Background: Palliative care is required for patients who have no chance of curative treatment. The age group 65 and older is a growing population. Palliative care for the elderly was uniquely challenging and differed from palliative care for younger patients. Palliative care for the elderly was not about prolonging life, it was about making the last phase of life as comfortable as possible. Aim: The aim was to describe nurses’ experiences of working with palliative care of the elderly. Method: A literature-basedstudy was conducted. Seven articles were analyzed according to Friberg’s five-stepmodel. Results: Three main themes emerged: feelings of insufficiency, working with aperson-centered approach and collegial cooperation. Seven sub-themes were identified: insufficiency in supporting relatives, insufficiency in giving satisfactory palliative care, a caring relationship, working for the patient’s best interest, the nurse’s need of support, lack of cooperation with physician and the nurse’s supportive role. Conclusion: when nurses were caring for the dying elderly, nurses were in need of more support. / Arbete som sker i närvaro av döden kan vara utmanande och innebär att ställas inför svåra situationer. Palliativ vård erbjuds till människor som är i livets slut samt där botande behandling inte längre är möjligt. Fokus för vården är då istället att lindra patientens lidande och främja patientens livskvalitet. Detta litteraturbaserade examensarbete beskriver sjuksköterskors upplevelser av arbetet inom palliativ vård av äldre. Det föreligger anledning att beskriva sjuksköterskors upplevelser av arbetet inom palliativvård av äldre eftersom åldersgruppen 65 år och äldre är en växande population som dessutom klassas som sårbar. Sjuksköterskor upplevde arbetet inom palliativ vård av äldre som känslomässigt utmanande med situationer som kantats av otillräcklighet, bristande samarbete och frånvaro av stöd. Trots detta belyste sjuksköterskor vikten av att arbeta utifrån ett personcentrerat förhållningssätt genom att skapa en vårdande relation med patienten och arbeta för patientens bästa. För att kunna bedriva en god palliativ vård för äldre är det viktigt att sjuksköterskor ges möjlighet till stöd för att minska känslan av otillräcklighet och för att hantera psykiska påfrestningar.

Bakgrund: I Sverige är dödshjälp inte lagligt men ämnet debatteras utifrån olika synsätt samt etiska aspekter. Sjukvårdspersonalens uppgift är att vårda patienter genom att lindra, trösta samt bota men om patienten inte längre vill leva samt efterfrågar dödshjälp ställs sjuksköterskan inför en utmaning. All vård skall bygga på en respekt för patientens autonomi enligt lag. Syfte: Syftet är att beskriva sjukvårdspersonalens upplevelser samt erfarenheter kring dödshjälp inom palliativ vård. Metod: En litteraturöversikt gjordes enligt Fribergs (2017) metod. De databaser författarna använde inför sökningen av vetenskapliga artiklar var följande: CINAHL Complete, PsycINFO samt PubMed . I arbetet inkluderades tio stycken kvalitativa, då författarna bedömde dessa svara på syftet. De utvalda artiklarna analyserades med hjälp av Fribergs analysmetod. Resultat: Författarna kunde identifiera tre teman genom sina valda artiklar. Sjukvårdspersonalens upplevelser samt erfarenheter av dödshjälp. Sjukvårdspersonalens teamwork. Sjukvårdspersonalens relation med patienten. Diskussion: Resultatdiskussionen delades in i tre delar, “Sjukvårdspersonalens upplevelser samt erfarenheter kring dödshjälp”, “Sjukvårdspersonalens teamwork inom dödshjälp” samt “Sjukvårdspersonalens relation med patienten”. Samt en metoddiskussion om styrkor samt svagheter om arbetets gång. / Background: In Sweden euthanasia isn't legal but the subject is still debated from different points of views and ethicals aspects. Health care professionals primary mission is to take care of patients by lindering and cure diseases. However if the patient no longer wants to live and asks for euthanasia the nurse is put in front of a challenge. All of the health care shall be built on respect for the patient's autonomy according to law. Aim: The purpose is to describe the healthcare professional’s experiences about euthanasia in palliative care. Method: A literature review was done according to Friberg's (2017) method. The databases the authors used for the search of scientific articles were as follows: CINAHL Complete, PsycINFO and PubMed. The work included ten qualitative articles, the authors assessed these to respond to the purpose of the study. The selected articles were analyzed using Friberg's method of analysis. Results: The authors was able to identify three themes through their selected articles. healthcare professional’s experience and experiences of euthanasia. Healthcare professionals teamwork. And the healthcare professionals relationship with the patients. Discussion: The discussion about the results was, divided into three parts, "Health care professional´s experience and experiences regarding euthanasia", “Health care professional´s teamwork within euthanasia” and "Health care professional´s relationship with the patient". We also did a method discussion about strengths and weaknesses of the process.

