Darwin's (1859) theory of evolution by natural selection accounts for the adaptations of organisms, but, as Fisher (1930) famously said, 'natural selection is not evolution.' Evolutionary theory has two major components: i) natural selection, which involves the underlying dynamics of populations; and ii) adaptive evolutionary change, which involves the optimisation of phenotypes for fitness maximisation. Many of the traditional theoretical frameworks in evolutionary theory have focussed on studying optimisation processes that generate biological adaptations. In recent years, however, a number of evolutionary theorists have turned to using frameworks such as the 'replicator dynamics' or 'eco-evolutionary dynamics', to explore the dynamics of natural selection. There has, however, been little attempt to explore how these dynamical systems frameworks relate to more traditional frameworks in evolutionary theory or how they incorporate the principles that embody the process of evolution by natural selection, namely, phenotypic variation, differential reproductive success, and heritability. In this thesis, I use these principles to provide the formal foundations of a general framework - a mathematical synthesis - in which the future state of an evolutionary system can be predicted from its present state; what I will call a 'dynamical systems theory of natural selection.' Given the state of an existing biological system, and a set of assumptions about how individuals within the system interact, the job of the dynamical systems theory of natural selection is no less than to predict the future in its entirety.

Bakgrund: Palliativ vård innebär en vårdform som syftar till att   främja en god livskvalité för patienter och närstående som drabbats av   obotlig och livshotande sjukdom. Idag föredrar allt fler att vårdas i det   egna hemmet och närstående involveras därför allt mer i vården av patienten.   Att en förtroendefull vårdrelation mellan sjuksköterskan, patienten och   närstående skapas tidigt ligger till grund för en trygg och god palliativ   vård. Syfte: Att belysa närståendes upplevelser av att bli en   informell vårdgivare vid palliativ vård i hemmet. Metod: Den valda metoden för studien var en   litteraturöversikt. Utifrån litteratursökningar i databaserna PubMed, CINAHL   Complete och Nursing and Allied Health valdes 11 kvalitativa vetenskapliga   artiklar ut som svarade på syftet. Artiklarna analyserades och tematiserades   enligt Fribergs metod. Resultat: Resultatet presenterades i fyra teman: Påverkan på den egna livssituationen,   rollförändringen, psykisk och fysisk påverkan. Den upplevda ensamheten i   relation till andra. Betydelsen av stöttande relationer och det betydelsefulla resultatet av att ha   vårdat i hemmet. Den vårdande rollen hade en stor inverkan på närståendes   liv och medförde ofta en känsla av otillräcklighet. De upplevde sig som ensamma   i sin vårdanderoll och upplevelsen av vårdtiden färgades av det stöd de   erhållit. Trots att det var en påfrestande tid var vården i hemmet inget de   ångrat. Diskussion: Resultatet diskuterades utifrån Bridges   transitionsteori. Närstående var i stort behov av stöd och avlastning och   ansåg sig inte förberedda på vad vården i hemmet innebar i sin helhet. Det   var viktigt att de tillät sig själva tid för återhämtning och tog emot det   stöd som erbjöds. Sjuksköterskans stödjande roll kan vara avgörande i   närståendes förmåga att orka med vården i hemmet. / Background: Palliative   care aims to promote a good quality of life for patients who suffer from   incurable and life-threatening illness, and their relatives. Today, more and   more people prefer to be cared for in their own homes, and families are   therefore increasingly involved in the care of the patient. The creation of a   trustworthy relationship between the nurse, patient and next-of.kin´s is the   basis for a safe palliative care. Aim: To   illuminate next-of-kin´s experiences of becoming an informal caregiver in palliative care at home. Method: The chosen   method for the study was a literature review. Based on literature searches in the databases PubMed, CINAHL Complete and Nursing and Allied Health, 11   qualitative scientific articles were selected that responded to the purpose.   The articles were analyzed and thematized according to Friberg's method. Results: The results  were presented in four themes: Impact   on their own life situation, role change, psychological and physical impact.   The perceived loneliness in relation to others. The importance of supportive   relationships and the significant   result of having a home care. The caring role had a major impact on the   lives of the next-of.kin´s and often led to a sense of insufficiency. They   felt lonely in their caring role and the experience of homecare were colored   by the support they received. Although it was a stressful time, the care at   home was nothing they regretted. Discussion: The result   was discussed based on Bridge's transition theory. Relatives were in great   need of support and relief and did not consider themselves prepared for what   the care at home meant in its entirety. It was important to allow time for   recovery and to accept the support offered to them. The nurses supportive   role can be crucial for the next-of kin´s ability to cope with home care.

