The grief experienced by the bereaved next of kin after a sudden death can result in both physiological and psychological outcomes. The nurse is often faced with the acute crisis that may arise. The meeting with dying patients is emotionally stressful for the nurse, who may experience a disbelief in their own capacity. The aim of the study was to highlight the nurse’s experiences of meeting with the next of kin after a sudden death. A literature review based on five studies with qualitative design and four with quantitative design. Searches were made in the databases CINAHL Complete, PubMed and Nursing & Allied Health Source. Coping strategies and the concept of health were used as theoretical frameworks. The results consist of five themes. The nurse’s experienced role in the meeting with next of kin which showed that the majority of the nurses experienced the meeting with the bereaved next of kin as their responsibility. Emotional stress of the meeting was for example helplessness, stress, failure and guilt. Fear of the next of kin’s possible reactions meant the nurses fear for the reaction from the next of kin. The experience of education and lack of knowledge were considered as an important foundation in the meeting with the next of kin, and The experience of lack of resources that showed a lack of resources and guidelines. Stress and other external factors may affect nurses’ health negatively; the use of different coping strategies can assist the nurse in affectively handling such stress. The nurse is required to be in good health to adequately meet the next of kin and their needs. Training in and knowledge of the meeting with the next of kin can contribute positively towards the nurse’s well-being. / Närstående som drabbas av en smärtsam förlust till följd av ett plötsligt dödsfall upplever sorg, vilket kan resultera i både fysiologiska och psykologiska besvär. Sjuksköterskan är ofta den som möter närstående i den akuta krisen som kan uppstå. Sjuksköterskan upplever mötet med döende patienter som emotionellt påfrestande och kan uppleva en misstro på sin kapacitet. Syftet var att belysa sjuksköterskans upplevelser av mötet med närstående vid plötsligt dödsfall. En litteraturöversikt baserad på nio vetenskapliga studier, fem av kvalitativ design och fyra av kvantitativ design. Sökningar gjordes i databaserna CINAHL Complete, PubMed och Nursing & Allied Health Source. Copingstrategier och begreppet hälsa användes som teoretisk utgångspunkt. Resultatet består av fem teman. Sjuksköterskans upplevda roll i mötet med närstående där det framkom att sjuksköterskorna upplevde mötet med de plötsligt sörjande närstående som deras ansvarsområde. Emotionella påfrestningar i mötet som exempelvis var hjälplöshet, stress och skuld. Rädslan för närståendes eventuella reaktioner som innebar en rädsla för reaktionen från de närstående. Upplevelsen av bristande utbildning och kunskap som ansågs vara en viktig grund i mötet med närstående och Upplevelsen av bristande resurser som visade på bristande resurser och riktlinjer. Stress och yttre påfrestningar kan påverka sjuksköterskans hälsa negativt och för att hantera detta kan olika copingstrategier användas. För att sjuksköterskan ska kunna möta de närstående på ett adekvat sätt krävs det att hen upplever hälsa. Utbildning och kunskap om mötet med närstående kan bidra positivt till sjuksköterskans välbefinnande och hälsa.

