Delirium is a disturbance of consciousness and cognition that affects many terminally ill patients before death. It can manifest as confusion, hallucinations, and restlessness, all of which are known to be distressing to patients, families, and professional caregivers. Underlying the contemporary palliative care movement is a belief in the idea that a good death is possible; that dying can be made better for patients and families through the proper palliation of distressing symptoms and through proper attention to psychological, social, and spiritual issues that affect wellbeing at the end of life. Given that delirium is potentially disruptive to all that the good death assumes, i.e., mental awareness, patient-family communication, peace and comfort, the question was asked: What is the relationship between end-of-life delirium and the good death in hospice care? Ethnographic fieldwork was conducted at a freestanding residential hospice over a period of 15 months in a suburban community in eastern Canada. The research methods included participant observation (320 hours over 80 field visits), interviews with 28 hospice caregivers, and document analysis. The findings of this study provide an in-depth examination of the nature of caregiving relationships with patients and with families in end-of-life care. They illustrate how a commitment toward providing for the good death prevails within the cultural community of hospice, and how the conceptualization, assessment, and management of end-of-life delirium are organized within such a commitment. In this setting, experiences of conscious and cognitive change in dying are woven by hospice caregivers into a coherent system of meaning that is accommodated into prevailing scripts of what it means to die well. At the same time, delirium itself provides a facilitative context whereby processes of supporting families through the patient’s death are enabled. This study highlights the relevance of considering the contextual and cultural features of individual end-of-life care settings that wish to examine, and perhaps improve, the ways in which care of delirious patients and their families is provided.

Objectives: The objective of this thesis is to identify and understand communication and information exchange events and their influencing factors that are precursors to medical errors. Methods: Palliative Sedation Therapy is used as a case study to understand how communication and information sharing occur on an in-patient palliative care unit. Data sources were non-participant observation and interviews. Directed content analysis was used to analyze the data, with previously published conceptual models of communication acting as the guides for this analysis. Results/Discussion: Results identified several communication issues that have the potential to act as precursors to medical error at different points in the communication act. A model identifying the points where these precursors can impact communication was created. Conclusion: These results can be used to identify how improvements to communication and information exchange can increase the effectiveness of communication and reduce the likelihood of medical errors occurring.

Cerebral vascular accidents (CVAs) rank as the third leading cause of death in Canada with more than 50,000 of these events occurring annually. The evidence base from which to provide end-of- life care to patients dying from a CVA is currently limited, and there is a dearth of research examining the experiences of nurses charged with the responsibility of caring for these patients. In order to begin to address this gap in the literature, a qualitative study, using van Manen’s interpretive phenomenology was conducted to examine and describe the lived experiences of nurses working on an acute neurosciences unit in a tertiary hospital. Nine nurses were interviewed initially, and two nurses participated in follow-up interviews to confirm the interpretation of the data. This manuscript will discuss the essence of nurses’ lived experience in caring for these patients, as well as implications for education, practice, and future research.

Bakgrund Inom den palliativa vården anammas ett holistiskt synsätt, vilket innebär att fokus ligger på såväl fysiska, psykiska, sociala som existentiella aspekter i patientens livsvärld. Tre grundläggande psykiska behov, autonomi, möjligheter och sammanhang är essentiella i upplevelsen av psykisk hälsa. Även önskningar, värderingar och mål bidrar till patientens psykiska välbefinnande. Det har tidigare visat sig att patienters psykiska behov inte tillgodoses och sjuksköterskor inom den palliativa vården brustit i förmågan att uppmärksamma dessa behov. Syfte Syftet med studien var att beskriva patienters psykiska behov inom den palliativa vården. Metod Litteraturstudien baserades på tolv kvalitativa originalartiklar. Analysen genomfördes induktivt med en manifest innehållsanalys. Resultat Resultatet visade på psykiska behov i fem kategorier och sju underkategorier. Behoven gällde patientens närstående, självständighet, framtiden, vården och att bo hemma. Slutsatser Resultatet visade att psykiska behov kunde grundas i fysiska och sociala aspekter. Patienter som får palliativ vård förekommer på fler ställen inom specifikt den palliativa vården. Därför är det viktigt att belysa patienternas olika uttryck av psykiska behov för att de ska kunna tillgodoses och bidra till välbefinnande hos patienten. / Background In palliative care a holistic approach is embraced, which means that the focus is on physical, psychological, social and existential aspects of the patient's life-world. Three basic psychological needs, autonomy, competence and relatedness are essential concepts in the experience of mental health. Even desires, values ​​and goals contribute to the patient's psychological well-being. It has previously been shown that patients' psychological needs are not being met and that nurses in palliative care lack the ability to identify and address these needs Aim The aim of the study was to describe patients' psychological needs in the palliative care setting. Method The literature review was based on twelve qualitative original articles. An inductive, manifest content analysis was conducted. Result The result showed psychological needs in five categories and seven sub-categories; needs related to patient's family, independence, future, the healthcare system and staying at home. Conclusions The results showed that psychological needs could be based on both physical and social aspects. Patients receiving palliative care often receive that care in different environments that are not necessarily within specific palliative care clinical settings. Therefore, it is important to highlight the patients' expressions of psychological needs so that those specific needs can be addressed and in the process, improve the overall well being of the patient.