Background: Every year, 480 families in Sweden are informed that their child is diagnosed with an incurable disease. Everyone involved is affected by the death of a child. When a familymember becomes incurably ill it affects the entire family. The family's commitment is vital in pediatric care, as the family is the child's greatest source of security. It is of great importance that the nurse who works in palliative care, has to be person oriented and family centered to meet the needs of the whole family. Aim: The aim of this study was to highlight parents’ experiences of having a child in palliative care. Method: A literature study based on 11 qualitative articles is performed. The analysis of these articles resulted in three main themes and seven sub themes. Results: Parents wanted, as far as possible, to be involved in their child’s care. They perceived a high quality of care when the care was provided with continuity and when a trustful relationship was created. A sense of security was experienced when the staff were compassionate and were able to take care of the whole family. The family also strived for a sense of normality in family life. Conclusion: Parents experienced that they were in an increased need of support from healthcare both during the palliative process but also after death. It was supportive and appreciated when the nurse encouraged the parents to take a more active role in their child’s care. / Syftet med detta examensarbete var att belysa föräldrars erfarenheter av vård av sitt palliativt sjuka barn. Barn som drabbas av en obotlig sjukdom och är i behov av vård som inte längre har ett botande syfte uppgår till en procent av den palliativa vården i Sverige. Palliativ vård av barn syftar till en vård som skall lindra symtom och skapa bästa möjliga förutsättningar för en god livskvalitet för barnet med en livsavgörande sjukdom. I examensarbetes resultat påvisades att familjen var betydelsefull och väsentlig i vården av det sjuka barnet och skulle ses som en enhet. Föräldrarna till ett döende barn gick igenom en känslomässig berg- och dalbana där känslor pendlade stundvis av optimism, hopp och perioder av ångest, skuld, stress, förlust och sorg upplevdes dagligen. Att ett barn dör är onaturligt och alla involverade påverkas av den betungande situationen. Sjuksköterskan möter ofta svårigheter i att stödja familjerna i sjukdomsprocessen av det sjuka barnet. Sorgen och kampen familjen går igenom i samband med deras barns sjukdomsprocess var genomgående i resultatet. Föräldrar beskrev sina erfarenheter av livet med det sjuka barnet som utmattande både fysiskt och psykiskt. Känslomässiga behov som föräldrarna upplevde var att känna tillit till och delaktighet i vården relaterat till barnets behandling och omvårdnadsåtgärder. Detta var faktorer som ledde till en ökad trygghet för familjen. Föräldrarna känner sitt barn bäst och har det fulla ansvaret för barnet och det var därför av yttersta vikt att sjuksköterskan hade förståelse för hur stöd och kommunikation kunde påverka föräldrarna till att fortsätta känna hopp och mening i en påfrestande livssituation. För att kunna belysa föräldrars erfarenheter har en kvalitativ litteraturstudie utförts i detta examensarbete där resultatet av 11 vetenskapliga artiklar har analyserats och nyckelfynden har skapat tre teman och sju underteman. Litteraturstudien beskriver två vårdvetenskapliga begrepp, lidande och hälsa, som är centrala i omvårdnad och är relevanta för syftet. I examensarbetes diskussionsdel lyfts diskussioner kring sjuksköterskans funktion i lindrandet av föräldrars lidande kring den förväntade och upplevda förlusten av sitt barn. Hinder som kan uppstå och förhindra att föräldrars förväntningar uppfylls, könsnormer och social hållbarhet lyfts också. Diskussionen behandlar begreppen familjecentrerad vård, hälsa och lidande som genomsyrar studien.