A key feature of social Hymenoptera is the division of labor in reproduction between one or a few fertile individuals – the queen(s) – and many sterile nestmates that function as helpers – the workers. The reproductive altruism of workers has long been considered as one of the most important paradox of Evolution. Today, kin selection (Hamilton 1964a,b) is recognized as a prime selective force for the evolution reproductive altruism in Hymenoptera. Hamilton’s kin selection theory states that workers may benefit helping relatives reproduce as long as the relatives they aid share a higher than average proportion of their genes with the workers and effectively pass on copies of the workers' genes to the next generation. Relatedness between colony members is therefore pivotal in kin selection theory, because it directly influences the benefits from indirect fitness. In social Hymenoptera, within-colony relatedness is usually high, because of the haplodiploid sex determinism system. However, several factors of the breeding system are known to affect the colony genetic structure and, hence, the workers’ indirect inclusive fitness: the number of breeders, their genetic relationships and their relative contribution to the reproduction. On the other hand, dispersal strategies influence the population genetic structure, which in turn may result in different interaction patterns between members from neighboring colonies. Despite its central role in the evolution of cooperation and reproductive altruism in animals, kin selection also predicts conflicts between colony members. Because the individuals from a colony are not genetically identical, their reproductive interests may be different (Trivers 1974). These conflicts are diversified, both regarding their actors and their causes (Trivers & Hare 1976; Bourke & Franks 1995; Keller 1995; Chapuisat & Keller 1999b; Keller & Reeve 1999; Sundström & Boomsma 2001). The first part of this work deals with the population genetic structure, mating system and dispersal strategies of two Pheidole ants, the Mediterranean ant Pheidole pallidula and the Mojave Desert ant Pheidole tucsonica. Chapter 1 investigates the population genetic structure, the breeding system, the colony kin composition and the colony genetic structure of the Mediterranean ant P. pallidula. This study was performed by using highly polymorphic DNA microsatellite marker loci. The results show that a single, unrelated male inseminates each queen. Colonies are monogynous (i.e. headed by one reproductive queen) or polygynous (i.e. headed by 2 to 4 functional queens). Moreover, they are genetically differentiated and form a population exhibiting significant isolation-by-distance, suggesting that some colonies originate through budding. Chapter 2 reports cross-species amplifications of microsatellite markers developed for the ant P. pallidula on 13 ant species belonging to the sub-family Myrmicinae. Moreover, levels of genetic diversity within a colony, as well as relationship among colonies are studied for the black ant Pheidole tucsonica. Chapter 3 characterizes the level of inter-nest aggression, the spatial distribution and the genetic structure of a P. tucsonica population. The results show that inter-colony aggression varies from none to “all out” fights and that it is largely non-transitive. No effect of geographical distance or genetic structure on inter-nest aggression levels is detected. Moreover, genetic data reveal high rates of polygyny and/or polyandry. Overall, these results do not support the idea of a simple mechanism of nestmate recognition through queen or worker-produced pheromones or environmental cues. The second part of this work is devoted to the queen-queen conflict over reproduction, and the queen-workers conflict over sex allocation in P. pallidula. Chapter 4 is a detailed analysis on the partitioning of reproduction among queens in polygynous colonies of the species. Our results show a significant departure from equal contribution of queens to reproductive female, male and worker production. Reproductive skew is greater for male production than for queen and worker production. There is no relationship between the magnitude of the reproductive skew and (i) the number of reproductive queens per colony, (ii) their relatedness and (iii) the overall colony productivity, some of the factors predicted to influence the extent of reproductive skew. Finally, this study reveals a trade-off in the relative contribution of nestmate queens to reproductive female and worker production. The queens contributing more to reproductive female production contribute significantly less to worker production. To our knowledge, such a trade-off is shown for the first time