Det är svårt att bedöma hur lång tid en människa har kvar i livet och brytpunkten för när en patients döende fas inleds kan vara otydlig (Ellershaw & Ward, 2003). Det är viktigt att den sista tiden blir så bra som möjligt och här spelar sjuksköterskan en viktig roll. Syftet med studien var att belysa sjuksköterskors upplevelser av att vårda döende patienter på en akutvårdsavdelning. Metoden som användes var kvalitativa fokusgruppintervjuer och data analyserades med induktiv innehållsanalys. Ett övergripande tema för studien kan benämnas vårdens vågskålar, dilemman och tillfredställelse, vilket speglar den dubbelbottnade natur vården har. Intervjuerna resulterade i tio koder, vilka delades in i tre kategorier. Under kategorin känsla av att räcka till fanns koderna behov av tid, etiska ställningstaganden, anhörigkontakt samt det goda döendet. Den andra kategorin var strukturer i vården och innehöll koderna organisationen, vårdplanens betydelse samt förbättringsmöjligheter. Den sista kategorin personliga dilemman innehöll koderna påverkan på sjuksköterskans person, våga tala om döden samt uppföljning. Det sjuksköterskorna framhöll behov av tid för att kunna ge en optimal vård. De beskrev ett glapp mellan vad de upplevde som god vård vid livets slut och de resurser de hade för att förverkliga detta. Resultatet styrks av tidigare forskning.

Thoraxkirurgiska ingrepp har väldokumenterade ökade risker för svåra smärtor postoperativt och tidigare forskning visar om den postoperativa smärtlindringen underbehandlas ökar risken att utveckla en kronisk smärta (CPSP) som drabbar 30-50% av alla som genomgår thoraxkirurgi. Detta leder till högre vårdkostnader för samhället, en kraftig försämring av patientens livskvalitet och ett vårdlidande för patienten. Sjukvården borde fokusera på att möta patienternas lidande och ge redskap och möjlighet för vårdarna att lindra lidandet och stärka patientens förmåga till egenvård av smärta i hemmet. Syftet med denna litteraturstudie var att belysa sjuksköterskans upplevelse av vad som behövs för att ge en bra smärtbehandling till patienter som genomgått större kirurgi exempelvis thoraxkirurgi och vilka hinder som måste överstigas för att lyckas. Examensarbetet genomfördes som en systematisk litteraturstudie där innehållet från elva artiklar analyserades och sammanställdes. I analysen av resultatet framkom två teman; Upplevda hinder och sjuksköterskans strategier. De beskriver hur sjuksköterskan på olika sätt arbetar med smärtskattning och vilka hinder som kan uppstå. Resultatet visar på stora problem i smärtbehandling, både vad gäller att smärtskatta som att lindra lidandet och berodde bland annat på bristande kunskap hos både patient och sjuksköterska. Slutsatsen är att sjukvården borde satsa på mer individualiserad patientinformation både preoperativt och innan hemgång, så patienten förstår varför smärtlindring är viktigt. Om detta görs kan man förhindra postoperativa komplikationer och kronisk smärta, som leder till lägre vårdkostnader och minst lika viktigt att bibehålla en patient med god livskvalitet.