Bakgrund: Stroke är en sjukdom som drabbar många människor. Strokeanfall medför inte bara bestående förändringar för den strokedrabbade utan påverkar även de närståendes situation. Det är inte ovanligt att närstående hamnar i en krissituation i det tidiga skedet av en stroke. Syftet: Syftet med studien är att beskriva upplevelsen av att vara närstående till en person med stroke. Metod: Detta är en litteraturstudie baserad på 10 vetenskapliga artiklar med kvalitativ ansats. Data insamlades genom litteratursökning i databaserna Cinahl och Pubmed. Artiklarna granskades och analyserades utifrån Fribergs (2012)  analysmodell litteraturstudier. Resultat: Resultatet visar att många närstående inte erhåller tillräckligt med information, stöd och vägledning i sjukvården. Situationen förändras för många närstående och detta påverkar olika aspekter så som närståendes sociala liv, relationer samt syn på tillvaron. Den nya situationen medför en känsla av oro, osäkerhet och ensamhet. Diskussion/slutsats: I resultatet framträder närståendes upplevelser anknutna till vårdpersonalen, den strokedrabbade samt andra närstående. Närståendes livsvärld påverkas när någon nära drabbas av stroke. Närstående vill ha mer uppmärksamhet från vårdpersonalen och framförallt delaktiggöras i patientens vård under sjukhusvistelsen. Denna litteraturstudie visar på att närståendes upplevelser kan se olika ut och att det därför är viktigt att sjuksköterskan uppmärksammar dessa som unika individer. Således bör den information samt stöd som de erhåller vara individuellt anpassat. Om närståendes behov och upplevelser bemöts på ett professionellt sätt kan sjuksköterskan bidra med att den nya situationen blir mer hanterbar för dessa. / Background: Stroke is a common disease that affects many people. Stroke causes permanent changes in the life of the stroke survivors and consequently affects the lives of next of kin. It is not uncommon for next of kin to end up in a crisis in the early stage of a stroke. Purpose: The purpose of this study is to describe next of kin’s experience of life after a close person suffered a stroke. Methods: A literature review based on 10 scientific articles with qualitative approach. Data were collected through literature search in the databases Cinahl and Pubmed. Articles were reviewed and analyzed using Friberg (2012)  analytical model. Result: The results show that most next of kin do not receive adequate support and guidance in health care. Situation changed for most next of kin and this in turn affect their social life, relationships and view toward life. This new situation leads them to feel sense of anxiety, insecurity and loneliness. Discussion/Conclusion: The results show next of kin’s experiences in relation to nursing staff, the stroke victims and other related next of kin.  Life situation and the life-world of next of kin is affected when someone close suffer a stroke. Next of kin’s wanted more attention from healthcare professionals and above all to be involved in the patient's care during hospitalization. This literature study shows that next of kin experiences can be different from person to person and it is therefore important that the nurse recognizes them as unique individuals. Thus, the information and support they receive should be individually adapted. If the next of kin’s needs and experiences are encountered in a professional manner, the nurse can assist in making the new situation more manageable for them.

Bakgrund: Alzheimers sjukdom är en demenssjukdom som främst drabbar äldre men kan även förekomma bland yngre individer. Sjukdomen medför begränsningar så att patienten bland annat får svårigheter att hitta i sin omgivning eller känna igen tidigare bekanta saker. Närstående är därför betydelsefulla i vårdande av den drabbade. Ju mer vårdbehovet ökar, desto mer påverkas närstående socialt, fysiskt och psykiskt då de har ett stort ansvar i vårdande och det påverkar deras hälsa negativt. Det är därför viktig att vårdpersonal erbjuder dem det stöd de behöver i vårdandet. Syfte: Att beskriva närståendes upplevelser av att vårda en familjemedlem som drabbats av Alzheimers sjukdom. Metod: En litteraturöversikt grundad på nio kvalitativa studier som hittades i databaserna: CINAHL, PubMed och Ageline. Studierna söktes fram samt analyserades och gemensamma teman identifierades.  Resultat: Fem huvudteman identifierades: att få diagnos, varierande känslor behov av kunskap och stöd, rollförändringar, och redskap i vårdande. Diskussion: Närståendes upplevelser var både positiva och negativa. Resultatet diskuteras utifrån Roys adaptionsteori med ”individen” i fokus. En bättre förståelse av närståendes upplevelser i vårdande av personer med Alzheimers sjukdom både i samhället och hos vårdpersonal kan underlätta vårdande för familjemedlem och främja hälsa hos närstående. För att förebygga ohälsa och främjar livsvillkor krävs det stöd till både närstående och patienter. Mer forskning samt kontinuerliga utbildningar om närståendes upplevelser i vårdande av en person med Alzheimers sjukdom behövs. / Background: Alzheimer's disease is a dementia that primarily affects elderly but may occur among younger people too. The disease causes severe memory loss so that the patient, among other things, has difficulty finding out in his surroundings or recognizing previously familiar things. The next of kin are therefore important in caring for the sick person. As the need for care increases, the more it affects the next of kin socially, physically and mentally, because they have a major responsibility/role in caring and it can negatively affect their health. It is therefore important that healthcare professionals provide them with the support they need in caregiving. Aim: To describe next of kin’s experiences of caring for a family member affected by Alzheimer's disease. Method: A literature review based on nine qualitative studies found in the databases: CINAHL, PubMed and Ageline. The studies were searched, analyzed, and the common themes identified. Results: Five main themes were identified: to get a diagnosis, the varying feelings, need of knowledge and support, role changes, and tools in caregiving. Discussion: Next of kin’s experiences were both positive and negative. The results are discussed based on Roys adaptation theory with the “individual” in focus. A better understanding of the next of kin’s experience in caring for a person with Alzheimer's disease both in society and healthcare professionals can facilitate care for a family member and promote the health of their next of kin. To prevent ill health and promote good living conditions, support is required for both next of kin and his/her family member. More research as well as good and continuous education about the next of kin’s experiences in caring for a person with Alzheimer’s disease is needed.