UNIVERZITA KARLOVA V PRAZE FAKULTA SOCIÁLNÍCH VĚD Institut sociologických studií Katedra veřejné a sociální politiky Zdeňka Zatloukalová Paliativní péče v České republice Diplomová práce Praha 2012 Diplomová práce Název práce 4 SUMMARY The master thesis "The palliative care in the Czech Republic" is focused on the reflection of the current situation of the problem which is defined as an insufficient capacity of the specialized palliative care. A mere fraction of dying (2,7 %) receives a specialized palliative care in the Czech Republic. Only 7,5 % of cancer patients are provided with the specialized palliative care. (Sláma, 2008) Specialized palliative care has different forms. It is hospice palliative care, special palliative care in the hospital facilities or consulting teams in the hospitals. The hospice palliative care is provided in the form of the inpatient hospice, home palliative care and day care canters. In the practical part of the thesis I focused on the analysis of the state of care through the statistical data obtained mainly from the Czech Statistical Office and the Institute of Health Information and Statistics of the Czech Republic. For the comparison with other countries I used the researches Palliative care in the European Union, 2008 and Economist Inteligence Unit, 2010. The annual...

Itch/pruritus can be very distressing in palliative care population and often is difficult to treat. Conventional antihistamines lack efficacy. Cutaneous and central pathogenesis of itch is extremely complex and unclear, making its treatment challenging. Neuronal mechanisms have been identified in the pathophysiology of itch hence providing a myriad of therapeutic options. It has been established that pruritus and pain neuronal pathway interact with each other, hence neuropathic analgesics like gabapentin has shown to be efficacious antipruritic therapeutic option. Gabapentin impedes transmitting nociceptive sensations to brain, thus also suppressing pruritus. Gabapentin is safe and found to be effective in uremic pruritus, cancer/hematologic causes, opiod-induced itch, brachioradial pruritis, burns pruritus, and pruritus of unknown origin. Further research is required in this area to establish whether gabapentin is consistently effective.

Itch/pruritus can be very distressing in palliative care population and often is difficult to treat. Conventional antihistamines lack efficacy. Cutaneous and central pathogenesis of itch is extremely complex and unclear, making its treatment challenging. Neuronal mechanisms have been identified in the pathophysiology of itch hence providing a myriad of therapeutic options. It has been established that pruritus and pain neuronal pathway interact with each other, hence neuropathic analgesics like gabapentin has shown to be efficacious antipruritic therapeutic option. Gabapentin impedes transmitting nociceptive sensations to brain, thus also suppressing pruritus. Gabapentin is safe and found to be effective in uremic pruritus, cancer/hematologic causes, opiod-induced itch, brachioradial pruritis, burns pruritus, and pruritus of unknown origin. Further research is required in this area to establish whether gabapentin is consistently effective.

Purpose: To explore the decision-making experiences of and the supports provided to the parents of children with life-limiting conditions. Qualitative Study: A qualitative interpretive description study guided by the Ottawa Decision Support Framework was conducted. Interviews with parents and healthcare professionals revealed that parents made difficult healthcare decisions for their child and were prone to experiencing decisional conflict. Participants described a need for interprofessional support, guided decision support, and a preference for formal and informal support networks. Scoping Review: A scoping review was conducted. The three eligible studies revealed that parents require early and timely decision support provided by an interprofessional team of healthcare professionals and aided by a structured decision support intervention. Conclusions: Decisions made by parents of children with life-limiting conditions are complex. Healthcare professionals are required to facilitate appropriate decision support interventions for parents including a parent based support network.

