Communication is central to palliative care. It unifies all nursing practice, and plays an integral role in the operationalization of palliative care. To deliver quality palliative care, it is paramount that nurses have adequate communication skills. Positive patient outcomes are derived when communication between the nurse and patient is effective. Ineffective communication may result in inaccurate information on treatment/medication increase patient risks and may cause patient dissatisfaction with care. It is therefore necessary to be familiar with the facilitators and barriers that influence communication. This study aimed to describe barriers and facilitators of effective communication between nurses and patients receiving palliative care. A literature review of fifteen articles was utilized to answer the study’s aim. Searching the CINAHL Complete and MEDLINE databases performed data collection. Data was analyzed using the matrix method. The findings were categorized into two main themes: barriers of effective communication and facilitators of effective communication. Three subthemes emerged under the barriers of effective communication and two sub themes for the facilitators. The main barrier to effective communication was the nurse’s lack of knowledge and skills. In conclusion, the nurse-patient interaction is compounded by variables such as: nurses’ competence, patient’s attributes and environmental or care setting. All together these factors require the nurse’s ability to overcome the communication barriers and highlight the facilitators. It would be of benefit if nurses receive training in communication skills in palliative care with emphasis on transitions and how to handle them within the palliative care scope.

According to the WHO cancer is one of the leading causes of morbidity and mortality in the world. In 2012 there was 14 million of new cases worldwide. A number of new cases is expected to rise in future. An increasing number of cases demanding a new approach from health care systems regarding the staff education, hospital equipment and interprofessional cooperation in order to give full service to the customers (patients). For several years palliative care education is a top priority in the education of nurses due to the fact that there are serious deficiencies in that area (Komaromy et al. 2000, Miller et al. 2004, Goodridge et al. 2005, Hasson et al. 2008). Nurses are the forefront of caring for terminally ill patients and their families approaching the end of life, which does not minimize role of other healthcare professionals, but nurses have main role in this process. Definition and competencies of nurses involved in this process must be precisely identified and measured from time to time in order to improve the process of end of life care and palliative care nursing. Continuous development of guidelines and protocols for palliative care nursing is particularly relevant (Watts, 2013; Gambles et al 2009, Hockey et al 2005, Jack et all 2003). Development of competencies is one of key issues in contemporary education it and can be achieved with development of proper curriculum and education schedule, especially development of a proper instrument for measurement of competencies. This research has identified most important 10 competencies in accordance with WHITE paper for EAPC and WHO. General objective. This research has one general objective and it is creation and validation of new questionnaire about competencies in field of palliative care nursing with aspect of realization of core competences in developed and under developing systems. This questionnaire is a new instrument in field of competence measurement in palliative care nursing. Specific objectives of the research are based on evaluation and comparison of competences among nurses from Bosnia and Herzegovina and Spain (Valencia area). Methodology. Methodology comprises research, cross – section, analytical method of research. Actions taken in this process were literature review, analysis of data available curricula of nursing schools, literature research, development of new instruments for measurement of competences in palliative care nursing, interviews with nurses in Bosnia and Herzegovina, development of online platform for nurses in Spain, translation of instruments to Spain language, data processing, Comparison of results from both group were done by every single item of instrument and by every competences. Results. Results are presented in two different parts: Part I (one) of results is about development of instrument PALCOM and part II (two) is about the data collected from Bosnia and Herzegovina and Spain. All results are shown in proper table and graphs that are reflecting research process. Results show the significant statistical difference between groups in Bosnia and Herzegovina and Spain (Valencia area) in some aspects, while in several aspect there is no difference. Working experience and level of education are in directly linked with self-competence measurement. There is a high statistical difference between groups with different level of education, and working experience, which has a direct impact on development of competence of nurses. Conclusion. Need for measurement of competencies is expressed in the daily development of palliative care, community palliative care, hospice care and subspecialty palliative care. Questionnaire that can measure all competencies does not exist but using general competencies in PALCOM questionnaire can cover this entire field with measurement of various domains and competencies specific to that domains. PALCOM as an instrument for evaluation of competencies in the field of palliative care, is, for the time being, a reliable instrument. With the development of palliative care, improvement can be done in the area of competencies in palliative care nursing. PALCOM is applicable in various health care systems and educational systems and it does not depended on external factors. PALCOM as instrument measures the competence level of nurses and preparedness for work in palliative care settings. First scale measure knowledge, while second scale is self-measurement of competences in accordance with the level of education and work experience. Need for the appropriate instrument for measuring competences in palliative care nursing leads us to this instrument following most economical and reasonable way of developing.