abstract: Arguments of human uniqueness emphasize our complex sociality, unusual cognitive capacities, and language skills, but the timing of the origin of these abilities and their evolutionary causes remain unsolved. Though not unique to primates, kin-biased sociality was key to the success of the primate order. In contrast to ancestral solitary mammals, the earliest primates are thought to have maintained dispersed (non-group living) social networks, communicating over distances via vocalizations and scent marks. If such ancestral primates recognized kin, those networks may have facilitated the evolution of kin-biased sociality in the primate order and created selection for increased cognitive and communicative abilities. I used the gray mouse lemur (Microcebus murinus) to model whether vocalizations could have facilitated matrilineal and patrilineal kin recognition in ancestral primates. Much like mouse lemurs today, ancestral primates are thought to have been small-bodied, nocturnal creatures that captured insects and foraged for fruit in the thin, terminal ends of tree branches. Thus, the mouse lemur is an excellent model species because its ecological niche is likely to be similar to that of ancestral primates 55-90 million years ago. I conducted playback experiments in Ankarafantsika National Park, Madagascar testing whether mouse lemur agonistic calls contain matrilineal kin signatures and whether the lemurs recognize matrilineal kin. In contrast to large-brained, socially complex monkeys with frequent coalitionary behavior, mouse lemurs did not react differently to the agonistic calls of matrilineal kin and nonkin, though moderate signatures were present in the calls. I tested for patrilineal signatures and patrilineal kin recognition via mating and alarm calls in a colony with known pedigree relationships. The results are the first to demonstrate that a nocturnal, solitary foraging mammal gives mating calls with patrilineal signatures and recognizes patrilineal kin. Interestingly, alarm calls did not have signatures and did not facilitate kin recognition, suggesting that selection for kin recognition is stronger in some call types than others. As this dissertation is the first investigation of vocal kin recognition in a dispersed-living, nocturnal strepsirrhine primate, it greatly advances our knowledge of the role of vocal communication in the evolution of primate social complexity. / Dissertation/Thesis / Ph.D. Anthropology 2014

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-27T15:30:53Z No. of bitstreams: 2 Dissertação - Halanna Cristina Barbosa Silva - 2016.pdf: 1692105 bytes, checksum: 1a6dba862cc9e4e590269d62f3d72bca (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-27T15:31:19Z (GMT) No. of bitstreams: 2 Dissertação - Halanna Cristina Barbosa Silva - 2016.pdf: 1692105 bytes, checksum: 1a6dba862cc9e4e590269d62f3d72bca (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-09-27T15:31:19Z (GMT). No. of bitstreams: 2 Dissertação - Halanna Cristina Barbosa Silva - 2016.pdf: 1692105 bytes, checksum: 1a6dba862cc9e4e590269d62f3d72bca (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-03-29 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / Bexarotene is an agonist to retinoid X receptors (RXR) clinically used in cutaneous T cell lymphoma (CTCL). The oral bexaroteno therapy results in disagreeable side effects related to lipid metabolism, such that topical administration presents as an alternative to bexaroteno use increasing the drug concentration at the target site. Nanostructured systems, such as the deformable liposomes can be an interesting alternative to facilitate or promote increased cutaneous permeation of bexarotene. So, the aim of this study was the development and characterization of deformable bexarotene liposomes. Three surfactants were evaluated for composition of deformable liposomes (Span 80, Tween 80 and Span 85) in different concentrations (5, 10 and 15%). Liposomes were evaluated for average diameter, PdI and elasticity. And then a full factorial