Palliative care has become an integral part of healthcare throughout the United States. The goals of this discipline are focused on improving patient quality of life during times of illness. These goals are universal throughout medicine and apply to all practicing providers. An interdisciplinary council developed core competencies for this discipline which includes pain assessment and management as a key component. Throughout healthcare, the assessment and management of pain continues to be a challenge for providers. A review of the literature has demonstrated that untreated pain has become an increasing burden on the patient population. Many providers feel training during their medical education is insufficient and they entered the workforce unprepared. An evaluation of current standards put forth by educational governing bodies has shown the regulations regarding palliative care, pain assessment in particular, to be scattered and non-specific. It is apparent a more concise curriculum, dedicated to palliative care and pain assessment is needed for all future medical providers to hone the essential tools needed to properly evaluate and treat pain. The proposed intervention consists of an educational module which combines a didactic session and student role playing module focused on pain assessment. This intervention will focus on Physician Assistant students in particular, as this profession will continue to play a large role in healthcare. Didactic sessions focused on pain assessment, a core competency of palliative care, will be presented to the students. A role playing exercise following these didactics will allow students to practice such pain assessment skills and also explore what it may be like to be a patient in pain and provide them with insight on the importance of adequately assessing related symptoms. The current model of education regarding palliative care has proven to be ineffective, especially regarding pain assessment. A more concise, dedicated module for this essential skill is needed for students to become more efficient, effective providers. With the ability to assess patients more effectively, providers will be able to manage patients’ pain and decrease the burden untreated pain has put on the population as a whole.

Palliative care (PC) is the comprehensive management of patients diagnosed with terminal illness. Care for PC patients focuses on relieving symptoms. The purpose of this study was to determine the difference between pretest and posttest scores on the Frommelt Attitude towards the Care of the Dying (FATCOD) and the Palliative Care Quiz for Nurses (PCQN) after an educational intervention to emergency department (ED) nurses. The framework for this project was Bandura's social cognitive theory. The FATCOD was used to assess ED nurses' attitudes toward PC, and the PCQN was used to assess ED nurses' knowledge about PC prior to the educational program. The educational intervention was developed using evidence obtained from the literature review and guided by the PCQN. The program presented to the ED nurses covered the essentials of palliative care and the information and skills needed by the ED nurse caring for the PC patient. The FATCOD and the PCQN were then administered as a posttest. A total of 70 nurses from two ED units volunteered to take part in the project. Results of the PCQN pre- and posttest showed a significant difference (p < .05), and the FATCOD pre- and posttest showed no significant difference (p = .849). The results revealed that education significantly improved knowledge of PC for the ED nurses participating in the project. Attitudes about PC were not significantly changed after the education program. The project promotes positive social change by raising awareness of the need for PC educational opportunities for ED nurses. By improving PC in the ED, patients and their families may experience increased satisfaction with end-of-life care and improved quality of life.

Incidence of incurable disease and disability has been increasing in the Western world in recent years. Parallel to this increase, survival rates for adolescents and young adults with life threatening illness, specifically cancer, have not improved relative to younger and older age groups. Palliative care is a total care for patients, regardless the type and status of the illness, and aims to improve quality of life by controlling symptoms and alleviating physical social, psychological and spiritual suffering. The varying level of physical, emotional and psychological maturity makes palliative and supportive care needs of adolescents distinct and challenging.  In this systematic review, the aim was to describe the experiences of palliative and supportive care for adolescents with life threatening illness, from the perspectives of adolescents, family and nurses as providers of palliative and supportive care.  A systematic review of descriptive meta-synthesis was the appropriate method of choice concerning the aims focus on subjective experiences of palliative and supportive care for adolescents. PubMed and CINAHL were the two databases used for data sources of qualitative published articles between the years of 2006-2016.  A total of 1066 qualitative published articles were identified, but only 16 articles have met the inclusion criteria. Nine articles were focusing on adolescents’ experiences, whereas five articles were focusing on families’ experiences and the remaining two were on the nurses’ experiences in providing palliative and supportive care to adolescents. A total of eleven themes have emerged. Four themes were from adolescent’s perspective: preserving self or identity, social support, acceptance and feeling positive and care setting. Another four themes were on family’s perspective: social support, information and decision making, care setting and perception of self-image. Whereas the remaining three themes were on nurse’s perspective: importance of family dynamics, reaching out to adolescents, balancing professional and personal involvement.  In conclusion this systematic review meta-synthesis showed that social support, specifically peer’s support had an impact in enhancing coping with the altered body image and ordinary daily social activities of adolescents due to life threatening illnesses and their treatment. Nurses have a key professional role in facilitating the social network of social support to promote quality of life by maintaining the need for normality.