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This research focused on the life situation of older people, who had moved to a nursing home at the end of life, from the perspectives of the older people themselves, care managers and nursing staff. The thesis is based on an analysis of 446 care manager assessments and decisions, interviews with seven care managers, six older people and 28 nursing staff. The main fi ndings are: (I); that there was a statistically signifi cantly shorter waiting time for a move to a nursing home for older people who were in hospital compared to those who were living in their own home at the time of the decision. Seventy percent of the decisions made by care managers’ concerned women. The waiting period for men was fi ve days shorter compared to women. (II); that the care managers’ descriptions revealed that their assessments of the needs and wishes of the older people were infl uenced by whether or not it was clear that the older person had only a limited time left to live. The care managers’ way of reasoning has been conceptualised as two approaches, the medical and the natural path to death, where the former was characterised as fl exible and collaborative, whereas the latter was governed to a greater extent by a “wait and see attitude”. (III); that the older people’s experiences of living in a nursing home have been conceptualised into three themes: feeling like a stranger in an unfamiliar culture, being excluded from life, and living while waiting for death. The latter involved a deep insight that life would soon come to an end; a fact the staff appeared to take into account to only a minor extent. (IV); that dying and death was characterised by a discourse of silence, with tension between avoidance of and a confrontation with death. Staff members who expressed a fear of death held it at a distance by concentrating on practical tasks and avoiding close contact with older people who were dying. The thesis highlights the fact that the dying and death of older persons was characterised by a discourse of silence and several transitions. Death was not a topic that the staff members or older people generally talked about, and care in the fi nal phase of life was not actively or explicitly planned. In terms of access to a nursing home bed, only older people with an extensive need for care obtained such a place. These fi ndings imply that all older people can be said to be in need of palliative care. The older people in our study were in a liminal phase, and waiting for death. Feelings of social and existential loneliness and that their living space was shrinking were evident. It was also clear that the older people and staff members inhabit the same place but appear to be in two different sub-cultures, where the norms and values that guided the staff members’ attitudes were dominant. Keywords: transition, older people, end of life care, palliative care, nursing home, caring, care manager and staff

The overall aim of this thesis was to study how family members, next of kin, and healthcare professionals construct and use knowledge in nursing praxis in human boundarysituations.The study was carried out on a surgical ward at a university hospital in Sweden.Methodology: Study I: A case study; data concerning a family with six familymembers were collected over 10 months using interviews, conversations, and diary notations.Study II: A hermeneutic approach; interviews with 27 family carers were conductedsix to eight months after a family member’s death. Studies III, IV: a combinedethnographic and hermeneutic approach; participant observations (285 hours), informalconversations (190), and interviews (25) were conducted with 25 nurses and 18 assistant nurses. The main findings were: (I) The family members used beliefs to explain and understandcancer, dying and death. The beliefs were aggregated into eight main beliefs and fourthemes: cancer is a deadly threat/death is a liberator; death can be held at bay/death canbe lived near; dying is done alone/dying should not be done alone; and life has anend/life is endless. These beliefs appear to oscillate between seemingly contrastingpoles. (II) The family carers made their own assessment of their loved one’s conditionand situation. Their actions were characterized by struggling to get treatment, being leftbehind, being partners, keeping the illness at a distance, hovering beside their loved one,waiting for death, and being experts and protectors. The family carers used practicalwisdom, phronesis, regarding what care was the best, or least harmful, for their lovedone in the encounter with professional care. (III) The nurses constructed knowledgethrough greeting the patient, and reading the patient. By being sensitive, using humor,and emotional involvement, understanding was deepened. By being suspicious and selfcritical,interaction was sought with nurse colleagues, the patient, relatives, and the doctor,and additional knowledge was obtained. They strived to be one step ahead in theirefforts to attain an understanding of the patient´s situation. The knowledge nurses makeuse of can be related to the intertwined and embodied forms of theoretical knowledge,i.e., episteme, practical professional knowledge, i.e., techne, and practical wisdom i.e.,phronesis. (IV) The nurses created and used emotional knowing that could be interpretedin relation to various rooms of emotions, thoughts and actions. They strived to dothings correctly in the normative room; created a safe, secure milieu for patients andnext of kin in the safety-security room; and questioned their actions in the critical room.They created an affinity for co-operation that was of benefit in encounters with patientsin the nurses’ affinity room. And they demonstrated compassion for patients and next ofkin; this compassion was particularly evident in the closeness room.Conclusion: In praxis, construction and use of knowledge occurs that often takes placebehind the routines. This knowledge constitutes an important content in nursing. Thehermeneutic spiral can serve a pedagogic purpose in elucidating nursing and its differentforms of knowledge.