Delivery of palliative care to patients in a patient’s home, where they live with their family or in a retirement or nursing home, is an improved, shared-care team approach of providing quality healthcare services at the end of a patient’s life to reduce pain and stress. The palliative care shared-care teams in the Local Health Integration Network (LHIN) for Hamilton Niagara Haldimand Brant (HNHB also called LHIN4) manage patient health care through documents and trackers created and retained by providers within the circle of care, using several different systems and communication tools. These systems are not currently integrated and are unable to connect in a way that enables the preview, transfer, and receipt of data between these systems to support the needs of palliative care users. The primary objective of this thesis is to provide a proposal to improve the user experience of palliative care users through enhancement and integration of some of the systems currently in use. These include OSCAR EMR (Open Source Clinical Application Resource Electronic Medical Record) Hospice – InfoAnywhere, CHRIS (Client Health Related Information System) and Clinical Connect. Integration of these systems will address other limitations the shared-care teams are facing, such as communication, system or organizational policies and privacy and information security concerns that stem from the sharing of patient information across the systems, to support a shared-care team’s ability to provide patient care. During this study, an extensive requirements gathering and analysis was carried out: in-person interviews and teleconference meetings, brain storming sessions on the current systems and review of the secondary data with key stakeholders in the palliative care community. The local hospice sites were visited and extensive input was received from hands-on palliative shared-care teams and hospices across the HNHB LHIN, to ensure that the project team implemented their expressed needs into the integrated solution. The used case and prototyping approach of gathering the requirements is then used on the initial requirements gathered by sending out an initial draft to the users and stakeholders for their review, changes and additional requirements, hence fostering communication between the business and the development teams each time the brain storming session is held to review the refined requirements, resulting in the development of a high-quality Business Requirement Document (BRD). The project manager, lead developer, software architect, and users/testers were all utilized throughout the entire delivery process to ensure they were all in sync with the documented requirements. This lays the foundation for programmers to implement a quality end product with a technical solution that will enhance and integrate the systems to improve the user’s experience at the point of care. / Thesis / Master of Science (MSc)

Background: Nurses are essential for good palliative care and their responsibility lies in relieving patients from suffering and being supportive to them and their relatives. It is required that the nurse has substantial knowledge in medical and caring treatments. Most of the palliative care is performed in a hospital or elderly care facility. Therefore, it is important to compare the differences and similarities between what the nurses experience. Aim: This study aims to describe the nurses’ own experiences of caring for elderly patients while in palliative care. Method: A literature-based study of 11 reports was performed. Friberg’s five-step model was used for the analysis. Three themes emerged from the analysis; to promote person-centered care, the feeling of not being enough and difficulties regarding the communication. Results: The results show that nurses experience that they must take on too much responsibility. They also feel that the division of labor many times is unclear to them. These factors could hinder the quality of person-centered care. The lack of time and education were two vital parts that clearly affected the nurses' experiences in a negative manner. Lastly, the results showed that communication between nurses and physicians, and between nurses and relatives did not always function adequately. Conclusion: The conclusion from this study is that nurses feel that they do not have the time or resources to perform the optimal care. Palliative care is emotionally distressing for nurses,and they need support from their employers and more experienced colleagues.

