Background: Around 100 000 people die in Sweden every day and most of them need palliative care. Palliative care means relieving relief and promoting good quality of life for dying persons. Palliative care is included in the education programme for nurses, although it varies during the education. The aim:To describe nurses experience of care in palliative care with focus on the end of life care. Method:A literature study based on eleven scientific articles. Main Result:Showed that care for dying patients are sensitive and emotional for nurses and this can affect palliative care. The experiences showed that nurses felt unprepared to meet dying patients, this was linked to deficiencies such as knowledge, time, experience and support. The result showed that communication and close relationships are basis for good palliative care and also the promotion of good quality of life for dying patients at the end of their lives. Conclusion: Palliative care is complex. In order for nurses to be able to offer good palliative care for the dying patients, better educations and strategies are needed to deal with difficult situations and build a stronger relationship with the patients and their relatives. Furthermore, lack of time and knowledge affects the care and nursing profession. Developing the experiences as well as constant reflection on nurse's work role can help to understand the care of dying patients better. / Bakgrund: Varje år avlider cirka 100 000 människor i Sverige. De flesta behöver palliativ vård. Palliativ vård innebär att lindra lidandet och främja god livskvalitet för döende personer. Palliativ vård ingår i utbildningen för sjuksköterskor, men innehållet varierar under utbildningens gång. Syfte: Att beskriva sjuksköterskors upplevelse av vårdandet inom palliativ vård med fokus på livets slutskede. Metod: En litteraturstudie baserad på elva vetenskapliga artiklar. Huvudresultat: Visade att vårda döende patienter är känslomässigt för sjuksköterskor och detta kan påverka den palliativa vården. Upplevelserna visade att sjuksköterskor kände sig oförberedda att möta döende patienter, detta förknippades till brister såsom kunskap, tid, erfarenheter samt stöd. Resultatet visade att kommunikation och nära relation är förutsättningar för en god palliativ vård och främjar god livskvalitet för döende patienter i livets slutskede. Slutsats: Palliativ vård är komplex. För att sjuksköterskor ska kunna erbjuda en god palliativ vård till döende patienter behöver de mer utbildning och strategier för att hantera svåra situationer samt skapa en bättre relation med patienterna och anhöriga. Brist på tid och kunskap påverkar vård och sjuksköterskors profession. Utveckling av upplevelserna samt ständig reflektion över sjuksköterskornas arbetsroll kan vara till hjälp för en bättre förståelse av att vårda döende patienter.

There is evidence of a relationship between sleep-wake disturbances and pain variables in cancer patients. It is hypothesized that pain affects all aspects of sleep patterns. Pain has been known to affect sleep disturbances; however there are different facets of sleep-disturbances and pain that can be evaluated. These variables include pain distress, pain intensity, pain at its worst, relief from pain, sleep distress, how well the patient sleeps, how tired one feels, and drowsiness distress. Several studies identify relationships between sleep-disturbances and pain. This study using secondary analysis was designed to correlate variables related to sleep-wake disturbance and pain in cancer patients admitted to hospice home care. The study sample included 209 cancer patients from a previously completed clinical trial with various cancer diagnoses. Results of sleep and pain variables were re-analyzed using Pearson correlations. The results showed significant positive relationships between pain distress and sleep distress (p = .000), difficulty sleeping and pain intensity (p = .008), and sleep distress and pain at its worst (p = .008). There were no significant relationships found between sleep distress and relief from pain, pain distress and how well the patient sleeps, pain distress and how tired one feels, and pain distress and drowsiness distress. Sleep-wake disturbances and pain have been studied in cancer patients, but there is little known concerning pain and its correlation to sleep disturbances of cancer patients admitted to hospice home care. This study provided important information on the relationship between sleep-wake disturbance and pain variables in this group of cancer patients. This study provides data to support the necessity to provide complete and accurate assessments of sleep and pain symptoms on admission to hospice home care and throughout the patient's care to aid in improved quality of life.

