Bakgrund: Idag lever många nära en person som drabbats av en livshotande sjukdom. Många som insjuknar har behov av den palliativa vården. Den palliativa vården syftar till att främja livskvalitet och lindra lidande, både för patienten och för de närstående. När en person i familjen blir sjuk är det naturligt för de flesta människor att ta rollen som vårdare och familjen anses ha en stor betydelse i vården av den sjuke. Att erhålla information samt stöd är viktiga förutsättningar för att de närstående ska kunna känna delaktighet i vården. Sjuksköterskan har till uppgift att lindra lidande, främja hälsa samt ge stöd och information. Syfte: Att belysa de närståendes erfarenheter av den palliativa vården. Design: En litteraturöversikt. Metod: 14 vetenskapliga artiklar som blivit publicerade under de senaste fem åren, har lästs flertalet gånger och därefter analyserats utifrån en innehållsanalys, för att finna gemensamma kategorier som beskriver de närståendes erfarenheter/ upplevelser. Resultat: Närheten till döden var något som väckte starka känslor, och situationen beskrevs vara fysiskt, psykiskt och emotionellt påfrestande. Resultatet visar att de närstående tog ett stort ansvar i vården av den sjuke, detta resulterade i ett ökat behov av stöd, framförallt från familj och vänner. En god relation till vårdpersonalen ökade förutsättningarna till en god vård. Trots den svåra situationen kunde meningsfullhet upplevas. Slutsats: Sjukdomen medförde att livssituationen förändrades och en ökad ansvarskänsla uppstod hos den närstående. Stöd från familj och vänner, samt vårdpersonal hade stor betydelse. Kunskap hos vårdpersonalen värderades högt och det var viktigt att den sjuke skulle få dö en värdig och fridfull död. / Background: A lot of people are today living close to a person who suffers from a life-threatening disease A lot of people who become sick has a need for palliative care. Palliative care aims to improve quality of life and ease suffering, both for the patient and for the next of kin. When a person in the family gets ill, it’s natural for most people to take on the role as the caregiver and the family is considered to have a great importance in the caregiving. To obtain information and support it’s important for the next of kin to feel involved in the care. The nurse’s task is to ease suffering, promote health and provide support and information. Aim: To describe the next-of kin`s experiences of palliative care. Design: A literature review. Methods: 14 articles, published in the last five years, has been read several times and then analysed through a content analysis, to find categories that describes the next of kin’s experiences. Results: The closeness/proximity of death was something that arouse strong emotions, and the situation was described as physically, mentally and emotionally stressful. The result revealed that the next of kin took a great responsibility in the care of the ill person, this resulted in an increased need of support, especially from family and friends. A good relationship to the healthcare professionals increased the chances to get good care. Despite the difficult situation, meaningfulness could be experienced. Conclusion: The disease led to a changed life situation and an increased sense of responsibility for the next of kin. Support from family and friends and healthcare professionals had great importance. Knowledge among healthcare professionals was highly valued and it was important that the ill person would be allowed to die a dignified and peaceful death.

No description available.

Inclusive fitness theory concerns the study of social traits. Often, individuals differ in their phenotype (e.g. size, weight, nutritional state) independently of their genetic make up, that is, individuals differ in their quality. Individuals can then be classified into different “classes” according to their quality, which enable us to understand social evolution in class-structured populations. This is important because individuals in natural populations often differ in quality, either because of intrinsic factors (e.g. size), or extrinsic factors (e.g. resource availability). My thesis concerns the evolution of social traits in class-structured populations. In chapter 1, I make a brief introduction to my thesis, providing the abstract of each chapter. In chapter 2, I outline a general theory of individual quality, where I show how individual quality impacts social evolution in two fundamental ways. In chapter 3, I show that resource heterogeneity greatly influences the evolution of conditional social behaviour. In chapter 4, I show that temporal group-size heterogeneity promotes the evolution of both conditional helping and harming. In chapter 5, I analyse the effect of individual quality on kin selection. I find that individual quality has an important impact in kin selection, which can lead to extreme forms of social behaviour. In chapter 6, I show that stable environments promote the evolution of negative density-dependent dispersal, while unstable environments promote the evolution of positive density-dependent dispersal. In chapter 7, I show that budding and low local quality promote the evolution of dispersal and cooperation.