People with a long-term illness and their close relatives regard encounters as the foundation of their relationshipwith the district nurses within the primary healthcare setting. The overall aim of this doctoral thesis was todescribe and elucidate the experiences of encounters for people with long-term illness, their close relatives anddistrict nurses within a primary healthcare setting. From the overall aim, specific aims were formulated asfollows: to describe district nurses’ views on quality of healthcare encounters in primary healthcare (I), toelucidate meanings of encounters for patients with long-term illness within the primary healthcare setting (II), toelucidate meanings of encounters for close relatives of people with a long-term illness within a primaryhealthcare setting (III) and to describe the experiences of dignity encounters from the perspective of people withlong-term illness and their close relatives within a primary healthcare setting (IV). Data were collected fromfocus group interviews (I), narrative interviews (II, III), and semi-structured interviews (IV). The interviewswere analysed using thematic content analysis (I, IV) and phenomenological hermeneutics (II, III). The findingsshow that encounters are given great importance among people who have a long-term illness, their closerelatives, and district nurses in the setting of primary healthcare. The manner in which the encounter wasexperienced in the relationship with healthcare personnel was, at many times, crucial for the whole careexperience to be viewed as beneficial or not. The findings show that district nurses described that the encountersformed the basis of their work as an important aspect and that many times they were difficult because of stressand lack of time. The first meeting with the patient was important since it was unique and unrepeatable. Districtnurses considered themselves as being the patients ‘advocate’ who helped them and protected their interests.They indicated the importance of confirming the patient as a person deserving of respect, and if a meeting turnedout poorly, it was their duty to give the patient an apology (I). The findings also show that patients with a longtermillness experienced that good encounters had health-promoting effects on their health and recovery. Patientsfelt well when they were welcomed as a person with respect, interest, and attention by the healthcare personnel.They wanted to participate in their own care by receiving regular information and follow-up dialogues abouttheir status with the healthcare personnel. Continuity with the healthcare personnel laid the foundation for apersonal and a trustful relationship (II). Close relatives of people with a long-term illness wanted to beencountered as part of the ill person’s family as they accompanied him or her to the healthcare centre. To beconfirmed as a family was important, as it gave meaning to their lives and strengthened their well-being. A goodencounter was characterised by aspects of being involved in the care of the ill person and being respected as avaluable person (III). The findings show that people with a long-term illness and their close relatives experienceddignity in the encounter when they had access to care. They experienced that it was important to be encounteredwith dignity, as it meant receiving help with their needs from the healthcare personnel. To be confirmed by beingseen and listened to was important. When the couples experienced dignity in the encounter, they felt satisfiedwith the care they received. To be encountered with dignity made they feel valuable; this facilitated their healthand well-being, and it contributed to a good impression of the healthcare personnel within primary healthcare(IV). In conclusion, the findings of this thesis show that healthcare encounters are more than just meetings; theyalso mean being confirmed as a human being by being treated with respect, engagement and dignity. Healthcarepersonnel should promote encounters for people with long-term illness and their close relatives in order tosupport their feelings of being regarded as persons and to feel that they are welcomed to primary healthcare withtheir needs, which can empower their health and well-being.