Hospital-based palliative care services aim to streamline medical care for patients with chronic and potentially life-limiting illnesses by focusing on individual patient needs, efficient use of hospital resources, and providing guidance for patients, patients’ families and clinical providers toward making optimal decisions concerning a patient’s care. This study examined the nature of palliative care provision in U.S. hospitals and its impact on selected organizational and patient outcomes, including hospital costs, length of stay, in-hospital mortality, and transfer to hospice. Hospital costs and length of stay are viewed as important economic indicators. Specifically, lower hospital costs may increase a hospital’s profit margin and shorter lengths of stay can enable patient turnover and efficiency of care. Higher rates of hospice transfers and lower in-hospital mortality may be considered positive outcomes from a patient perspective, as the majority of patients prefer to die at home or outside of the hospital setting. Several data sources were utilized to obtain information about patient, hospital, and county characteristics; patterns of hospitals’ palliative care provision; and patients’ hospital costs, length of stay, in-hospital mortality, and transfer to hospice (if a patient survived hospitalization). The study sample consisted of 3,763,339 patients; 348 urban, general, short-term, acute care, non-federal hospitals; and 111 counties located in six states over a 5-year study (2007-2011). Hospital-based palliative care provision was measured by the presence of three palliative care services, including inpatient palliative care consultation services (PAL), inpatient palliative care units (IPAL), and hospice programs (HOSPC). Derived from Institutional Theory, Resource Dependence Theory, and Donabedian’s Structure Process-Outcome framework, 13 hypotheses were tested using a hierarchical (generalized) linear modeling approach. The study findings suggested that hospital size was associated with a higher probability of hospital-based palliative care provision. Conversely, the presence of palliative care services through a hospital’s health system, network, or joint venture was associated with a lower probability of hospital-based palliative care provision. The study findings also indicated that hospitals with an IPAL or HOSPC incurred lower hospital costs, whereas hospitals with PAL incurred higher hospital costs. The presence of PAL, IPAL, and HOSPC was generally associated with a lower probability of in-hospital mortality and transfer to hospice. Finally, the effects of hospital-based palliative care services on length of stay were mixed, and further research is needed to understand this relationship.

HIV-positive children in sub-Saharan Africa have numerous challenges to overcome. These challenges increase psychosocial stress as well as symptom burden including fatigue, weight loss, pain, and mental changes. The symptoms may persist even after initiation of antiretroviral therapy, so such children need additional care. Palliative care lays emphasis on holistic patient-centered care, including physical, psychological, social, and spiritual symptoms, alongside antiretroviral therapy. There is limited data on the impact of integrating palliative care with standard HIV care and treatment in children. The purpose of this study was to fill the gap in the literature by investigating the impact of palliative care on health status in HIV-positive children on antiretroviral therapy. The theoretical framework was based on the humanistic nursing theory. Using the Mann Whitney U and logistic regression tests, the health-related quality of life of 97 children who received palliative care in addition to standard HIV care was compared to 180 HIV-positive children who received standard HIV care only through chart reviews. According to study results, children receiving palliative care alongside antiretroviral therapy have better physical and psychosocial health compared to children receiving only antiretroviral therapy. Increasing age was a contributing factor to better psychosocial and physical health in patients receiving palliative care. Emotional, social, and school functioning are important factors that determine treatment outcomes in children on antiretroviral therapy, and addressing those factors through palliative care will create a positive social change by improving treatment outcomes, quality of life, and longevity.

The hospice care population with cancer are often older adults who report many cancer-related symptoms experienced often in clusters. Most prevalent of these symptoms is fatigue and often it co-occurs with depressive symptoms and poor physical functioning. This dissertation examined fatigue, symptom clusters, depression, physical activity, and functional status in older adults with cancer. The aims of the literature review were to understand the relationship among physical functioning, cancer fatigue, fatigue-related symptom clusters, and their relationship with functional status In older adults. The literature related to these associations is insufficient and inconclusive. The methods section aimed to investigate the reliability and validity of the Center for Epidemiology Studies-Depression scale, Boston Short Form (CESD-10). Using Structural Equation Modeling (SEM) for confirmatory factor analysis, the factor structure of responses in a cross-sectional sample (N = 200) of adults with different types and stages of cancer was examined. Internal consistency reliability estimate Cronbach’s alpha =0.737. The CESD-10 four-factor model (positive affect, depressive affect, somatic complaints, and interpersonal challenges) fits the data well. The CESD-10 was a valid and reliable measure for assessing depressive symptoms in this study. The final section examined fatigue related symptom clusters and their relationships with functional status in older adult hospice patients with cancer (N=519). The fatigue-related symptom cluster (lack of energy, feeling drowsy and lack of appetite), significantly predicted poor functional status. Experiencing physical and psychological symptoms has a significant impact on functional dependence. Hospice healthcare professionals should be alert to older adults’ symptom cluster experience during assessment and management.