Bakgrund: Alzheimers sjukdom medför många förändringar som inte bara påverkar de drabbade utan även de anhöriga. Dessa förändringar hanteras med hjälp av olika copingstrategier. Syfte: Att beskriva vilka copingstrategier anhöriga till personer med Alzheimers sjukdom använder sig av. Metod: Studien genomfördes som en kvalitativ studie med en deduktiv ansats, där materialet samlats in från självbiografier. Det insamlade materialet analyserades och delades in med hjälp av formuläret “Ways of Coping”. Resultat: Anhöriga använde sig av copingstrategier så som att till exempel “sätta ner foten” (konfronterande coping), skylla på annat (avståndstagande), dölja sina känslor (självkontrollerande) samt hjälp och stöd från omgivningen (söka socialt stöd), att lägga skulden på sig själva (accepterande av ansvaret), distraherande tankar och aktiviteter (undkommande och undvikande), informationssökande (planerande problemlösning) och positiv självförändring (positiv omvärdering). Slutsats: Kunskap om copingstrategier hos vårdpersonal kan hjälpa anhöriga i sin roll som vårdare till personer med Alzheimers sjukdom. / Background: With Alzheimer's disease comes many changes that affect not only the affected but also their families. These changes are managed using a variety of coping strategies. Aim: To describe coping strategies among informal caregivers of people with Alzheimer's disease. Method: The study was conducted as a qualitative study with a deductive approach, where the data is collected from autobiographies. The data was analyzed and sorted with help from the instrument "Ways of Coping". Result: The caregivers of the study used coping strategies such as, for example, putting the foot down (confrontive coping), blame others (distancing), hiding emotions (self-controlling) and help and support from the surroundings (seeking social support), to blame oneself (accepting responsibility), distracting thoughts and activities (escape-avoidance), information seeking (planful problem solving) and positive personal change (positive reappraisal). Conclusion: Knowledge of coping strategies among health care workers could help families in their role as caregivers of the person with Alzheimer's disease.

Bakgrund: Cancer är idag en vanlig sjukdom och vid sidan av en person med cancer finns närstående som kan riskera att glömmas bort. Att vara närstående kan vara en påfrestande upplevelse och riskerar att leda till ohälsa. Närstående bör involveras i vården och deras välmående bör tas hänsyn till. Syfte: Studiens syfte var att beskriva de närståendes upplevelse av stöd som fenomen, när en person i deras närhet drabbats av cancer. Metod: En deduktiv litteraturöversikt med KASAM som teoretisk utgångspunkt. För att besvara syftet användes kvalitativa artiklar. Sökningar i CINAHL gjordes och resulterade i 16 resultatartiklar. Resultat: Närstående upplevde den nya livssituationen som ofattbar, information kring sjukdom och behandlingsmöjligheter från vårdpersonal gjorde situationen mer begriplig. De närstående använde olika strategier för att anpassa sig till situationen och fann stöd i vänner och familj. Att närvara vid behandlingar ledde till delaktighet i vården vilket gjorde att de närstående upplevde ett syfte. Slutsats: Genom stöd kan en känsla av sammanhang upplevas trots närvaro av sjukdom. Att som närstående bli sedd och lyssnad till underlättar för att hantera den nya situationen och att finnas där för den sjuka personen. / Background: Cancer is a common disease and is often associated with death, although the treatments are getting better and the number of survivals is growing. In the shadow of a person with cancer there will always be loved ones who should not be forgotten.    Aim: The aim of the study was to describe the next of kin’s experience of support as a phenomenon, when a loved one is affected with cancer. Method: A deductive literature review with sixteen qualitative articles was made, using Sense of Coherence [SOC] as a theoretical approach. Searches for result articles was made in CINAHL. Result: Relatives experienced the new life situation as unimaginable, information from healthcare staff about the disease and possibilities of treatment made the situation understandable. Relatives used different strategies to adjust to the new situation and found friends and family to be a source of support. Being present during treatment gave the relative a sense of purpose. Conclusion: With support a sense of coherence can appear even in the presence of disease. To be seen and listened to makes it easier for the next of kin to handle the new situation and be able to be there for the ill person.