design with 3² triplicate central point was applied to analyze the influence of variables ethanol concentration and surfactant in the elasticity of the vesicles. A global solution was proposed by analyzing the Statistica 7.0 software applying the desirability tool and the deformable liposomes encapsulating bexarotene were prepared from the obtained response. Deformable liposomes were prepared by lipid film hydration and extrusion polycarbonate membrane (200 and 100 nm). The desirability function provided a global solution with 5.25% (v / v) ethanol and 5% (w / v) Span 80. Deformable liposomes had encapsulation efficiency of 99.67±3.4%, diameter average of 93.69±1.95 nm and PDI 0.092±0.02. Lyophilized liposomes showed higher elasticity parameters than non-lyophilized formulations, with elasticity up to 215.5±5.5 (mg.s-1.cm-2) for formulations with sucrose and 22.13±1.04 (mg. s-1.cm-2) for conventional liposomes. EPR studies demonstrated that lyophilized formulations presented higher molecular dynamics of lipids regarding the non lyophilized in all formulations, while the formulations without BXT was most dynamic in formulations in which sucrose was used as cryoprotectant, in formulations with BXT occurs the oposite. In vitro skin permeation studies, BXT deformable liposomes had a penetration rate EC about 5 times greater than the conventional liposomes. Thus, the developed deformable liposomes present as bexarotene the potential permeation enhancer on the skin. / O bexaroteno é um agonista dos receptores retinoides X (RXR) clinicamente utilizado no tratamento de linfoma cutâneo de células T (LCCT). A terapia oral do bexaroteno resulta em efeitos colaterais desagradáveis relacionados ao metabolismo de lipídios, de forma que a via tópica se apresenta como alternativa para administração do bexaroteno, aumentando a concentração de fármaco no sítio alvo. O uso de sistemas nanoestruturados, como por exemplo, os lipossomas deformáveis, pode ser uma alternativa interessante para facilitar ou promover maior permeação cutânea do bexaroteno. Assim, o objetivo deste trabalho foi o desenvolvimento e caracterização de lipossomas deformáveis de bexaroteno. Para selecionar os componentes da formulação foram avaliados três tensoativos (Span 80, Tween 80 e Span 85) em três concentrações diferentes (5, 10 e 15%). Os lipossomas foram avaliados quanto ao diâmetro médio, PdI e elasticidade. A seguir um planejamento fatorial completo 3² com triplicata do ponto central foi aplicado para analisar a influência das variáveis de concentração do etanol e do tensoativo na elasticidade das vesículas. Uma solução global foi proposta mediante análise pelo software Statistica 7.0 aplicando-se a ferramenta desejabilidade e, os lipossomas deformáveis encapsulando bexaroteno foram preparados a partir da resposta obtida. Lipossomas deformáveis foram preparados por hidratação do filme lipídico e extrusão em membrana de policarbonato (200 e 100 nm). A função desejabilidade ofereceu uma solução global com 5,25% (v/v) de etanol e 5% (p/v) de Span 80. Os lipossomas deformáveis obtidos apresentaram eficiência de encapsulação de 99,67±3,4 %, diâmetro médio de 93,69±1,95 nm e PdI 0,092±0,02. Os lipossomas liofilizados indicaram parâmetros de elasticidade superiores as formulações não liofilizadas, com elasticidade de até 215,5±5,5 (mg.s-1.cm-2) para formulações com sacarose e 22,13±1,04 (mg.s-1.cm-2) para lipossomas convencionais. Os estudos de RPE demonstraram que as formulações liofilizadas apresentaram maior dinâmica molecular dos lipídios em relação as não liofilizadas em todas as formulações, enquanto nas formulações sem BXT houve maior dinâmica nas formulações em que a sacarose foi utilizada como crioprotetor, nas formulações com BXT ocorre o contrário. Nos estudos de permeação cutânea in vitro, os lipossomas deformáveis de BXT tiveram uma taxa de penetração no EC cerca de 5 vezes superior aos lipossomas convencionais. Dessa forma, os lipossomas deformáveis desenvolvidos se apresentam como potencial promotor de permeação do bexaroteno na pele.