Syfte: Att beskriva sjuksköterskans roll och upplevelser vid vård i livets slutskede. Syftet var även att värdera vilken betydelse datainsamlingsmetoden har för de inkluderade artiklarna. Metod: Beskrivande litteraturstudie baserad på 13 vetenskapliga artiklar som söktes i databaserna Cinahl och PubMed via Högskolan i Gävle. En metodologisk granskning av de ingående artiklarnas datainsamlingsmetod genomfördes. Resultat: Vård i livets slutskede krävde teamarbete där både vårdpersonal, patient och närstående ingår. Sjuksköterskans roll innefattade ett professionellt förhållningssätt där patient och närstående inkluderades som en helhet. Resultatet visade betydelsen av sjuksköterskans närvaro och lyhördhet i omvårdnaden men beskrev även vikten av att bevara en balans mellan närvaro och distans. Sjuksköterskans upplevelser innefattade både positiva och negativa upplevelser, vilket påverkade sjuksköterskan både i privat- och arbetslivet. Tidsbrist och otillräcklig kunskap upplevdes som hinder för att uppnå god vård. Vård i livets slutskede upplevdes även som unikt och ett privilegium som gav sjuksköterskorna en personlig utveckling. Semistrukturerade intervjuer förekom i 6 artiklar och resterande 7 artiklar använde ostrukturerade intervjuer. Slutsats: Sjuksköterskans roll innefattar flera element och för att utöva god omvårdnad vid vård i livets slutskede krävs ett professionellt förhållningssätt. Vård i livets slutskede ger sjuksköterskan både positiva och negativa upplevelser. Vald datainsamlingsmetod i de inkluderade artiklarna ger djupare förståelse för det fenomen som studeras. / Aim: To describe the nurse's role and experiences of end-of-life care.The aim was also to value which significance data collection method have for the included articles. Method: Descriptive study based on 13 scientific articles which were searched in the databases Cinahl and PubMed through the University of Gävle. Methodological examinations of the included articles data collection method were performed. Results: End-of-life care required teamwork where healthcare professionals, patients and families are included. Nurse's role comprised a professional approach in which the dying patient and relatives were included as a whole. The results showed the importance of the nurse's presence and responsiveness of care but also described the importance of maintaining a balance between presence and distance. Nurses' experiences included both positive and negative experiences, which affected the nurse both in private and professional life. Lack of time and knowledge were experienced by nurses as barriers to achieve good care. End-of-life care was perceived also as unique and a privilege that gave nurses a personal development. Semistructured interviews occurred in 6 articles and the remaining 7 articles used unstructured interviews. Conclusion: Nurses role includes several elements and to practice good care in end-of-life care requires a professional approach. End-of-life care give nurses both positive and negative experiences. Selected data collection method in the included articles provides a deeper understanding of the phenomenon being studied.

Darbo tikslas - išanalizuoti bendruomenės slaugytojų vaidmenį teikiant paliatyviosios priežiūros paslaugas. Darbo uždaviniai: 1. ištirti bendruomenės slaugytojų požiūrį į jų dalyvavimą nepagydoma liga sunkiai sergančių ligonių priežiūroje; 2. ištirti bendruomenės slaugytojų vaidmenį nepagydoma liga sunkiai sergančio ligonio priežiūroje; 3. ištirti bendruomenės slaugytojų vaidmenį teikiant paramą šeimai nepagydoma liga sunkiai sergančio artimojo priežiūros metu ir netekties atvejais; 4. išsiaiškinti priežastis, turinčias įtaką paliatyviosios pagalbos paslaugų teikimui Lietuvoje. Tyrimo metodika: tyrimas atliktas vienkartinės anoniminės apklausos būdu Kauno miesto atsitiktinės atrankos būdu parinktose 2 pirminės sveikatos priežiūros įstaigose 2008 m. kovo mėnesį. Tyrimo objektas – bendruomenės slaugytojų vaidmuo teikiant paliatyviosios priežiūros paslaugas nepagydoma liga sunkiai sergantiesiems ir jų artimiesiems priežiūros metu ir netekties atveju. Tyrime dalyvavo 64 bendruomenės slaugytojos. Naudota anoniminė anketa, sudaryta pagal literatūros analizę. Tyrimo išvados: 1. Slaugytojų požiūris į dalyvavimo nepagydoma liga sunkiai sergančių ligonių priežiūroje svarbumą priklauso nuo jų pasitenkinimo atliekamu vaidmeniu (p<0,05), tuo tarpu slaugytojų vaidmens lūkesčių atitikimas atliekamo darbo svarbai įtakos neturi (p>0,05). 2. Ištyrus bendruomenės slaugytojų vaidmenį nepagydoma liga sunkiai sergančio ligonio priežiūroje, nustatyta, kad bendruomenės slaugytoja dažniausiai... [toliau žr. visą tekstą] / Aim of study: to traverse community nurses role in lending palliative care assistance. Objectives: 1. To explore attitude of community nurses to rendering palliative care assistance. 2. To explore community nurses role in terminal ill patients care 3. To explore community nurses role in rendering family support during terminal ill patients care and bereavement 4. To find out a factors that have hold on rendering palliative care assistance by community nurses. Methods: the research was performed in the way of onetime anonymous questionnaire at Kaunas primary health institutions, in the march, 2006. The object of research – the community nurses role in rendering palliative care assistance to terminal ill patients and their family providing care and in bereavement. There were 64 community nurses. An anonymous questionnaire was used, which was developed according to literature analysis. Conclusions: 1. The community nurses attitude to importance of participation in terminal ill patient’s care is under influence of satisfaction with job (p<0,05) and is not under influence of nurses expectation of role (p>0,05). 2. After exploring community nurses role in terminal ill patient care, it was set, that nurses render palliative care assistance in a team in large part as family doctors assistant, also as health educator, consultant, render of health care assistance, while leading role is not prevalent. 3. After exploring community nurses role in lending support to terminal ill... [to full text]

Thesis (M.S.)--University of Michigan, 1981.

