–0.97]; p < 0.05). No statistically significant differences in using outpatient nursing care between women and men were found (OR = 1.26, 95% CI: [0.87–1.81]; p = 0.225). Further, the use of home care was mainly associated with health-related variables (e.g., stroke, Parkinson’s disease) and walking impairments. Conclusions: Our study showed that gender differences exist in using paid household assistance and in culinary dependency. For example, meals on wheels’ services are of great importance (e.g., for individuals living alone or for individuals with low social support). Gender differences were not identified regarding outpatient nursing care. Use of professional home care servicesmay contribute to maintaining autonomy and independence in old age.

Introduction: There is a growing interest in how technology can be used in order to provide efficient healthcare. Aim: The aim is to explore perceptions on the use of home telemonitoring in patients with COPD.                                                                                                                             Method: Semi-structured individual interviews were carried out with eight women and five men who were part of a larger project aiming to develop and evaluate a telemonitoring system. Participants were interviewed after having used the system for two to four months. Interview transcripts were analysed with qualitative content analysis. Results: The analysis resulted in the theme a transition towards increased control and security and the categories: facing enablers or barriers, increasing control over the disease, providing easy access to care and affecting technical confidence or concern. Participants expressed initial feelings of insecurity, both in practical aspects using the telemonitoring system as well as regarding their disease. The telemonitoring system could reinforce and confirm the participants´ feelings of their current state of health, and the practical management of the telemonitoring system became easier with time.     Conclusion: Telemonitoring can be a valuable complement to healthcare with the potential to contribute to equity in care. However, in order to improve further development and implementation of telemonitoring, several actions are needed such as improved patient education and the use of co-creation. Additional research is needed particularly in the design of user-friendly systems as well as tools to predict which patients are most likely to find the equipment useful as it may result in reduced costs and increased empowerment. / Introduktion: Intresset för hur teknologi kan användas för att erbjuda effektiv sjukvård ökar. Syfte: Syftet är att utforska KOL-patienters upplevelse av att använda ett webbaserat rapporteringssystem i hemmet. Metod: Semi-strukturerade individuella intervjuer med åtta kvinnor och fem män som deltog i ett större projekt med syfte att utveckla och utvärdera ett webbaserat rapporteringssystem. De intervjuades efter att ha använt systemet två till fyra månader. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i temat en övergång till ökad kontroll och trygghet samt kategorierna: möta möjligheter eller hinder, ökad kontroll över sjukdomen, skapar lättillgänglig vård samt påverkar teknisk självkänsla eller oro. Deltagarna uttryckte till en början osäkerhetskänslor, både vad gäller praktiska aspekter i användandet av rapporteringssystemet samt kring själva sjukdomen. Det webbaserade rapporteringssystemet kunde förstärka och bekräfta deltagarnas egna känsla av mående och det praktiska hanterandet av rapporteringssytemet blev lättare med tiden. Konklusion: Webbaserade rapporteringssystem kan vara ett värdefullt komplement till sjukvården med potential att bidra till jämlik vård. I syfte att förbättra fortsatt utveckling och implementering bör förbättrad patientinformation samt vikten av att ta med användarna i utformningen beaktas. Mer forskning behövs för att optimera användarvänlighet samt att identifiera de patienter som har bäst nytta av systemet då det kan ge hälsoekonomiska vinster och inte minst öka patienters delaktighet.

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This research explores the training needs of nannies in the United Kingdom in terms of the content and structure of introductory training. The research question formulated for this study is: What are the introductory training needs of nannies in the United Kingdom? The researcher approached the study qualitatively and empirical data was collected by means of a focus group discussion with a group of nannies. Empirical data indicates that nannies need training regarding: • The professional aspect of nannying; • the physical, emotional, and intellectual needs of children; • the various developmental levels of children and the role of the nanny within each phase; • working with parents; • different religions and cultures and their childcare practices. It was found that nannies need training that is structured in an affordable, brief, specific and practical way. The study therefore reveals that nannies have specific needs regarding both the content and structure of childcare training. / Thesis (M. Ed.)

The purpose of this study was to describe the experiences that HIV and AIDS patients who are on Community Home Based Care Programme have in the Lilongwe district of Malawi. Finally; concrete propositions were developed for the implementation of quality community and home based care programmes in Malawi. A qualitative research design using an interpretive phenomenology was used. The study took place in semi-rural and urban areas of Lilongwe district using patients from 3 major organizations dealing with people living with HIV and AIDS. Purposive sampling technique was used to choose the sample and a total of 15 in-depth interviews were conducted. Data was analyzed using ATLAS ti version 5. Findings revealed that the majority of the participants were concerned that they were living with HIV and AIDS. Most of them expressed anxiety, worries and fears of death. Another majority complained about the burden of opportunistic infections. Almost half of the participants felt guilty bringing misery to their families and complained of stigma and discrimination. However, a minority group of participants felt that to live with HIV and AIDS is not the end of life. Relatives were mentioned as the main care providers to HIV and AIDS patients. However, they were also cited high as a source of stigma. Conclusions were made that women and girls are at the highest risk as they bear the burden of care. It was therefore recommended that the Government of Malawi and all Non Governmental Organizations should develop women social economic status through promotion of education, provision of loans and provision of Gender Sensitive trainings. Formal training for care of HIV and AIDS patients should be introduced to all primary caregivers to render quality care in the homes and therefore this study has developed and pre-tested an educational program for this group. / Health Studies / D. Litt. et Phil. (Health Studies)

HIV/AIDS is a global challenge and its impact is evident. This places a burden on hospitals and health professionals. To ease this burden there are home-based care programmes which, through home-based caregivers, provide patients living with HIV/AIDS with physical and palliative care. However, these HBCGs face various challenges such as poverty, discrimination and stigma when caring for PALHIV, and their own emotional strain, which becomes burdensome without sufficient support from the home-based care centre. The qualitative study undertaken investigates the challenges and coping mechanisms of the HBCGs. Thirteen research participants were drawn from a centre in Mamelodi. Data was gathered through interviews and observations, categorised into themes and analysed. Major findings revealed that social challenges faced by HBCGs include poverty, stigmatisation and discrimination. Emotions experienced by HBCGs include guilt, anger, hopelessness, but they have spiritual reliance through prayer as one of their coping mechanisms. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)