in the Formicidae. Chapter 5 focuses on queen-workers conflict over sex allocation. Colonies of the Mediterranean ant P. pallidula show a strong split sex ratio, with 85% colonies producing more than 80% sexuals of one sex. Genetic analyses reveal that this species has an unusual breeding system, with colonies being headed by a single or a few unrelated queens. As expected in such a breeding system, our results show no variation in relatedness asymmetry between monogynous (single queen per colony) and polygynous colonies. Nevertheless, sex allocation is tightly associated with the breeding structure, with monogynous colonies producing a male-biased brood and polygynous colonies almost only females. In addition, sex allocation is closely correlated with colony total sexual productivity. Overall, our data show that when colonies become more productive (and presumably larger) they shift from monogyny to polygyny and from male production to female production, a pattern that has never been reported in social insects so far. A new explanation based on the concept of the “tragedy of the commons” is proposed to explain the strong sex ratio specialization observed in P. pallidula and in other species characterized by facultative polygyny. Chapter 6 investigates the relationship between the breeding system (monogynous vs. polygynous colonies) and the biosynthesis rate of juvenile hormone. Previous works in P. pallidula showed (i) that maternal effects induced by hormones and/or other compounds transferred to the eggs could influence the caste fate of female eggs and (ii) that sex specialization is tightly associated with the breeding structure (monogynous colonies produce a male-biased brood and polygynous colonies almost only females - Chapter 5). This study reveals a strong relationship between the biosynthetic rate of juvenile hormone (JH) production and the breeding system. Because in this species the breeding structure is closely associated with colony sex ratio, we propose that the rate of JH in queens could be a critical parameter in colony sex ratio determination. Queens of P. pallidula would exert partial control over sex ratio by laying different proportions of worker-destined eggs and queen-destined eggs according to the structure monogynous or polygynous of their colony. To conclude, some perspectives for future research on the different topics presented in this work are suggested. / Doctorat en Sciences / info:eu-repo/semantics/nonPublished

Mötet med närstående till patienter som avlidit är ett stressfyllt möte, både för närstående och sjuksköterskan. Tidigare forskning visade att närstående önskade få tydlig information och söker trygghet hos varandra. Närstående upplevde sjuksköterskan som en stor källa för trygghet och stöd i sorgprocessen. Den professionalitet och säkerhet hon förmedlar var av stor vikt för närståendes upplevelse av hela vårdtiden. Syftet med studien var att beskriva erfarna intensivvårdssjuksköterskors reflektioner från möten med närstående till patienter som avlidit. En intervjustudie med kvalitativ ansats gjordes. Informanterna i denna studie kunde alla klassificeras som skickliga och expertsjuksköterskor enligt Benners utvecklingsstadier för sjuksköterskan. Informanterna beskrev möten som kunde delas in i följande huvudteman för att ge stöd till de närstående som, trygghet, lyhördhet, stillhet och lugn. Med hjälp av dessa huvudteman upplevde informanterna att de kunde skapa optimala förutsättningar för att skapa stillhet och lugn. / Meeting patient’s next of kin after decease is a stressful meeting for both the next of kin and the advanced practice nurse. Preceding research showed that the next of kin sought to receive information that was easy to understand and that they seek solace from each other. The advanced practice nurse was experienced as a great source of comfort and support in the grieving process by next of kin. Professionalism and support mediated by the advanced practice nurse was of great importance for the next of kin’s experience of the hospitalization period. The aim of this study was to describe experienced intensive care unit nurses reflections of meeting next of kin to patients who are diseased. An interview study with a qualitative approach was done. The informants in this study could all be classified as the skilful and the expert nurse according to Benners stages of progression for the nurse. The informants described main themes to support and comfort the next of kin, they were; feeling secure, attentiveness, stillness. With the aid of these categories the informants experienced that they could create the optimal conditions in creating stillness in the storm that the next of kin are in after death has occurred.