Alloparenting has played a pivotal role in every society throughout human history in ensuring the survival and healthy development of children. A large amount of theory (e.g. kin-selection) and evidence exists to support this claim, and though alloparenting is certainly not unique to humans, it is difficult to suggest that any other species benefits from it more, and certainly not one as ubiquitous as Homo sapiens. However, there is a surprising dearth of empirical research examining the causes of individual variation in the amount and type of alloparental behavior that a child receives, and what effect this variation has on previously validated measures of child well-being. We propose how different measures of familial relatedness and the spatial distribution of relatives might be used to predict the amount and type of alloparental care a child receives, and how these variables may interact to affect a child’s health. We employed a variety of different methods; genealogical modeling, genetic analysis, geospatial mapping, ethological behavioral observations, and anthropometric measurements in order to generate objective data to test these predictions. As members of a relatively isolated native people in Sonora, Mexico, our study population (the Comca'ac) is uniquely suited to help us test our hypotheses. From just this pilot study, we have made many methodological developments and found strong support for many of our hypotheses. There are many new questions to answer as well, which together suggest the future directions for an intensive study of a broader sample of this population, and alloparental behavior in humans in general.

La consanguinité est connue par les biologistes pour diminuer la valeur sélective des individus en diminuant par exemple leur survie ou leur fertilité. De ce fait, la sélection naturelle devrait favoriser l'apparition de comportements permettant l'évitement des accouplements entre apparentes pour limiter les conséquences néfastes dues à la dépression de consanguinité. Cette dépression de consanguinité est particulièrement visible chez les Hyménoptères avec un système de détermination du sexe appelé single-locus Complementary Sex Determination (sl-CSD), où elle amène à la production de males diploïdes non viables ou stériles. Mon travail de thèse a ainsi consiste à étudier le phénomène d'évitement d'accouplements entre apparentes dans des populations naturelles d'un hyménoptère parasitoïde avec sl-CSD, Venturia canescens, ainsi que des signaux utilisés par les femelles pour déterminer l'apparentement qu'elles ont avec les individus qu'elles rencontrent. Nous avons d'abord étudié le lien unissant type d'habitat (continental, iles ou laboratoire), diversité génétique et production de males diploïdes dans 11 populations de V. canescens. En effet, un cadre théorique nomme "Vortex d'extinction du aux males diploïdes" prédit une corrélation négative entre isolations des populations, diversité génétique et production de males diploïdes pouvant amener à l'extinction de populations d'Hyménoptères. Nous avons ainsi démontré une corrélation négative entre diversité génétique et production de males diploïdes dans les populations isolées de V. canescens. Ensuite, il a été montré précédemment que les femelles de cette espèce étaient capables de discriminer les males qui leur étaient apparentes et d'éviter les accouplements entre apparentes en laboratoire. Nous nous sommes ainsi intéressés à ce phénomène d'évitement d'accouplement entre apparentes dans des populations naturelles grâce au génotypage de 450 individus du terrain et leur descendants. Nous avons montré que les femelles toléraient les accouplements entre apparentes sur le terrain ainsi qu'en laboratoire en présence de plusieurs males, nous permettant de mettre en lumière l'importance des conditions environnementales sur le choix du partenaire sexuel. Nous nous sommes enfin concentrés sur le système de reconnaissance des apparentes au niveau mécanistique en étudiant les signaux chimiques utilisés par les femelles pour reconnaitre leurs apparentes dans deux contextes écologiques différents, le choix du partenaire sexuel et l'évitement du superparasitisme lors de la ponte. Nous avons ainsi montré des similitudes entre les compositions chimiques de ces deux signaux mais aussi qu'ils n'étaient pas interchangeables entre les deux contextes écologiques étudiés. Au final, les résultats obtenus apportent un nouvel éclairage sur les conditions nécessaires à l'apparition d'un évitement d'accouplements entre apparentes dans des populations naturelles ainsi que sur les signaux utilisés lors de la reconnaissance de parentèle chez un hyménoptère parasitoïde / Inbreeding is well known by biologists to lower the fitness of individuals by or example decreasing survival or fertility. Therefore, natural selection should favour behaviours preventing the reproduction of genetically-related individuals or mitigating harmful consequences, called inbreeding depression. Inbreeding depression is particularly visible in Hymenoptera with a sex-determination system called single-locus Complementary Sex Determination (sl-CSD), where it leads to the production of diploid males that are either unviable or sterile. My PhD work has thus been devoted to the study of sib-mating avoidance in natural populations of a parasitoid with sl-CSD, Venturia