Bakgrund: Nuförtiden har det blivit mer vanligt att patienter som lider av obotliga sjukdomar vill vårdas och dö i hemmet vid palliativt skede. Trots insatser från hälso- och sjukvården spelar närstående ofta en avgörande roll i vården. Närstående tar ofta på sig rollen som vårdare för att uppfylla den sjukes önskan. Att engagera sig i vårdandet av en anhörig lägger ett stort ansvar på närstående vilken kan påverka de närståendes fysiska och psykiska hälsa. Syfte: Syftet var att beskriva närståendes upplevelse av att vårda sin anhöriga i hemmet vid palliativt skede. Metod: Metoden för studien var en litteraturöversikt som grundade på tio vetenskapliga kvalitativa artiklar. Vid sökning användes tre databaser; CINAHL Complete, PubMed och PsycINFO. Artiklarna kvalitetsgranskades och analyserades enligt Friberg (2017). Resultat: I resultatet framkom tre huvudkategorier och nio subkategorier. De första huvudkategorierna var positiv upplevelse av att vårda anhöriga med tre subkategorier; förbättrade relationer, att känna sig delaktighet i sin vårdande roll och att uppfylla önskan. De andra huvudkategorierna var negativ upplevelse av att vårda anhöriga med subkategorier; vårdbördan och ansvar, isolering och ensamhet, att vara osäker och rädslan och ångest. De tredje huvudkategorierna var närståendes upplevelse av hälso – och sjukvården med två subkategorier; otillfredsställelse - och tillfredsställelse med hälso-och sjukvård. Diskussion: Resultatet diskuteras utifrån Meleis transitionsteori, områdets utgångspunkt som beskrivs i litteraturöversiktens bakgrund och annan forskning. Utgångspunkten tas framförallt ifrån Meleis transitionsteori som var relaterad till närståendes upplevelse av rollövergångar. / Background: Nowadays, it has become more common for patients suffering from incurable diseases to be cared for and die at home at palliative stages. Despite efforts from the health and medical care, next-of-kin often play a crucial role in the care. Next-of-kin often take on the role of carer to fulfil the sick person's desire. Engaging in caring for a family member adds great responsibility to the next-of-kin which can affect their physical and mental health. Aim: The purpose was to describe the next-of-kin experiences of caring for their relatives in the home at the palliative stage. Method: The method of the study was a literature review based on ten scientific qualitative articles. When searching, three databases were used; CINAHL Complete, PubMed and PsycINFO. The articles were quality-reviewed and analysed according to Friberg (2017). Results: The result showed three main categories and nine subcategories. The first major categories were positive experiences of caring for relatives with three subcategories; improved relationships, feeling involved in their caring role and fulfilling desire. The other main categories were negative experiences of caring relatives with subcategories; care burden and responsibility, isolation and loneliness, being insecure and fear and anxiety. The third main categories were next-of-kin experiences of health professionals with two subcategories; satisfaction and dissatisfaction. Discussion: The result is discussed based on Melei's transition theory, the background of the literature review and other research. The starting point is mainly taken from Melei's transition theory, which was related to the next-of-kin experience of role transfers.

<p>The welfare of the elderly population is one of the most important goals of the public health services. At macro level the Swedish National Board of Health and Welfare state that the premier goal is for elderly people to have dignified and comfortable lives. They should have a life with a sense of value and feel confident. These ethical values which are expressed on macro level or as normative ethics are expected to prevail at micro level. In our study the micro level is the caring encounter between the elderly patient, next of kin and nurses. Ethical values and morals are important aspects that influence the quality of care, videlicet in empiric ethics.</p><p>The aim of study (I) was to identify and describe the ethical values experienced by the older person in the daily interaction with nurses in a ward for older people during caring encounters. In study (II) the aim was to identify and describe the governing ethical values that next of kin experience in interaction with nurses who care for elderly patients at a geriatric clinic. Study (I) which was an empirical observational study included follow-up interviews. Twenty-two older people participated voluntarily. In study (II) interviews with fourteen next of kin were conducted. In both studies Constant comparative analysis, the core foundation of grounded theory was used.</p><p>Five categories; Being addressed, receiving respect, desiring to participate, increasing self-determination and gaining self-confidence formed the basis for the core category in study (I): Approaching. Approaching concerns the way people become closer to each other in a physical space .It also includes how people become closer to each other in a dialogue, which involves verbal or bodily communication. Approaching indicates the ethical values that guide nurses in their caring encounters with older people. This ethical value is noted by the older person and has an individual value, as well as leading to improved quality of their care. The older person will be confident and satisfied with the caring encounter if the desired components in the nurse’s approaching are exhibited.</p><p>Four categories were identified in study (II): Receiving, showing respect, facilitating participation and showing professionalism. These categories formed the basis of the core category: “Being amenable”, a concept identified in the next of kin’s description of the ethical values that they and the elderly patients perceive in the caring encounter. Being amenable means that the nurses are guided by ethical values; taking into account the elderly patient and next of kin. Nurses who focus on elderly patients’ well-being as a final principle will affect next of kin and their experience of this fundamental situation.</p>