Thesis (M.S.)--University of Michigan, 1981.

O presente estudo teve como objetivos: identificar o significado de Enfermeira Obstétrica para as usuárias; analisar os significados atribuídos à Enfermeira Obstétrica pelas usuárias; e, desenvolver um modelo teórico explicativo da construção do significado de Enfermeira Obstétrica sob a ótica das usuárias. Trata-se de uma pesquisa descritiva com abordagem qualitativa interpretada pelo Interacionismo Simbólico, como referencial teórico e, tendo a Grounded Theory, como referencial metodológico. Foram participantes da pesquisa, 20 (vinte) usuárias atendidas por Enfermeiras Obstétricas em diversos cenários de cuidado, tais como: domicílio, Unidades Básicas de Saúde, Maternidades, Casas de Parto/Centros de Parto Normal de diversos municípios do Estado do Rio de Janeiro - durante o pré-natal, trabalho de parto e parto. A coleta dos dados ocorreu entre setembro de 2012 e julho de 2014, após este projeto ter sido aprovado pelo Comitê de Ética em Pesquisa da Universidade do Estado do Rio de Janeiro/UERJ/SR2 em julho de 2012. Utilizou-se a entrevista semi-estruturada gravada, iniciada com uma questão comum: Fale-me como foi sua gestação, seu acompanhamento pré-natal e seu parto. Os resultados revelam que as usuárias chegam até as enfermeiras obstétricas porque procuram por alguém que atenda seu desejo de vivenciar uma gestação e um parto natural sem intervenções desnecessárias e com a presença de familiares, principalmente os companheiros. Fica evidente, neste estudo, que as usuárias desconhecem, até o estabelecimento da interação social, a profissional enfermeira obstétrica e chegam até elas por: indicação de amigos e/ou familiares; por indicação de outros profissionais de saúde (enfermeiras, fisioterapeutas ou médicos); ou por intermédio de grupos de mulheres nas redes sociais. Vale ressaltar que, as mulheres que optaram por serem atendidas por enfermeiras obstétricas durante o pré-natal, trabalham de parto e parto, buscaram informações sobre gestação, fisiologia do trabalho de parto, atuação e formação as enfermeiras obstétricas, direitos sexuais e reprodutivos, legislação sobre direitos dos usuários dos serviços de saúde, dentre outros, nas redes sociais; compartilharam vivências em grupos na internet e acabaram referenciando as enfermeiras obstétricas a outras mulheres. A análise comparativa dos dados identificou três categorias: Desejando vivenciar o parto natural; Procurando alguém que atenda o desejo de vivenciar o parto natural; e Encontrando e vivenciando os cuidados da Enfermeira Obstétrica. As usuárias agem em relação às Enfermeiras Obstétricas com base no significado que estas têm para ela, ou seja, apresentam como símbolos significantes para o objeto social Enfermeiras Obstétricas: aquela que presta um cuidado concreto, um cuidado abstrato, um cuidado afetivo e um cuidado com conhecimento científico. Os significados retratam que o vínculo estabelecido entre as envolvidas extrapola a competência técnica e ratificam que, a necessidade de vínculo pessoal é imprescindível para que o cuidado humanizado aconteça. / This study aimed to: identify the meaning of Obstetric Nurse for users; analyze the meanings attributed to Obstetric Nurse by users; develop a theoretical model to explain the construction of the Obstetric Nurse meaning from the perspective of users. This is a descriptive qualitative research performed by the Symbolic Interactionism as a theoretical framework, and had the Grounded Theory as a methodological reference. Were participants, twenty (20) users assisted by Nurses Obstetric care in various scenarios such as: home, Basic Health Units, Maternity, Childbirth Homes / Normal Delivery Centers of several municipalities in the state of Rio de Janeiro - during the prenatal, labor and delivery. Data collection took place between September 2012 and July 2014, after this project was approved by the Research Ethics Committee of the State University of Rio de Janeiro / UERJ / SR2 in July 2012. We used semi-structured taped interview, which began with a common question: "Tell me about your pregnancy, your prenatal care and give birth". The results show that users come to obstetric nurses because they are looking for someone who meets their desire to experience a pregnancy and a natural childbirth without unnecessary interventions and the presence of family members, especially his companions. It is evident in this study that the users are unaware, until the establishment of social interaction, professional midwife and reaches them by: indication of friends and / or family; by indication of other health professionals (nurses, physiotherapists or doctors); or through women's groups in social networks. It is noteworthy that women who chose to be attended by midwives during prenatal care, work in labor and delivery, sought information on pregnancy, the labor physiology, performance and training obstetric nurses, sexual and reproductive rights, legislation on the rights of users of health services, among others, in social networks; shared experiences in groups on the internet and just referencing the obstetric nurses to other women. The comparative analysis of the data identified three categories: Wishing to experience natural childbirth; Looking for someone who meets the desire to experience natural childbirth; and Finding and experiencing the care of obstetric nurse. The users act in relation to obstetric nurses based on the meaning they have for her, that is, present as significant symbols for the business purpose Obstetric Nurses: one that provides a concrete care, an abstract care, an affectionate care and care with scientific knowledge. The meanings depict the relation established between the involved goes beyond the technical competence and confirm that the need for personal connection is essential for the humanized care happen.

O presente estudo teve como objetivos: identificar o significado de Enfermeira Obstétrica para as usuárias; analisar os significados atribuídos à Enfermeira Obstétrica pelas usuárias; e, desenvolver um modelo teórico explicativo da construção do significado de Enfermeira Obstétrica sob a ótica das usuárias. Trata-se de uma pesquisa descritiva com abordagem qualitativa interpretada pelo Interacionismo Simbólico, como referencial teórico e, tendo a Grounded Theory, como referencial metodológico. Foram participantes da pesquisa, 20 (vinte) usuárias atendidas por Enfermeiras Obstétricas em diversos cenários de cuidado, tais como: domicílio, Unidades Básicas de Saúde, Maternidades, Casas de Parto/Centros de Parto Normal de diversos municípios do Estado do Rio de Janeiro - durante o pré-natal, trabalho de parto e parto. A coleta dos dados ocorreu entre setembro de 2012 e julho de 2014, após este projeto ter sido aprovado pelo Comitê de Ética em Pesquisa da Universidade do Estado do Rio de Janeiro/UERJ/SR2 em julho de 2012. Utilizou-se a entrevista semi-estruturada gravada, iniciada com uma questão comum: Fale-me como foi sua gestação, seu acompanhamento pré-natal e seu parto. Os resultados revelam que as usuárias chegam até as enfermeiras obstétricas porque procuram por alguém que atenda seu desejo de vivenciar uma gestação e um parto natural sem intervenções desnecessárias e com a presença de familiares, principalmente os companheiros. Fica evidente, neste estudo, que as usuárias desconhecem, até o estabelecimento da interação social, a profissional enfermeira obstétrica e chegam até elas por: indicação de amigos e/ou familiares; por indicação de outros profissionais de saúde (enfermeiras, fisioterapeutas ou médicos); ou por intermédio de grupos de mulheres nas redes sociais. Vale ressaltar que, as mulheres que optaram por serem atendidas por enfermeiras obstétricas durante o pré-natal, trabalham de parto e parto, buscaram informações sobre gestação, fisiologia do trabalho de parto, atuação e formação as enfermeiras obstétricas, direitos sexuais e reprodutivos, legislação sobre direitos dos usuários dos serviços de saúde, dentre outros, nas redes sociais; compartilharam vivências em grupos na internet e acabaram referenciando as enfermeiras obstétricas a outras mulheres. A análise comparativa dos dados identificou três categorias: Desejando vivenciar o parto natural; Procurando alguém que atenda o desejo de vivenciar o parto natural; e Encontrando e vivenciando os cuidados da Enfermeira Obstétrica. As usuárias agem em relação às Enfermeiras Obstétricas com base no significado que estas têm para ela, ou seja, apresentam como símbolos significantes para o objeto social Enfermeiras Obstétricas: aquela que presta um cuidado concreto, um cuidado abstrato, um cuidado afetivo e um cuidado com conhecimento científico. Os significados retratam que o vínculo estabelecido entre as envolvidas extrapola a competência técnica e ratificam que, a necessidade de vínculo pessoal é imprescindível para que o cuidado humanizado aconteça. / This study aimed to: identify the meaning of Obstetric Nurse for users; analyze the meanings attributed to Obstetric Nurse by users; develop a theoretical model to explain the construction of the Obstetric Nurse meaning from the perspective of users. This is a descriptive qualitative research performed by the Symbolic Interactionism as a theoretical framework, and had the Grounded Theory as a methodological reference. Were participants, twenty (20) users assisted by Nurses Obstetric care in various scenarios such as: home, Basic Health Units, Maternity, Childbirth Homes / Normal Delivery Centers of several municipalities in the state of Rio de Janeiro - during the prenatal, labor and delivery. Data collection took place between September 2012 and July 2014, after this project was approved by the Research Ethics Committee of the State University of Rio de Janeiro / UERJ / SR2 in July 2012. We used semi-structured taped interview, which began with a common question: "Tell me about your pregnancy, your prenatal care and give birth". The results show that users come to obstetric nurses because they are looking for someone who meets their desire to experience a pregnancy and a natural childbirth without unnecessary interventions and the presence of family members, especially his companions. It is evident in this study that the users are unaware, until the establishment of social interaction, professional midwife and reaches them by: indication of friends and / or family; by indication of other health professionals (nurses, physiotherapists or doctors); or through women's groups in social networks. It is noteworthy that women who chose to be attended by midwives during prenatal care, work in labor and delivery, sought information on pregnancy, the labor physiology, performance and training obstetric nurses, sexual and reproductive rights, legislation on the rights of users of health services, among others, in social networks; shared experiences in groups on the internet and just referencing the obstetric nurses to other women. The comparative analysis of the data identified three categories: Wishing to experience natural childbirth; Looking for someone who meets the desire to experience natural childbirth; and Finding and experiencing the care of obstetric nurse. The users act in relation to obstetric nurses based on the meaning they have for her, that is, present as significant symbols for the business purpose Obstetric Nurses: one that provides a concrete care, an abstract care, an affectionate care and care with scientific knowledge. The meanings depict the relation established between the involved goes beyond the technical competence and confirm that the need for personal connection is essential for the humanized care happen.

Bakgrund: Den palliativa vården innebär i helhet att behandla patienten ur ett holistiskt perspektiv, där patientens olika värden respekteras och inkluderas. Enligt de allmänna lagar och förordningar om palliativ vård finns det övergripande mål för att minska patientens lidande och främja livskvaliteten. Genom att öka den palliativa vårdförståelsen för vårdpersonalen kan detta leda till att patienterna som befinner sig i livets slutskede upplever självständighet och främjad livskvaliteten vilket är en mycket viktig och effektiv aspekt för att uppnå en värdig död. Syfte: Syftet med denna litteraturöversikt var att beskriva sjuksköterskors och patienters perspektiv på autonomi inom palliativ vård. Metod: En litteraturöversikt enligt Friberg metod. Datasökning efter original artiklar gjordes i CINAHL Complete, PubMed och PsycINFO. Elva studier; "Fyra kvantitativa och sju kvalitativa" undersöktes för att stödja resultaten av denna litteraturöversikt. Resultat: Författarna identifierade två huvudteman som var sjuksköterskans stödjande roll, och patientens upplevelse av autonomi. Teman indikerade att sjuksköterskornas förhållningssätt gentemot patienterna speglade patienternas upplevelse av autonomi i palliativ vård. Diskussion: Patienter upplevde en brist på kommunikation som hade avgörande konsekvenser för patientens upplevelse av autonomi och ökad livskvalitet. Enligt Katie Eriksson kan sjuksköterskan lindra patientens lidande genom att stödja patienterna i sin egen tro, konversation, uppmuntran, tröst, ärlig och uppfyller önskningarna. I motsats till hämmande åtgärder från vårdpersonal var det även främjande åtgärder som relaterade till den värdiga döden och god palliativ vård. / Background: The palliative care means in entireness to treat the patient from a holistic perspective where the different values of the patient are respected and included. According to the palliative care general laws and regulations there are overall intentions; reducing the patient suffering and promoting the quality of live. Raising the palliative care understanding for the healthcare professionals help to lead the patients in the final stage of life to experience the extraordinary degree of autonomy and promoting the quality