canescens, and to understand the cues used by females recognize their kin. We first studied the link between habitat type (continental, island or captive), genetic diversity and diploid male production in 11 V. canescens populations. Indeed, a theoretical framework called "Diploid male extinction vortex" predict a negative correlation between populations’ isolation, genetic diversity and diploid male production that could lead to the extinction of hymenopteran populations.We actually showed a negative correlation between genetic diversity and diploid male production in isolated populations. Previous studies have furthermore demonstrated kin discrimination and sib-mating avoidance by V. canescens females in the laboratory. We therefore studied the sibmating avoidance behaviour in natural populations of this species by genotyping more than 450 wild individuals and their offsprings. We demonstrated that females tolerated inbreeding in the wild as well as in the laboratory when several males were present. We highlighted the importance of environmental conditions on mate choice. At last, we were interested in the kin recognition system and researched the chemical cues used by females in two ecological contexts, mate choice and superparasitism avoidance. This allowed us to identify similarities in the composition of the two chemical signals and that they were not interchangeable between the two studied ecological contexts. In the end, the results we obtained shed new light on the necessary conditions for the apparition of sib-mating avoidance in natural populations, as well as on the cues used for kin recognition in a parasitoid

Bakgrund: Ett hjärtstopp är ett ytterst allvarligt tillstånd som påverkar inte bara patienten själv utan hela familjen, speciellt en nära anhörig. Patienten svävar mellan liv och död, och om patienten överlever är det ofta med mer eller mindre bestående men. Vid patientens sida finns de anhöriga som vill vara nära, hjälpa och stöda sin närstående samtidigt som det också kan vara en mycket svår situation för dem. Syfte: Syftet med den här kvalitativa litteraturstudien var att belysa anhörigas upplevelser av en närståendes hjärtstopp, för att i framtiden bättre kunna tillmötesgå dem inom vården. Metod: En kvalitativ sammanfattande litteraturstudie baserad på åtta vetenskapliga artiklar som hade studerat anhörigas upplevelser under själva hjärtstoppet, på intensiv-vårdsavdelningen eller efter hemkomst. Resultat: Hjärtstoppet var en kaotisk och traumatisk upplevelse för den anhöriga. Patienten var viktigast, all fokus var på patienten men det lämnade ofta den anhöriga ensam med den oro och rädsla situationen framkallat. Tillgång till kontinuerlig information och professionellt bemötande var ytterst viktigt för den anhöriga. Möjligheten att få vara nära närstående dygnet runt ingav säkerhet och trygghet. Brist på information och uppföljning efter utskrivning och en känsla av att vara ensam med allt ansvar var återkommande teman. Slutsats: Att som anhörig vara nära vid ett hjärtstopp var en stark existentiell upplevelse där alla aspekter av delaktighet fanns beskrivna; att veta, att göra och att vara. För bästa resultat, ett delaktigt vårdande i ljuset, krävs en samverkan mellan den vårdande personalen, patient och anhörig. Mer stöd och uppmärksamhet bör i framtiden riktas även mot den anhöriga. / Background: Sudden cardiac arrest is a life threatening condition, not only affecting the patient but the whole family. The patient’s life is on hold and if the patient survives, this is often with more or less physical and psychological complications. Close to the patient a family member or relative, tries to support and help the patient while at the same time the situation may be extremely stressful for the relative. Aim: The aim of this qualitative literature review was to get a better understanding of family members lived experiences during a loved one’s sudden cardiac arrest, in order to better also support the relatives in healthcare. Method: A summary of the literature based on eight qualitative studies on the perceptions of family members experiences of a sudden cardiac arrest by a loved one; during the cardiac arrest, at the intensive care unit and after discharge from hospital. Results: The cardiac arrest was experienced as a chaotic and traumatic event by the relative. The patient was the most important person at the moment but at the same time it left the relative alone with her feelings of anxiety and fear that the situation induced. Receiving information continuously about their next of kin’s condition as well as a considerate and professional encounter with the intensive care unit staff was important for the relative. The possibility to stay with the patient at the intensive care unit felt comforting, reassuring and safe. Lack of information and follow up, as well as a feeling of being alone with the responsibility, was a common theme after discharge from the hospital. Conclusion: To be present during the next of kin’s cardiac arrest was a strong existential experience where all aspects of involvement and participation were described; to know, to do and to be. For best results, an involving care in the light, collaboration between the professional care, the patient and the family member is needed. More support and attention should be given to family members in the future.

Antalet barn som anhöriga till patienter som erhåller vård och transport till sjukhus är okänt. Barn under 18 år kan ibland vara närvarande på hämtplatsen när ambulanssjukvården hämtar barnets anhörig. Hur många barn som anhöriga som är närvarande är okänt inom ett västsvenskt ambulansområde. Triagesystemet RETTS används vid triagering och bedömning av anhöriga till barnen. Syftet med studien är att kartlägga hur många barn som är närvarande då deras anhöriga ges vård, behandling och transport till en vårdinrättning vid prioritet 1 och 2 larm. En enkät skapades för att samla in data till studien. Barn som anhöriga finns även inom ambulanssjukvård. I denna studie identifierades 155 barn vid 95 ambulansuppdrag. Barn som anhörig ses till både vuxna, vanligen en förälder, som till barn. Ett flertal barn som anhöriga är närvarande när en anhörig påvisar svåra, kanske livshotande symptom. Sammanfattningsvis visade studien att stödet till barn och kunskapen om stöd fanns inte inom det ambulansområde där studien är genomförd. / Children as next of kin to patients who are treated by an ambulance nurse in Swedish ambulance service in unknown. Children under 18 years of age may sometimes be present when their parent or other next of kin, has to call the ambulance service due to illness or accident. How many children who experience their next of kin transported to hospital within a Western Swedish ambulance service district is unknown. The purpose of this survey is to identify how many children actually are present when their next of kin may need care and treatment from an ambulance service. Purpose: Survey how many children are present when an ambulance nurse cares and treats a next of kin due to illness or an accident, prioritized as priority 1 or 2. Method: a survey conducted by ambulance nurses in a western Swedish ambulance service. The survey has a quantitative design. Children as next of kin are present within a Swedish ambulance service district, in this survey 155 children was identified in a total of 95 ambulance missions. Children as next of kin are seen as adults, in most cases, a parent as well as children usually a sibling. Many children are present when their relative shows sign and symptoms of severe illness.

Bakgrund:Suicid är en självdestruktiv handling som leder till döden och som ofta är en konsekvens av psykiskt lidande och sjukdom. Suicid leder till ett stort lidande för efterlevande närstående. Därför behöver sjuksköterskor sträva efter att fånga upp dessa närstående och hjälpa dem. Syfte: Syftet med studien är att beskriva närståendes upplevelser efter att en person har begått suicid för att skapa förståelse för hur sjuksköterskor kan bemöta närståendes behov. Metod: Studien är baserad på sju självbiografier som analyserades enligt Dahlborg-Lyckhages metod att analysera berättelser. Resultat: Närstående beskriver en stor sorg över suiciden, känslor som skuld, skam men även lättnad upplevs efter en anhörigs suicid. Närstående beskriver hur omgivningen undviker dem och att de upplever sig utpekade och isolerade efter en anhörigs suicid. Närstående beklagar sig också över att det inte erbjuds professionellt stöd och hjälp utan att de själva måste söka det. Konklusion: De närstående är främst i behov av professionellt stöd i form av stödsamtal och gemensamma samtal med resten av familjen. Dessutom är de närstående i behov av socialt stöd i form av stödgrupper från till exempel SPES. Sjuksköterskans roll blir att stödja de närstående i deras sorgeprocess. / Background: Suicide is self-destructive act that leads to death and is usually a consequence of mental illness and disease. Suicide also leads to great suffering for the relatives left behind. The nurse’s role in cases like these is therefore to acknowledge and support relatives in their grieving process. Aim: Is to describe relatives’ lived experiences after their next of kin commits suicide in order to create an understanding on how nurses can respond to their needs. Method: The study was based on seven autobiographies. Dahborg-lyckhage’s method for analyzing narratives was used to analyze the chosen biographies. Results: The results describe the relatives’ feelings like guilt, shame, relief among others and reactions after their next of kin’s suicide. They experienced avoidance by people in their surroundings. They also lacked professional support to assist them in their bereavement and had to reach out for it themselves. Conclusion: Nurses have a role to fulfill with supporting relatives in their grieving process with aim to help on improving their wellbeing and relieve their suffering. Information about support groups and helpful organizations like SPES as a form of social support can be very helpful in achieving this.