<p><strong>Bakgrund:</strong> Att få kunna vårdas och dö hemma i en familjär och välkänd miljö innebär för de allra flesta en känsla av trygghet. För många anhöriga är det självklart att leva nära den döende och ta ansvar för omvårdnaden. Ur ett systemteoretiskt perspektiv kan familjen liknas vid en mobil, vid obalans påverkas alla familjemedlemmar. <strong>Syftet</strong> med studien var att belysa patientens, anhörigas och sjuksköterskors erfarenheter av palliativ vård i hemmet för att få en ökad förståelse för sjuksköterskors roll i detta sammanhang. <strong>Metod:</strong> Litteraturstudie där tidigare forskning i ämnet undersökts och sammanställts. Studien består av tolv artiklar från olika vetenskapliga tidskrifter. <strong>Resultat:</strong> Att få vårdas och dö hemma hade stor betydelse för patientens livskvalitet. Sjuksköterskans stöd och engagemang kan i många fall ha avgörande betydelse för om patienten avlider i hemmet, på hospice eller på sjukhus. Viljan för anhöriga att vårda kunde vara större än förmågan att orka med. Sjuksköterskans uppgift var att försöka läsa av och möta patientens och anhörigas behov. Att skapa en god relation till familjen visade sig vara av största vikt inom palliativ hemsjukvård. <strong>Slutsats: </strong>En god kommunikation med familjens medlemmar skapar förutsättningar för en god relation. Det är en svår men viktig balansgång för sjuksköterskan att kunna identifiera och tillfredsställa behoven hos varje enskild familj.</p> / <p>Background: To be cared for and to die at home in a familiar and well-known environment implicates for the vast majority a sense of security. For many families, it is obvious to live close to the dying and take responsibility for nursing care. From a systems theory perspective, the family can be likened to a mobile, the imbalance affects every member of the family. The purpose of this study was to illuminate the patient's, next of kin's and nurses' experiences of palliative care at home to get a better understanding of nurses' role in this context. Method: Literature study in which previous research on this subject were examined and compiled. The study consists of twelve articles from various scientific journals. Results: to be cared for and die at home had a significant impact on patient quality of life. Nurse's support and commitment can often be crucial if the patient dies at home, in hospice or in hospital. The willingness of relatives to care could be greater than the ability to cope with. Nurse's task was to try to read and respond to patients 'and next of kin's needs. Building a good relationship with the family proved to be of paramount importance in palliative home care. Conclusion: A good communication with family members creates the conditions for a good relationship. It is a difficult but important balance for the nurse to identify and meet the needs of each family.</p>