Bakgrund: När någon drabbas av sjukdom eller skada är det inte bara patienten som påverkas utan även de anhöriga. I kritiska lägen, när döden plötsligt blir ett verkligt hot, kastas både patient och anhöriga in i en krissituation. I familjefokuserad omvårdnad ses familjen som en helhet. Om något händer en individ påverkar det även de andra familjemedlemmarna. Även om det inte är den anhöriga som har drabbats av sjukdom kan de ändå ofta uppleva ohälsa och lidande. Syfte: Syftet var att beskriva anhörigas upplevelser när en närstående drabbas av plötslig, kritisk sjukdom. Metod: En litteraturbaserad studie med kvalitativ innehållsanalys.  Resultat: Resultatet består av tre huvudkategorier; behov av att få vara delaktig, känslor som tar över och en vilja att agera. Kategorierna definierar de anhörigas beskrivningar av sina upplevelser. Konklusion: Anhörigas upplevelser vid omhändertagandet när en närstående blivit kritiskt sjuk kan vara omtumlande. Vårdpersonal har möjlighet att påverka upplevelsen genom att möjliggöra och uppmuntra till delaktighet. Delaktighet minskar känslan av att vara avskärmad från verkligheten och underlättar för anhöriga att kunna ingripa och att föra patientens talan. / Background: Sudden illness affects not only the patient but also the patient’s close family. In critical situations both patient and relatives are thrown into a crisis situation. In addition to providing medical care to the patient, nurses must also be able to care for and support the patient’s family. Families’ reactions and needs, however, may look very different from one situation to another. Aim: The aim of the study was to describe family members’ experiences when a relative becomes critically ill. Method: A literature based study using a qualitative content analysis. Results: Three main categories were identified; a need to participate, emotions that take over, a desire to intervene. The categories describe the family members’ experiences. Conclusion: Experiencing critical illness of a family member can be overwhelming. Healthcare professionals can influence the experience by enabling and encouraging family members to participate in the care. Participation reduces the feeling of losing touch with reality and enables families to act.

Notre relation avec nos apparentés forme une grande partie de notre monde social; et la façon dont nous reconnaissons et traitons nos apparentés a donné lieu à une importante somme de recherche. Lorsqu'il s'agit de reconnaître un apparenté direct, la similarité faciale est considérée comme un indice d'apparentement. Dans cette thèse, j'étudie si elle joue un rôle comparable lorsqu'il s'agit de reconnaître un apparentement entre des tiers, en menant deux lignes de recherche: les prédictions de comportement népotistiques et les prédictions de préférences de couple, par des tiers, en présence de stimuli faciaux. La catégorisation devant servir l'action, la similarité faciale doit avoir un effet dépendant du contexte sur ces prédictions, susceptible à des changements de valence et de domaine. En l'absence de contexte, les individus semblent pouvoir détecter la similarité faciale et la mettre en relation avec l'apparentement. Nos deux séries d'expériences offrent une conclusion différente. Quand la valence du contexte change et que nous analysons les prédictions des participants en terme de kin selection, leurs choix ne semblent pas mettre en relation similarité faciale et apparentement. / Our relation to our kin shapes much of our social world. It's no surprise then, that how we recognize and react to our own kin has been a widely investigated topic. In particular, when tackling direct kin recognition, facial similarity has emerged as a putative cue of relatedness. In this thesis, I investigate whether or not the same can be said for third party kin recognition. Split between two lines of research, we explore individuals' predictions of nepotistic and mating behavior} in third party scenarios using facial stimuli. These two domains provide the backbone of our research. Categorization must serve action. So, what would strengthen the notion of a presence of third-party kin recognition in humans? Facial similarity \emph{must have} a context-dependent effect on participants predictions, susceptible to valence changes in scenarios and switches from the prosocial and mate choice domains. This is precisely what we set out to do with our two lines of research. Though our literature review revealed that when context is starved participants seem to be able to detect similarity and seemingly connect it to relatedness. Our nepotism and mating series of experiments, by re-inserting context, offers us a different conclusion altogether. Within scenarios in which valence is modified and our participants analysis is bounded by predictions made by kin selection, their choices do no reflect a connection between similarity and relatedness.