<p>Denna uppsats behandlar ämnet palliativ vård ur sjuksköterskors perspektiv. Begreppet palliativ vård innebär att fokus läggs på lindrande åtgärder då det inte längre är möjligt att bota patienten. För att skapa en bra vårdrelation, vilket är grunden i fungerande vård, krävs en bra kommunikation. Att kommunicera med en döende patient kan vara svårt för sjuksköterskor då de inte vet vad de skall säga eller hur de skall agera. Känslor hos både sjuksköterskor och patienter kan utgöra hinder i kommunikationen, vilket riskerar att vårdrelationen påverkas negativt. Syftet var att belysa sjuksköterskors upplevelser av kommunikationen med patienter i palliativ vård. Metoden som användes var systematisk litteraturstudie där vetenskapliga artiklar analyserades. Resultatet sammanställdes i sex stycken teman: att inte veta vad man skall säga, tyst kommunikation, känslor som hinder, kunskap, anhörigas påverkan på kommunikationen samt andliga samtal. Sjuksköterskor ser kommunikationen med döende som något viktigt, samtidigt som de är rädda för mötet med döden.</p><p> </p>

<p>Statistik från år 2002 visade att 24,6 miljoner människor i världen lever med cancersjukdom. Sjuksköterskor möter många av dessa patienter i det dagliga omvårdnadsarbetet. En stor del av vårdarbetet är medicinskt inriktat men betydelsen av upplevd livskvalitet hos patienter med cancersjukdom har visat sig ha stor betydelse för både behandling och sjukdomsförlopp. Livskvalitet omfattar upplevelser och känslor inom individen. Att mäta upplevd livskvalitet kan vara svårt då det är en individuell upplevelse. Det är svårt att hitta ett generellt mätinstrument för livskvalitet därför kan det underlätta att mäta de omkringliggande faktorerna till livskvalitet. När det inte längre är möjligt att bota en cancersjukdom finns möjlighet till olika behandlingsalternativ för att lindra cancersjukdomens symtom, palliativ vård. Syftet med denna litteraturstudie var att belysa livskvaliteten hos patienter med cancersjukdom i palliativ vård. Litteraturstudien omfattar 13 vetenskapliga artiklar. Resultatet delades in i 5 olika kategorier med faktorer som påverkade livskvaliteten; fysiska faktorer, psykologiska faktorer, sociala faktorer, andliga faktorer samt omvårdnadsfaktorer. Resultatet speglade vikten av symtomkontroll såväl för patientens livskvalitet som för sjuksköterskans omvårdnad. Det är viktigt att sjuksköterskan uppfattar negativt upplevda symtom hos patienten tidigt för att kunna göra patienten delaktig i omvårdnaden och därigenom främja livskvaliteten. Det borde ägnas mer forskning åt patienter med cancersjukdom och deras upplevelse av livskvaliteten.</p>

<p>Närstående till patienter inom palliativ vård utsätts för olika påfrestningar. Sjuksköterskans uppgift är att skapa en samlad bild av vilket behov av stöd de närstående har, samt de stödåtgärder som hon kan tillgodose.</p><p>Syftet<strong> </strong>var att belysa de närståendes behov av stöd inom den palliativa vården och de stödåtgärder som sjuksköterskan kan tillgodose.</p><p>Metoden var en litteraturstudie där 12 vetenskapliga kvantitativa och kvalitativa artiklar ingick.</p><p>Behovet av stöd varierade över tid och berodde på den närståendes tidigare relation till den sjuke. För många närstående var det stödjande att prata med andra med liknande erfarenheter. Professionellt stöd utgjorde ett komplement. En viktig uppgift för sjuksköterskan var att undervisa de närstående om specifika omvårdnadsproblem som kan uppstå, inklusive hantering av medicinteknisk apparatur. Sjuksköterskan strävade efter att utforma ett individuellt anpassat stöd för varje familj/familjemedlem. I resultatet framkom de fyra kategorierna; Behov av emotionellt stöd, behov av bekräftande stöd, behov av informativt stöd samt behov av instrumentellt stöd.</p><p>Kommande forskning kan fokusera på om behovet av stöd till närstående skiljer sig åt beroende på om patienten vårdas i öppen eller sluten vård, om insjuknandet är hastigt eller mer långvarigt samt hur hälso- och sjukvården kan integrera de närstående i vården på ett bättre sätt.</p> / <p>Relatives to patients receiving palliative care are subjected to all kinds of different pressures. The duty of the nurse is to assess and form a complete picture of the support the relatives need, and what kind of support that she can provide for them.</p><p>The purpose of the study was to illustrate the different kind of support the relatives to patients in palliative care have, and what the nurse can do for them.</p><p>The method used was a literature study based on 12 research articles, both qualitative and quantitative.</p><p>The need for support varied over time and depended on how the relative’s relationship had been to the patient prior to illness. Many relatives found it very helpful to be able to talk to others with similar experiences. Professional help worked as a complement. One important task for the nurse was to teach the relatives about the specific care problems that could arise, including how to operate certain medical equipment. The nurse’s aim was to be able to give individual support that was specifically adapted to each relative’s need. In the result four categories emerged; the need of emotional support, the need of confirmatory support, the need of informative support and the need of instrumental support.</p><p>Future research may focus on if the need of support to relatives differs depending on if the patient is treated in non-institutional care or in hospital care, if the patient becomes ill rapidly or slowly, and how the health care system can integrate the relatives in the care in a better way.</p>