of life which is a very important and effective aspect that achieve the worthy death. Aim: The aim of this literature review was to describe nurses and patient’s perspectives of autonomy in palliative care. Method: A literature review according to Friberg method. Data search for original articles was made in CINAHL Complete, PubMed and PsycINFO databases. Eleven studies; “four quantitative and seven qualitative” were investigated to support the outcomes of this literature review. Results: The selected studies were divided into two main themes, the nurse's supporting role and the patient's experience of autonomy. The whole studies finds of both themes indicate the nurses’ behaviours and roles to deal with the patients as the main features for promoting the patients autonomy in palliative cares. Discussion: Patients experienced a lack of communication that had decisive consequences for the patient's experience of autonomy and increased quality of life. According to Katie Eriksson, the nurse can relieve the patient's suffering by supporting the patients in their own faith, converse, encouragement, comfort, being honest and fulfilling the desires. In contrast to inhibitory measures from healthcare professionals, there were also promotional measures that’s related to the worthy death and good palliative care.

Bakgrund: Anmälningarna av barnmisshandel har ökat på sistone och hälsovårdspersonal har som plikt att anmäla vid misstanke av barnmisshandel till Socialtjänsten. Det finns många riskfaktorer relaterade till om ett barn kommer att bli misshandlade eller inte, både kring förövarna men även riskfaktorer kring barnet. Statistisk sett är majoriteten av förövarna föräldrarna till barnet.   Syfte: Att beskriva sjuksköterskans erfarenheter av barnmisshandel inom Hälso- och Sjukvården samt vidare beskriva en metodologisk ansats valda artiklar använt sig av. Metod: Beskrivande litteraturstudie utifrån nio kvalitativa och tre kvantitativa artiklar där medverkande sjuksköterskor haft erfarenhet av barn som utsatts misshandel.   Resultat: Det framkom att sjuksköterskans erfarenhet av sin egna förmåga, känslor, stöd och omgivning påverkar hur och om anmälningen av barnmisshandel genomförs. Trots att sjuksköterskor i studierna var medvetna om anmälningsplikten var det en del sjuksköterskor som inte anmälde vid misstanke om barnmisshandel. Sjuksköterskorna erfors även av många olika känslor när de var inblandad i barnmisshandelsfall, samt att samtliga sjuksköterskor i studien erfor att de saknade kunskap av barnmisshandel och många önskade att de haft mer stöd när det kom till våld mot barn.   Slutsats: Erfarenheten av barnmisshandelsfall tog hårt på sjuksköterskorna till den grad att vissa ignorerade tecknen och undvek att anmäla till Socialtjänsten. Sjuksköterskorna erfor att de behövde mer stöd från en erfaren kollega men även att de behövde mer kunskap och erfarenhet. / Background:  Reports of child abuse have increased recently and healthcare staff are obligated by law to report any possible suspicion of child maltreatment to the Social Services. There are a lot of risk factors involved concerning whether a child will be abused or not, factors related to the perpetrators but also factors related to the child itself. Statistically the majority of perpetrators are the child's own parents. Aim: To describe the registered nurses experiences of child abuse within healthcare and also to describe one methodological aspect of the articles that this study is based upon.   Method: A descriptive literature review based on nine qualitative and three quantitative articles, where the participating registered nurses have experience of children that have been abused. Results: It was found that the nurse’s own personal experiences, based upon their own feelings, the support they received and the actual environment affects how and indeed if child abuse will be reported. Although the registered nurses were aware that they are obliged to report all cases, some nurses failed to report child abuse to the Social Services. The nurses experienced a variety of emotions that arose when they were involved in child abuse cases. All nurses in this study experienced that they lacked knowledge concerning child abuse also a lot of nurses wished that they had had more support during child abuse cases. Conclusion: The experience of child abuse cases severely affected the nurses even to the extent that some ignored the signs and failed to report to the Social Services. The registered nurses experienced a need for more support from an experienced colleague and wanted to attain more knowledge and experience themselves.