Bakgrund: Allt fler människor väljer att vårdas hemma i livets slutskede. Denna utveckling ställer stora krav på de närstående att bära ansvaret för den döende anhöriges vård. Syfte: Syftet var att belysa närståendes upplevelser av palliativ vård i livets slutskede i hemmet i Norden. Metod: Studien som baseras på 12 kvalitativa artiklar analyserades med en innehållsanalys. Resultat: Analysen genererade tre kategorier som belyser hur de närstående upplever den palliativa vården i livets slutskede i hemmet. Dessa kategorier är: Förändrad vardag, Sjukvårdspersonalens betydelse och Närståendes behov och känslor. Resultatet visade att de närstående var i behov av stöd från sjukvårdspersonal för att kunna hantera situationen. Det framkom även att de närstående strävade efter att bibehålla sin vardag och att de ville vara involverade i vården. Slutsats: Studien påvisar hur betydelsefullt stöd från sjukvårdspersonal är för att ge de närstående tillräckligt med resurser att ansvara för den palliativa vården. Behovet av kunskap, att veta vad som ska göras och hur, är centralt för att känna delaktighet.

This study explored the experiences of bereaved family caregivers (FCGs) with uncomplicated grief in hospice palliative care and what they found helpful and challenging in their adjustment to the loss of the person for whom they were caring. The cumulative effects of both caregiving and bereavement can be detrimental to FCGs’ physical, social, and mental well-being. Many FCGs with uncomplicated or normal grief ask for assistance in bereavement. Yet, in the bereavement care literature, there is uncertainty about what may be beneficial to them and how best to support them. An interpretive descriptive design was used for this study of eleven bereaved FCGs with uncomplicated grief. The FCGs included five daughters, 5 spouses (2 wives, 2 husbands, 1 same-sex partner), and one sibling who had cared for a dying family member and who ranged in age from 23 to 76 years. All participants resided in the Vancouver Island Health Authority – South Island region. Data were collected through eleven in-depth interviews and one focus group. Data were analyzed using inductive analysis. The FCGs reported that the impact of loss was experienced as a magnitude of changes in their everyday lives, the loss of the connection with the cared-for person, and changes within themselves. They also reported a need for a safe community in which to grieve where they had quality relationships and/or shared common experiences of loss with others. Finally, the FCGs reported active engagement in their adjustment in bereavement that included such strategies as remembering the person who died, striving for balance, and awareness of personal growth. The findings from this study have the potential to assist health care and other professionals to understand the bereavement experiences of FCGs in hospice palliative care and to inform bereavement care for FCGs with uncomplicated grief.

Introduction: Uganda is seen as a leading country in Africa regarding palliative care, but still far from all dying patients receive this specialized care. Many of them decease in non- palliative hospital wards, taken care of by nurses who do not have specialized education in palliative care. No research has been done in Uganda where these nurses’ experiences and perceptions of providing palliative care has been examined. Purpose: To describe the experiences and perceptions of providing palliative care among general nurses in a non-palliative medicine ward at Mulago hospital in Kampala, Uganda. Method: A qualitative method was used consisting of semi-structured interviews with seven general nurses working in a non-palliative medicine ward at Mulago Hospital in Kampala, Uganda. The participants were chosen through convenience sampling, and the data were analyzed by a qualitative content analysis. The results were discussed on the basis of the theoretical framework chosen for this study, the cognitive-motivational-relational theory of Lazarus. Results: In this study five categories were identified: providing palliative care by own preconditions, giving symptom relief, involving the relatives, informing and communicating and working in a team. The nurses were familiar with the concept of palliative care but their knowledge about it was limited, often perceiving it as mostly being about physical pain relief. The nurses showed a willingness to improve their work with end-of-life care, but problems like staff shortage and lack of knowledge were described as hindering. To communicate with the patients and their relatives was identified as the biggest challenge among the nurses. Conclusion:  The nurses experienced providing palliative care as difficult in many aspects such as communicating, symptom relief, teamwork and supporting relatives. They described the providing of palliative care as being emotionally challenging. Staff shortage and lack of knowledge and resources were perceived as hinders, preventing them from doing a good job. Overall the nurses wished more education in the subject, showing a willingness to improve their work with palliative patients.

Euthanasia is frequent phenomenon in modern society and that is why the number of discussions on the subject increases. The aim of the paper is to answer the question after having analyzed the legal acts of various contries: is euthanasia a crime or a justifiable way of killing. In the beginning the concept of euthanasia is educed and it is marked off from the non-practice of the stubborn treatament. The experience of the states that have legitimated euthanasia, prohibited euthanasia, legalized suicides assisted.

Bakgrund: När en person blir svårt sjuk, är döende och behöver vårdas palliativt berörs inte bara den sjuke, utan även personer i dennes närhet. Det har framkommit att närstående inte alltid uttrycker sina behov i situationen. Närståendes involvering är ett faktum, och deras upplevelser varierar. Närståendes upplevelser knyts i resultatdiskussionen an till begreppet om Känsla av sammanhang.    Syfte: Litteraturöversiktens syfte är att beskriva upplevelser av att vara närstående till en palliativ vårdtagare. Metod: En kvalitativ litteraturöversikt, inkluderande elva studier, har genomförts där dessa studier granskats, bearbetats och analyserats utifrån Fribergs femstegsmodell. Resultat: Det framkom att närstående upplevt förändringar i vardagen sedan deras närstående blivit sjuk. De upplevde åsidosättande av egna behov och intressen. Vårdpersonal fick en betydande roll i situationen, och närstående upplevde trygghet när de var närvarande, men upplevde en otrygghet när kontinuitet och löften inte hölls. Behov av information och stöd visade sig vara viktigt för hanterandet av situationen. Slutsats: Utifrån huvudfynden konstateras att närstående genomgår förändringar genom hela den sjukes palliativa period. Förändringarna upplevs olika, då varje situation är unik, de närstående har individuella behov som behöver tillfredsställas. Uttryckt behov av stöd och information gör att vårdpersonal får en betydande roll i deras liv. / Background: When a person becomes seriously ill, dying and in need of palliative care, not only the sick person get´s affected, even the next of kin´s are concerned. Next of kin´s is not always expressing their needs in such situations. That next of kin´s get´s involved is a fact, and what their experiences are varies. Next of kin’s experiences are in the discussion connected with the theory of Sence of coherence.      Aim: The aim of the literature review is to describe experiences of being next of kin to a person who´s in palliative care. Methods: A qualitative literature review, including eleven studies, have been conducted, and theese studies have been examined, processed and analyzed by the five steps of Friberg. Findings: Findings revealed that next of kin´s experienced changes in everyday life since their relative got ill. They experienced that they had to set aside their own needs and interests. The health care professionals were given a significant role in the situation, and the next of kin´s felt a sense of security when they were present, but experienced insecurity when continuty and promises were not kept. A need for information and support turned out to be important to cope with the situation. Conclusion: Based on the main findings it was stated that next of kin´s undergoes changes throughout the sick persons palliative period. The changes are experienced differently, as each situation is unique, the next of kin´s have individual needs which need to be satisfied. Expressed needs for support and information enables health professionals to have a significant role in their lives.

Health system restructuring combined with the preferences of palliative care recipients to be cared for at home has lead to a shift in the delivery of care from the hospital to the home setting. An analysis was conducted on five main home-based palliative care health service components: home-based nurse visits, home personal support worker visits, home-based physician visits, ambulatory physician visits, and other ambulatory and home-based visits. First, we assessed the proportion of total cost associated with the main services at different time points over the palliative care trajectory. Second we examined the socio-demographic and clinical factors that predict the propensity and intensity of service use, using a two-part model. The results suggest that the greatest contributor to the total cost of home-based palliative care was personal support worker visits, followed by nurse visits. The regression analysis revealed that patient age as well as functional status most often predicted health service use.