<p>Elderly patients experiences of palliative care – a rewire</p><p>The purpose of this paper was to study elderly patient’s experience of palliative care with present knowledge as starting point. The questions were; what criteria do the elderly, dying person think is most important to fulfill in palliative care? and how satisfied is the elderly, dying person with the palliative care that are giving to him/her? The information were collected by a data based search trough science magazines and technical literature. Four relevant studies were found; Costello (2001), Heyland (2005), Wilson (1999) and Formiga (2004). Results in this studies show that the communication between patients, physicians and nurses need to improve. The elderly patients demands better, straighter and clearer information from the nurses and physicians, especially about their condition. The elderly demands more emotional and spiritual support from the health care and people with chronic diseases like COPD and CHF seems to bee less satisfied with palliative care then those with cancer. The reason for this can bee that, this group of patients is less likely to not being offered palliative care at all, much because it is harder for the physicians to set a proper medical prognosis.</p><p>Keywords: palliative care, elderly, patient- satisfaction</p>

<p>Palliativ vård innebär att ge vård till en svårt sjuk patient när sjukdomen inte längre går att bota. Omvårdnadspersonalen som arbetar med palliativ vård måste kunna se och fånga upp olika behov hos den svårt sjuke. Ett starkt engagemang och lyhördhet från omvårdnadspersonalen behövs i arbetet med palliativ vård. Att kunna se döden som en naturlig del av livet är en förutsättning för omvårdnadspersonalen att ha med sig i sin yrkesroll. Enligt den personal som intervjuats är kommunikation ett viktigt redskap i arbetet med palliativ vård för att kunna bemöta de svåra situationer som kan uppstå i arbetet. <strong>Syftet</strong> med vår studie var att ta reda på hur omvårdnadspersonalen upplevde det att arbeta inom palliativ vård. <strong>Metoden</strong> som använts har varit kvalitativ och sökningar har gjorts i databaser på Örebro universitet för att kunna förstå och bearbeta våra frågeställningar och därmed försöka uppfylla studiens syfte. I <strong>resultatet</strong> framkommer omvårdnadspersonalens uppfattning av att arbeta med palliativ vård var att det upplevdes som ett mycket meningsfullt och givande arbete. I studien belyser också omvårdnadspersonalen ett antal faktorer som är av vikt vid mötet med den svårt sjuke och som bidrar till att kunna uppnå en god och värdig död.</p><p> </p> / <p>Palliative care involves providing care to a seriously ill patient when the disease is no longer curable. The nursing staff working in palliative care must be able to see and capture the needs of the seriously ill. A strong commitment and sensitivity of the nursing staff are needed in the work of palliative care. To view death as a natural part of life is a prerequisite for nursing staff and to carry in their professional role. According to the nursing staff, the ability to communicate verbal and also non - verbal is an important tool in the work of palliative care to enable responding to the difficult situations that may arise at work. <strong>The aim</strong> of our study was to find out how the nursing staffs experience of their work in palliative care. <strong>The method</strong> used was qualitative and searches have also been done in the databases at Örebro University to better understand the study's aim. Nursing staff’s perceptions of working with palliative care were that it was perceived as a very purposeful and rewarding work. <strong>The results </strong>are based on informant’s fruitful information that we have taken note of by the interviews. The study will support nursing staff to highlight a number of important factors that are important in meeting difficult situations in the care of patients in order to achieve a good and dignified death for the patients.</p>