Bakgrund: Allt fler patienter med palliativt vårdbehov vårdas i hemmet. Detta kan skapa en komplex situation för den närstående då det kan upplevas betungande att vårda en svårt sjuk familjemedlem. Det är därmed värdefullt att vårdpersonal har kunskap om bemötandet av närståendes behov för att kunna ge anpassat stöd att hantera sin och den sjuke familjemedlemmens situation. Detta gör det betydelsefullt att undersöka närståendes upplevelser av vilka åtgärder och insatser denne är i behov av.  Syfte: Att beskriva närståendes behov av stöd när en familjemedlem vårdas med palliativ vård i hemmet. Metod: Studien genomfördes som en litteraturöversikt. En deduktiv analysprocess genomfördes där kodningen skedde utefter ett befintligt teoretiskt ramverk av Andershed och Ternestedt (1999) som sedan prövades gentemot aktuell forskning. Resultat: Att närstående kunde få möjlighet att förbereda sig genom information kring palliativ vård men också kring praktiska åtgärder och sjukdomsförlopp möjliggjorde en ökad trygghet hos närstående. Att få bekräftelse och bli sedd var något närstående ansåg som betydande. Vårdpersonalens tillgänglighet under dygnets alla timmar var av vikt men även att de tog tid för patient och närstående. Hjälp med praktiska göromål var av vikt då närståendes möjlighet att få tid för sig själv och avlastning visade sig vara en bärande punkt. Även samordning med andra professioner och vårdgivare ansågs värdefullt, liksom optimering av hemmiljön för att underlätta vården. Slutsats: Om de närstående får stöd anpassat efter deras behov underlättas deras situation och känsla av utsatthet kan minska. Generellt behöver närstående kunskap, trygghet och avlastning. Palliativ vård ställer krav på vårdpersonals förmåga att möta de närstående på en individanpassad nivå där denne befinner sig för att kunna möta de närstående med insatser efter deras behov.

Background: Patients with life-threatening illnesses benefit from palliative care, which seeks to improve their quality of life. When a patient is diagnosed with a serious illness, it is the professional role of the nurse to contribute to supporting patients with safe and good palliative care, and to support individual to live with dignity in the face of incurable disease and the end of life. Aim: The aim of the study was to describe the nurse´s experiences providing good nursing in late palliative care. Method: Literature-based study was used with qualitative design since it was used addressing the study’s aim. Seven articles were included. Results: The result was compiled and from this emerged two main themes, Emotional impact and Organizational shortcomings. When nurses work in palliative care, they can face a variety of stresses. When caring for patients in their later stages of life, nurses often feel inadequate due to lack of time and resources. Nurses also suffer from a lack of organization, which means that they cannot provide the best possible treatment in palliative care. Conclusion: When nurses work in palliative care, they may face a variety of pressures. When caring for patients in their later phases of life, nurses often feel inadequate due to a lack of time and resources. Nurses also suffer from a lack of organization, which means that they lack organizational opportunities, because they cannot provide the best possible treatment in palliative care

Abstrakt Bakgrund: Palliativ vård baseras på ett förhållningssätt utifrån ett helhetsperspektiv av människan. Målet med palliativ vård är att minska lidande och att öka livskvaliteten i livets slutskede. Det handlar inte bara om att lindra det fysiska lidandet, utan även om att ge stöd till patienten och dennes anhöriga. Att ge palliativa omvårdnad innebär att stödja och underlätta för den döende och dennes anhöriga utan att påskynda eller fördröja döden. Den palliativa vården hjälper också patienten att leva med värdighet och välbefinnande under den sista tiden som är kvar. Syfte: Syftet med denna litteraturstudie är att beskriva sjuksköterskors upplevelser av att ge omvårdnad till patienter i livets slutskede. Metod: En integrativ litteraturöversikt användes. Databaser som användes var Cinahl och PubMed, där tio vetenskapliga artiklar utvaldes. Artiklarna var kvalitativa och kvantitativa som analyserades enligt metoden av Friberg (2022). Resultat: I resultatet framkom olika upplevelser som sjuksköterskor lyfte fram i omvårdnaden av patienter i livets slutskede och anhörigas betydelse. Resultatet presenteras i fyra kategorier. (1) Kommunikation och samarbete, (2) Andliga och existentiella behov, (3) Kunskaper och färdigheter och (4) Anhörigas betydelse i omvårdnad. Slutsats: Sjuksköterskorna kunde tillfredsställa en god och säker vård för patienter i livets slutskede genom att tillgodose deras önskemål, bevara deras värdighet samt genom att stödja deras andliga och existentiella behov. Grundutbildade sjuksköterskor upplevde brist på kompetens, så som utbildning och kliniska erfarenheter inom palliativ vård, vilket påverkar deras upplevelser negativt av att ge omvårdnad till patienter i livets slutskede.