<p>ABSTRACT</p><p>The purpose of this thesis has been to increase the knowledge about the life situation for next of kin who are caring for the elderly and mentally disabled. Also, the impact of “supportive actions” on the quality of life for the next of kin has been assessed. This study tried to answer the following questions:</p><p> How do next of kin perceive their every day life.</p><p> Do supportive actions lead to a better situation in your every day life.</p><p> Do supportive actions raise the quality of life for next of kin</p><p>To answer the questions above a qualitative method was used. Individual interviews were chosen to get a deeper understanding of how the target group was experiencing their life situation. The participants in our study were six women, three were home nursing their husbands and the other three were caring for their parents.</p><p>Through the interviews it was concluded that their life situation was trying and strenuous before the “supportive actions” begun. Stress, anxiety and confinement were common place. In the study it was identified that the “supportive actions” had a positive influence on the life situation and as a consequence the next of kin had a more manageable everyday life after the actions were implemented. The support created the necessary conditions for an increased quality of.</p> / <p>SAMMANFATTNING</p><p>Syftet med denna c-uppsats var att få en ökad förståelse för anhörigas vardag som ger omsorg/vård till äldre och långtidssjuka samt om de stödinsatser som ges har någon betydelse för deras livskvalité. De frågeställningar som vi utgick ifrån var:</p><p> Hur uppfattar anhöriga sin vardag.</p><p> Leder stödinsatserna till en förbättrad livssituation.</p><p> Förbättrar stödinsatserna livskvaliteten hos anhöriga.</p><p>Vi använde en kvalitativ metod för att besvara syftet och vi valde personliga intervjuer för att få en djupare förståelse hur informanterna upplevde sin livssituation. Deltagarna i vår studie var sex kvinnor, varav tre av dem var anhörigvårdare till sin make och de övriga var omsorgsgivare till sina föräldrar.</p><p>Genom intervjuerna med de anhöriga har vi kommit fram till att i livssituationen innan de fick stödinsatserna, så upplevde anhörigvårdarna och omsorgsgivarna att situationen var påfrestande och ansträngd. Många upplevde att det skapades stress, oro och en bundenhet i vardagen. Vi kunde i vår studie se att stödinsatserna har påverkat livssituation i rätt riktning och att många i dag upplevde att deras vardag har blivit mer hanterbar och att stödet har förbättrad livskvalitén.</p>

Everyday life can be complex when next of kin of haemodialysis patients are preoccupied with taking care of the patient and his/her health, which implies the difficulties and requirements needed. The general aim of this thesis was to explore and describe everyday life among next of kin of haemodialysis patients with focus on the life situation, health, time and professional support. Two perspectives of the thesis was applied: a holistic perspective on the everyday life of next of haemodialysis patient and a social perspective with focus on human communication and understanding of next of kin’s experience of everyday life. A qualitative descriptive and explorative design, comprising a phenomenographic and content analysis was used in Studies I-IV. The data collected in the studies consisted of interviews with next of kin to haemodialysis patient and analysis of professional support for next of kin to chronic haemodialysis patients in nursing documentation from two hospitals in Sweden. The experience of time in everyday life among next of kin of haemodialysis patients demonstrated that time for them is minimised and life space contracted. Next of kin experienced ambivalence towards their own health, especially in cases of patients’ spouses When next of kin of haemodialysis patient’s became involved in the patients’ care, they experienced arduousness in relation to their own health as well as less uninterrupted time for themselves in everyday life, and their life situation was characterised by confinement and social isolation. They were aware of the prognosis of renal disease and the fact that haemodialysis is a life-sustaining treatment, which forced them to live for the moment. The everyday life among the next of kin changed when the family became involved in the care, which in turn lead to a changed life situation and restrictions in everyday life. Lack of knowledge in nursing documentation of professional support revealed necessity of the readiness of next of kin. It is therefore important to be familiar with this in the nursing process, especially when the patient and their next of kin need support and attention in everyday life. Original papers not included. / <p>Linköping University Medical Dissertation, 926, I. Ziegert K. &amp; Fridlund B. Conceptions of life situation among next of kin of haemodialysis patients. Journal of Nursing Management 2001; (9) 231-239. doi:10.1046/j.1365-2834.2001.00233.x, II. Ziegert K., Fridlund B. &amp; Lidell E. Health in everyday life among spouses of patients on haemodialysis; a content analysis. Scandinavian Journal of Caring Sciences, Volume 20, Number 2, June 2006, pp. 223-228(6). DOI: 10.1111/j.1471-6712.2006.00400.x, III. Ziegert K., Fridlund B. &amp; Lidell E. Time in everyday life as experienced by next of kin of haemodialysis patients (Submitted for publication)., IV. Ziegert K., Fridlund B. &amp; Lidell E. Professional support for next of kin of patients receiving chronic haemodialysis treatment. A content analysis study of nursing documentation. Journal of Clinical Nursing, Volume 16, Number 2, February 2007, pp. 353-361(9). DOI: 10.1111/j.1365-2702.2006.01597.x,</p>