Bakgrund: Intensivvård är en avancerad behandling med noggrann övervakning av kritiskt sjuka patienter. Patienterna är i ett utsatt läge och i beroendeställning av vårdpersonal såväl sina närstående. Tidigare studier tar upp vikten av delaktighet men utifrån ett patientperspektiv. Det har erfarits att närstående inte görs delaktiga i vården som de skulle kunnat vara. Det saknas även studier där närståendes delaktighet undersökts. Att vara närstående till en kritiskt sjuk person kan vara svårt och det är intensivvårdssjuksköterskans ansvar att göra de närstående delaktiga. Negativa effekter kan ske för de närstående som inte får vara delaktiga, så kallat “post-intensive care syndrom”. Syfte: Studiens syfte var att beskriva närståendes upplevelser av delaktighet i vården av en vuxen kritiskt sjuk person på intensivvårdsavdelningen. Metod: En systematisk litteraturstudie med kvalitativ ansats med 15 vetenskapliga artiklar. Artiklarna har analyserats med hjälp av Bettany-Saltikov och McSherrys metod. Resultat: I resultatet framkom tre huvudkategorier: Att finnas till för patienten, Involverad i kommunikationen med vårdpersonal samt Delta i den fysiska omvårdnaden. Slutsats: Närståendes upplevelse av delaktighet har en betydande roll för intensivvården. Närstående känner sig delaktiga genom att få vara med fysiskt i omvårdnaden men även att vara passiv. De uppskattar att få information, att få valmöjligheter och på så sätt känna sig delaktiga. Närståendes delaktighet speglades även när de var nära, uppmuntrade och förde patientens talan. Att ta vara på närstående och göra dem delaktiga på intensivvårdsavdelningen är något att ta lärdom av. / Background: Intensive care involves an advanced treatment and close monitoring of critically ill patients. Patients are in a vulnerable position that depends on both their next-of-kin as well as advanced health care. Previous studies address the importance of participation but from a patient perspective. Former experiences from intensive care have pinpointed that relatives are not as involved in the care as they could be. There currently are few studies where the participation of relatives has been investigated. Being close to a critically ill person can be difficult and it is the intensive care nurse´s responsibility to involve the relatives. Negative effects can occur for the relatives who are not allowed to participate, so called “post-intensive care syndrome”.  Aim: The aim of the study was to describe relatives' experiences of participation in the care of an adult critically ill person in the intensive care unit. Method: A systematic literature study with a qualitative approach from 15 scientific articles. The articles have been analyzed using Bettany-Saltikov and McSherry´s method. Results: The results showed three main headings: To be there for the patient, Part taking in the communicational aspects with the care givers and Participate in physical care. Conclusion: Relatives' experience of participation has a significant role for intensive care. Relatives feel involved by being physically engaged in the care, but also by being passively active. They appreciate recieving information, having choices and through that feeling more involved. The participation of relatives was also reflected when they were close, encouraged and brought the patient´s voice. Taking care of relatives and making them involved in the intensive care unit is something to learn from.

Menopause, the cessation of female reproduction well before death, is a puzzling phenomenon, because evolutionary theory suggests there should be no selection for survival when reproduction has ended. Nevertheless, menopause does exist in a limited number of species, and besides humans it has predominately evolved among toothed whales (Odontoceti). The aim of this thesis is to review both adaptive and non-adaptive theories. Of the latter, the most prominent proposes that menopause is a product of a physiological trade-offs between reproductive benefits early in life and negative late-life reproduction. Among the adaptive theories the grandmother hypothesis is the most acknowledged. This theory is based on inclusive fitness benefits gained from increasing the reproductive success of kin at an advanced age, when prospects of successfully raising additional offspring is reduced. Alternatively, the mother hypothesis suggests that increased investment in already produced offspring at late life explains menopause. There are support for both the care of mothers and grandmothers, but whether this is enough to compensate for repressed reproduction is debated. The reproductive conflict hypothesis provides a complementary explanation, and suggests that inter-generational conflict between either in-laws or kin selects the older female to shift investment into the younger female’s offspring due to asymmetries in how older and younger females are related to one another’s offspring. The evolution of menopause is a complex issue, containing many factors, kinship dynamics among the most important. Theories apply unequally to various species and populations, meaning an integrated approach is necessary for decrypting the evolution of menopause.

Bakgrund: Personcentrerad omvårdnad är en av sjuksköterskans sex kärnkompetenser. Detta innefattar att bemöta olika personer. Trots detta upplever sjuksköterskor svårigheter med att bemöta anhöriga i den allmänna palliativa vården. Detta på grund av att sjuksköterskor upplever sig ha bristande kompetens inom området. Samtidigt uttrycker anhöriga en önskan att involveras i vården. Syfte: Att belysa anhörigas upplevelser vid vård i livets slutskede. Metod: Totalt 14 kvalitativa artiklar som fokuserar på anhörigas upplevelser vid vård i livets slutskede identifierades och analyserades för att finna gemensamma teman. Resultat: Fyra huvudteman identifierades. Vikten av sociala relationer samlar anhörigas upplevelser kring mellanmänskliga relationer med sjuksköterskan, patienten men även relationen till sig själv. Vikten av att vara delaktig handlar om hur vården kan påverkas genom anhörigas upplevelser och kunskap. Vikten av god vård för patienten påvisar att patienters upplevelser påverkar anhöriga. Vikten av att ta hand om sig själv beskriver olika sätt att som anhöriga kunna anpassa sig till vård i livets slutskede. Konklusion: Eftersom både anhöriga och sjuksköterskor upplever svårigheter i mötet krävs utökad kompetens hos sjuksköterskan för att kunna bemöta anhöriga vid vård i livets slutskede. / Background: Person-centred care is one of the nurses six core competencies. Which includesmeeting different people. Despite this fact nurses’ experiences difficulties when meeting next of kins in general palliative care. This is caused by nurses’ lack of competence in the field. While next of kins expresses a wish to be involved in caring. Aim: To illustrate next of kins experiences in end-of-life care. Method: A total of 14 qualitative articles which focuses onnext of kins experiences of end-of-life care were identified and analysed in order to findcommon themes. Results: Four main themes were identified. The importance of social relationships gathers next of kins experiences of interpersonal relationships with nurses, the patient but also the relationship to oneself. The importance of being involved focus on how care can be affected by next of kins experiences and knowledge. The importance of good carefor the patient demonstrates that patients’ experiences affect next of kins. The importance of selfcare describes different ways next of kins can adapt to end of life care. Conclusion: Expanded competency in nurses is demanded, since both next of kins and nurses experience difficulties in encounters in end-of-life care.

Bakgrund: Plötslig död är ett svårdefinierat begrepp då det kan orsakas av många faktorer. Att hantera plötslig död och sorg som sjuksköterska samt att bemöta anhöriga i dessa situationer är utmanande. Sorgereaktioner är individuella och kan skilja sig mycket från person till person. Det är oftast sjuksköterskor som etablerar kommunikationen mellan anhöriga och vårdteamet vilket ställer höga krav på professionen. Syfte: Beskriva sjuksköterskors upplevelser av att bemöta anhöriga i sorg efter plötsliga dödsfall som inträffat inom akutsjukvård.Metod: En litteraturöversikt med kvalitetsgranskade kvalitativa artiklar från åren 2012–2021. Artikelsökningar gjordes i databaserna; Cinahl, Medline och PubMed. Analysen gjordes utifrån Fribergs (2017) beskrivning av en femstegs analys. Resultat: I resultatet framkom tre teman: Emotionell påverkan (Känslomässiga aspekter, känslor av misslyckande och otillräcklighet samt otrygg i mötet), Kommunikation (Informerande samtal och bygga goda relationer) samt Arbetsmiljö (Tidsbrist och samverkan i team). Slutsats: Sjuksköterskor upplevde mötet med anhöriga vid plötslig död som komplicerat. Bristfällig kunskap inom ämnet sågs som ett problemområde. Att ge möjlighet för sjuksköterskor att utveckla sina färdigheter genom utbildningar kring bemötande vid sorg skulle kunna medföra en hälsosammare arbetsmiljö för sjuksköterskan. Ökad utbildning skulle också kunna ha betydelse för kvalitén på vården då det gäller stöd till anhöriga. / Title: The nurse`s meeting with relatives in the event of sudden death: A qualitative literature review Background: Sudden death is a difficult concept to define as it can be caused by many factors. Dealing with sudden death, relatives and bereavement as a nurse is challenging. Reactions in bereavement are individual, it can differ between people. It is the nurse who often establishes the communication between relatives and healthcare, which places high demands on the nurse. Aim: Describe nurses´ experiences of treating relatives in bereavement after sudden deaths that occurred in emergency care. Method: A literature review was performed with a base in quality reviewed qualitative articles from the years 2012-2021. Searches of articles were made in databases Cinahl, Medline and PubMed. The analysis was based on a five-step analysis described by Friberg (2017).Result: The result revealed three themes: Emotional impact (Emotional aspects, feelings of failure and inadequacy and insecurity during the meeting), Communication (Informative conversations and create good relations) and Work environment (Lack of time and team collaboration). Conclusion: Nurses experienced the meeting with bereaved relatives after sudden death as complicated. Lack of knowledge in the subject was seen as a problem. Providing opportunities for nurses to develop their skills through education in bereavement could lead to a healthy work environment and a healthcare with high quality to support relatives.