Bakgrund: En god kommunikation krävs alltid i palliativ vård för att kunna bidra till en bra och fungerande vård. Kommunikation är en av de fyra hörnpelare som är en viktig del av sjuksköterskans arbete. De fyra pelarna är symtomlindring, närståendestöd, teamarbete samt kommunikation och relation.Syfte: Syftet med litteraturstudien var att beskriva sjuksköterskors erfarenhet av kommunikation med patienter i palliativ vård.Metod: Det användes 10 primära kvalitativa vetenskapliga studier till litteraturstudien som analyserades och granskades efter Willman et al (2011) analysmetod. Resultat: Resultatet presenterar två huvudkategorier. Den första huvudkategorin är faktorer som kan förbättra ett samtal, den är delad i fyra underkategorierna som är; kommunikation som ett verktyg, sjuksköterskors erfarenhet främjar kommunikation, sjuksköterskors närvaro i samtal och betydelse av icke- verbala kommunikation. Den andra huvudkategorin är faktorer som kan förhindra ett samtal, den är delad i tre underkategorierna vilka är; brist på klinisk erfarenhet och Kulturell, språklig och känslomässig påverkan på kommunikation samt tidsbrist.Konklusion: Det visade sig att kommunikationen hade en stor betydelse för patienten. Det finns flera faktorer som sjuksköterskan bör tänka på för att bidra till en god kommunikation såsom ha tillräckligt med tid, erfarenhet samt att ha tillräckligt med kunskap om patienten hen har framför sig. / Background: Good communication is essential in palliative care in order to facilitate a good and effective care. Communication is one of the crucial elements of the four pillars of nursing work. One of the most difficult duties of nursing is to care for and to communicate with the dying patients.Purpose: The purpose of this literature review/study was to describe nurses’ experience of communication with patients in palliative care.Method: 10 primary qualitative scientific studies were analyzed and reviewed according to Willman et al. (2011) analysis.Results: Results: The results present two main categories. The first main category is related to different factors that can improve a conversation. This category was divided into four subcategories that include; communication as a tool, promotion of communication through nurses’ experience, the presence of nurses during a conversation and the impact of nonverbal communication. The second main category is about factors that prevent a conversation. This is split into three subcategories. The subcategory includes; lack of clinical experience, cultural, linguistic and emotional impact on communication and lack of time. Conclusion: It was concluded that communication had a significant impact on patients in palliative care. There are several factors that nurses should consider in order to achieve good communication; such as having enough time for the patients and to having knowledge about the patients.

In the United States, the golden standard of treatment for patients afflicted with cancer is adjuvant chemotherapy treatment. Chemotherapy treatment has proven efficacy in eradicating cancer cells, but the treatment itself is associated with a variety of negative side effects. Side effects such as nausea and vomiting have been effectively treated with anti-emetics, but other negative side effects, such as fatigue and reduced quality of life, have no proven pharmacologic agents that effectively treat them. The goal of this paper is to identify alternative approaches to treat the side effects associated with chemotherapy treatment. This paper reviewed a large collection of literature concerned with determining the efficacy of exercise, music therapy, and spiritual techniques in reducing the magnitude of the negative symptoms associated with chemotherapy treatment. The data showed that exercise was the most effective therapy in reducing fatigue in cancer patients; meanwhile music therapy and spiritual techniques displayed efficacy in improving a patient's overall quality of life. However, further studies are needed in order to definitively determine the efficacy of exercise, music therapy, and spiritual techniques as adjuncts to chemotherapy treatment. This paper concluded that exercise, music therapy, and spiritual techniques have the potential to be effective tools that physicians can utilize when helping cancer patients alleviate the side effects associated with chemotherapy treatment. Moreover, exercise has shown the most evidence, through studies, as being an effective adjunct treatment to chemotherapy. Future research should focus on utilizing multiple therapeutic approaches in order to reduce the negative side effects associated with chemotherapy treatment.

京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第24291号 / 社医博第127号 / 新制||社医||12(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 古川 壽亮, 教授 髙橋 良輔, 教授 阪上 優 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM