This research focused on experiences of dying patients and hospice nurses in a hospice unit. The research objectives were to (i) acquire more extensive knowledge about how dying patients and hospice nurses experience life and death and (ii) describe patients who were cared for during a 10-year period in an inpatient hospice ward. Data were gathered via interviews with 19 nurses and 11 patients. An interpretive description method was used to analyze interview results. Data were also gathered from institutional care records that included gender, age, marital status, diagnosis, referral source, and length of stay (666 women and 555 men). Descriptive statistics were used to describe basic features of the study's data and to compare differences between women and men. The main finding from interviewing the nurses was that they were struggling to acknowledge and unveil the person within the weakening body. In doing so, they used various strategies such as (i) striving to understand patients’ experiences of body function loss; (ii) encouraging patients to uphold body functions and daily habits; (iii) acknowledging and balancing patients’ need for body control; and (iv) providing tender care for the body. After 2 years of work in hospice care, nurses described that facing the dying and death of many patients had an impact on daily work and private life. The close relationship with the dying patient led to existential issues concerning the meaning of life and death, which were conceptualized into this theme: death as an agent of change. Eleven years later, the presence of death took a less dominant place in the nurses’ lives, and the theme became: death as a companion in life. In the long-term, nurses emphasized that their relationships with dying patients fostered their professional and personal growth. The findings from interviewing the patients revealed that when death became a reality, life took on new meaning, and they acquired new values that were important to preserve or protect; this triggered need for feeling secure within this situation. These revelations were manifest in three sub-themes: (i) when possible death becomes a reality; (ii) living with death as a reality, and (iii) a need for a feeling of security. And this main theme was conceptualized: making sense of life close to death. Results regarding patients in hospice ward care over a 10-year period revealed significant differences between women and men. More women than men were single, had cancer with relatively short trajectories, and were referred from the oncology department. More men than women were diagnosed with types of cancer with somewhat longer trajectories. Despite longer trajectories, length of stay was shorter for men than for women. The most frequent referral source was the hospital. But compared to women, men (particularly younger men) were more often referred from home-based hospice care. The findings expand knowledge about dying and its various configurations; consequently, care and support needs will vary. For the dying person, it is important to know that care is provided according to the person’s preferences and given when needed.

Background Palliative care services have widened beyond cancer in recent years, yet frail older adults rarely receive such services. There is a need to understand the dynamic multidimensional end-of-life experiences of this group in order to assess how or if a palliative approach could be beneficial. Physical end-of-life trajectories for frail older people have been described but there remains little person centred research that describes changing experiences across physical, social, psychological and existential dimensions. Aims and objectives To explore the changing multidimensional experiences of frail older people towards the end of life and to reflect on the utility of a qualitative longitudinal multi-perspective design for this population. Methods Thirteen cognitively intact, community dwelling older adults considered to be moderately or severely frail, using a clinical frailty scale, and thirteen nominated informal carers participated in up to three narrative interviews over eighteen months. Eight nominated professionals were also interviewed. The interviews were participant led, audio-recorded and fully transcribed. The ‘voice centred relational’ narrative method, incorporating analyses of multidimensional experience, was used to analyse the data. The data were then analysed longitudinally to compile case studies for each older person. Findings The narratives of these frail older people approaching the end of life illustrate patterns of multidimensional experience that differ from the end-of-life trajectories of other groups. All participants experienced physical decline however three possible patterns of psychological, social and existential experience emerged. These were stable, regressive and tragic according to the capacity to hold on to core values, and maintain a sense of self and of belonging in the world and are illustrated using visual trajectories. When the sense of self was threatened these frail older people lacked valued alternative identities and struggled with the absence of clear causative factors to explain their circumstances. The participants frequently described fears of burdening others, of moving to a nursing home or of developing dementia more than fears of dying. Losses and sustaining factors are described for physical, social, psychological and existential dimensions revealing the importance of social and community networks for supporting frail older people. There were constraints and benefits to using a qualitative longitudinal multi-perspective method, however the method enabled a deep, contextualised and rich understanding of the dynamic experiences of frail older people. Conclusion Frail older people may be supported towards the end of life by considering ways to promote the integration of the self. This may involve promoting valued alternative identities, protecting personhood through social and health care practices and by investigating ways to alleviate or make tolerable greatest fears. Community health and social care structures and social and community networks appear essential for addressing the end-of-life needs of frail older people. A qualitative, longitudinal, multi-perspective design was beneficial for investigating the experiences of frail older people.

The purpose of this study was to describe Registered Nurses’ attitudes toward death and their perspectives on education and training related to death and end-of-life patient care. A complementary goal was to determine whether nurses’ attitudes and perspectives are associated with background variables. The three attitudes toward death included anxiety, escape, and neutral attitudes. The background variables of the nurses included formal educational level, age, gender, ethnicity, years of nursing practice, state of residence, and area of nursing practice. A survey including four sections was used for data collection. The first section of the survey utilized an established 32-item survey based on the Death Attitude Profile Revised survey developed by Wong, Reker, and Gesser in 1994. The questions asked how nurses felt about the topic of death. The second section of the survey was about the extent of palliative care education and training, while the third section was concerned with the demographics of the respondents. Part four of the survey included two open-ended questions regarding attitudes toward death and how prepared respondents felt in meeting their patients’ end-of-life needs. The survey was sent to state nurses’ associations across the United States in 2015. Survey Monkey was the link for the survey and it was opened for a three-week period. The original responses totaled 248 participants. Responses with any missing values were excluded. The final dataset included 167 total responses. Data was analyzed using descriptive statistics and regression analysis to determine the association between the variables of interest. The results of the study were most significant in relation to anxiety toward death. Nurses who were more experienced on the job, female, and with more formal education had lower anxiety levels, as did nurses with a higher confidence level in dealing with death. For the neutral attitudes, the best predictor was the rating of the nurses’ end-of-life preparation. The best predictor of the escape attitude was years of nursing experience. The results supported the need for college level end-of-life education and the significance role of nursing experience in relation to less anxiety towards death. The surprising result was that post-college end-of-life education actually increased the anxiety attitude toward death. More research is needed to ascertain if these results could be replicated. There is a need to determine what type of post-collegiate education would decrease death anxiety in nurses.

La question de la fin de vie et du processus de deuil qui s’ensuit pour le proche du défunt reste toujours d’actualité tant elle comporte d’énigmes. Comment pouvons-nous penser que le travail du deuil puisse être facilité ? La présente recherche a pour objectif d’étudier, en appui sur les travaux et les théories de D. W. Winnicott, comment le soin peut être transitionnel dans la relation et dans l’espace intersubjectif créé par la triade composée du soignant, du patient et du «proche-tiers». A partir d’un échantillon de 30 patients, les entretiens semi-directifs de 21 soignants et de 8 proches ont été analysés. Cette analyse nous permet de montrer de quelle manière le soin est transitionnel dans l’accompagnement. Elle nous montre également quels bénéfices peut avoir l’accompagnement en fin de vie, d’une part pour le patient dans l’ici et maintenant de sa fin de vie, d’autre part, pour le soignant dans l’ici et maintenant de l’accompagnement proposé mais aussi dans «l’après-coup» pour les autres accompagnements qu’il pourra proposer. Enfin, un troisième bénéfice certain est pour le «proche-tiers» dans l’ici et maintenant de l’accompagnement de son proche malade mais également par la suite dans la conduite du deuil. / Questions revolving around end of life and the grieving process that follows for loved ones are as relevant as they are puzzling. Is it unrealistic to think that mourning can be facilitated? This research aims to examine and build upon the work and theories of D. W. Winnicott. This research delves into how care may be transitional in the relationship and in the intersubjective space created by a triad of care: medical caregiver(s), patient and loved ones. From a sample of 30 patients, semi-structured interviews with 21 medical caregivers and 8 relatives were analyzed. This analysis shows how the care is transitional in the accompaniment. This research reveals the benefits of creating a transitional space during end of life care. First and foremost, it assists the patient in the here and the now of end of life; it, then, aids the caregivers. Medical caregivers and loved ones alike benefited from accompanying the patients in death both during the palliative care stages as well as afterwards as they worked through the grieving process.

This study examined strategies that can be used for bringing about HIV/AIDS awareness in primary schools. The strategies are effective teaching skills that can be employed by educators for bringing HIV/AIDS awareness to primary school learners. The responsibilities of educators in the implementation of HIV/AIDS programs in primary schools were discussed. It was noted that educators have a great responsibility of teaching learners about HIV/AIDS, the most important of which was to provide learners with accurate information regarding HIV/AIDS. Another one was that educators should also make sure that effective teaching and learning of HIV/AIDS does takes place in the schools. The study has also examined knowledge that children should have regarding the HIV/AIDS epidemic. The basic awareness of HIV/AIDS by children was found to be essential. Some of the factors that promote the spread of HIV infection were also discussed. Different types of STIs were discussed. From the discussions, it is evident that there is a link between STIs and HIV/AIDS. Although STIs can be treated by medication, they are sometimes hard to cure. In this study, it was discovered that the early and correct treatment of STIs is an important weapon in the armoury against HIV transmission. The significance of life skills programs in primary schools was also examined. It was discovered that the subject of HIV/AIDS could not be taught in isolation; life skills programs should always be included. The issue of primary school learners who are infected and affected by HIV/AIDS was also discussed. It was discovered that in the context of HIV/AIDS, learners fall into two main groups, namely the infected and affected. Infected learners are those learners who are living with the virus in their bodies, while affected learners are those who have infected family members or friends. Various ways by which HIV can be transmitted and prevented in primary schools were also examined. Strategies that can be used for bringing about HIV/AIDS awareness in primary schools were dealt with in chapter six. Recommendations based on teaching skills that can be used by educators in presenting HIV/AIDS lessons were made. / Dissertation (Magister Educationis (Learners Support, Guidance and Counselling))--University of Pretoria, 2006. / Educational Psychology / unrestricted

Background: Nurses's knowledge of palliative care is important in order to preserve patient dignity. In the final stages of life, nurses' actions largely focus on relieving suffering and nursing is characterized by holistic and ethical approaches. Aim: The aim was to describe the nurse's experience of palliative nursing. Method: Literature review with a qualitative design. 12 articles were included. Result: The result was structured into five themes: Person-centered Nursing, Relationship with Relatives, Awareness, A Way to Symptom Control, Misunderstanding and Disagreement between Nurses and Doctors, Emotional Stress. Conclusions: Communication was central in palliative nursing and nurses had an important interaction with patient and close associates. Collaboration with the physician had a crucial role in palliative care but often led to conflicts. In palliative care, symptom control was also important, but provided a sensitivity to the patient's individual needs in nurses. Palliative care meant emotional stress. Keywords: Communication, palliative care, nurse, experience. / Bakgrund: Sjuksköterskors kunskap om palliativ omvårdnad är viktig för att bevara patientens värdighet. I livets slutskede inriktas sjuksköterskors åtgärder till stor del mot att lindra lidande och omvårdnaden präglas av helhetssyn och ett etiskt förhållningssätt. Syfte: Syftet var  att beskriva sjuksköterskors erfarenhet av palliativ omvårdnad. Metod: Litteraturöversikt med kvalitativ design. 12 artiklar inkluderades Resultat: Resultatet strukturerades i fem teman: Personcentrerad omvårdnad, Samspel med närstående, Lyhördhet, en väg till symtomkontroll, Missförstånd och oenighet mellan sjuksköterskor och läkare, Känslomässiga påfrestningar. Slutsatser: Kommunikation var centralt inom palliativ omvårdnad och sjuksköterskor hade ett viktigt samspel med patient och närstående. Samarbetet med läkaren hade en avgörande betydelse inom palliativ omvårdnad men ledde ofta till konflikter. Inom palliativ omvårdnad var också symtomkontroll viktigt men förutsatte en lyhördhet för patientens individuella behov hos sjuksköterskor. Palliativ omvårdnad innebar känslomässiga påfrestningar.  Nyckelord: Kommunikation, palliativ omvårdnad, sjuksköterska, erfarenhet

Aim: To investigate families’ perceived life situation when living with cancer, with a focus on health and family sense of coherence. Methods: Study I is a population-based register study that explored how cancer influenced the health of cohabitating partners of persons with cancer in Sweden by examining the onset of new diagnoses, health care use, and health care costs among the partners. Study II focused on familial interaction patterns for families living with cancer in a palliative phase, based on family interviews, and analysed using Gadamerian hermeneutics. In study III, Family Sense of Coherence scale (S-FSOC-S) was culturally adapted and evaluated for reliability and validity, using psychometric analyses. Study IV explored associations between family sense of coherence and hope, anxiety, and symptoms of depression using descriptive statistics and nested linear regression. Results: Study I showed that the partners of persons with cancer had significantly increased health care use and health care costs both one and two years after the cancer diagnosis, and that use patterns and costs varied according to the type of cancer that had been diagnosed. Study II revealed that the familial interaction patterns were adjusted in response to changes in family life - changes which encompassed three different, but interrelated, patterns: power dynamics in the family, the “secret game” in the family, and multifaceted closeness and distance in the family. Study III suggested that S-FSOC-S is useful for assessing familial coherence and shows satisfactory reliability and validity. Study IV showed that stronger family sense of coherence was associated with higher hope and lower anxiety and symptoms of depression levels in both persons with cancer and their family members. Conclusions: Families’ life situation was affected by the cancer diagnosis, which had an impact on both individual family members and the family as a unit. The type of cancer may help to determine partners’ risk of ill health. The changed familial interaction patterns increased the families’ ability to deal with family life without hurting each other. The S-FSOC-S is a useful instrument for assessing family sense of coherence and can help identify families with weak family sense of coherence, who may need professional support.

Background: Caring for an elderly person at the end of life means a complex care situation for healthcare professionals. There are several factors to consider in this regard; the patient's, relatives and healthcare staff as described in this work from the nurse. Aim: The purpose of the study was to describe municipality nurses' experiences of caring for older people in the final stages of life. Method: The study had a descriptive design with a qualitative approach. Data were collected through eight interviews and analyzed using a qualitative manifest content analysis, whereas five categories and ten sub-categories emerged. Results: The result is that the nurse practitioners saw this work as meaningful but also emotional stress. Feelings like insufficiency, participation, adequacy and existential issues were raised at the nurse's nurse. The palliative care complexity was visualized as the patient's self-determination, relatives, and nursing staff's needs were made visible and met. Conclusion: Palliative care is a person-centered care based on patient needs, which proved to be complex. Corresponding to these expectations and implementing the required care creates experiences, good and less good, with nurses who consciously or not, affect them regardless of patient or care opportunity and give a chance of reflection, further experience and opportunity to grow as a person and in profession. Keywords: C aring, end-of-life care, elderly care, nurses’ experience, palliative care

Bakgrund: När en patient avlider fortsätter vården även efter dödsögonblicket, vårdpersonal tar hand om både patient och närstående även efter att döden har inträtt. Att göra iordning den avlidne (post mortem care) är en uppgift omgärdad av symboliska handlingar och ritualer. Utbildningar lägger ringa vikt vid att lära ut färdigheter kring denna typ av vård och upplevelsen av att vårda en avliden patient är sparsamt undersökt i forskning och litteratur. Syfte: Att beskriva vad sjuksköterskor upplever som viktigt och meningsfullt i sitt arbete med vård av avlidna patienter i palliativ verksamhet. Metod: Arbetet har en deskriptiv design och är en kvalitativ intervjustudie med både fokusgruppintervju och enskild intervju som datainsamlingsmetod. Materialet bearbetades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i tre huvudkategorier och sju underkategorier: Kunskap och erfarenhet: teoretisk kunskap erfarenhetsbaserad kunskap Relationer och roller: sjuksköterskors relation till patienten närståendes roll och betydelse för sjuksköterskor Handlingar och ritualer: symboliska handlingar avslut och avsked reflektion Diskussion: Resultatet diskuterades med KASAM som teoretisk referensram och överensstämmer med tidigare forskning. I resultatet framkom att vården av avlidna ansågs vara meningsfull och en arbetsuppgift som sträcker sig längre än omvårdnad, t.ex. inkluderades närståendestöd och egen reflektion som delar av post mortem care. Resultatet visar också att kunskapen till största del är erfarenhetsbaserad och att deltagarna i studien tycker det är viktigt att erfarna får tid och möjlighet att lära nya/oerfarna.

Bakgrund: En person som vårdas i livets slutskede benämns palliativ. Med detta menas att patienten inte längre kan botas utan de symtom som patienten har lindras. De 6 S:n är en omvårdnadsmodell inom palliativ vård och syftar till personcentrerad vård som kan bidra till en värdig död. För att kunna uppnå en god vårdrelation krävs en förmåga hos sjuksköterskor att kunna sätta sig in i patientens situation. Sjuksköterskor utbildas idag inom palliativ vård i grundutbildningen. Dessa ser dock olika ut runtom i Sverige. Syfte: Beskriva hur sjuksköterskor upplever att vårda patienter palliativt utifrån grundutbildningen. Metod: En litteraturöversikt med kvalitativ utgångspunkt utgör metoden. Resultat: Två kategorier har bildats genom analysen; Negativa upplevelser och Positiva upplevelser. Ur dessa har fem underkategorier formats; Frustration, Otillräcklig och ensam, Utmanande vård, Personligt involverad och Inre styrka. Diskussion: Den palliativa vården skapar mycket känslor. Sjuksköterskorna upplever utmaningarna som uppstår i palliativa vårdandet som positiva, men uttrycker att de behöver mer kunskap kring hur de ska bemöta patienternas existentiella frågor och emotionella behov. Konklusion: Erfarenheten har en central roll inom den palliativa vården. Mer kunskap kring palliativ vård behövs i sjuksköterskornas grundutbildning. / Background: A person in the stage of end of life is called palliative. This means that the patient no longer can be cured; only the symptoms can be alleviated. The “6:S” is a nursing model in palliative care and the purpose is person-centered care that can contribute to a worthy death. To achieve a good care relationship, the ability of nurses to get into patient's situation is needed. Today nurses’ are trained in palliative care in the under graduate education. However, across Sweden it looks different. Aim: Describe how nurses experience palliative care based on basic education. Method: A qualitative literature review is the method. Result: Two categories have been formed through the analysis; Negative experiences and Positive experiences. From these five subcategories has been formed; Frustration, Inadequate and lonely, Challenging care, Personally involved and Internal strength. Discussion: The palliative care creates a lot of emotions. Nurses experience the challenges as positive, but express that they need more knowledge about how to respond to the patient’s existential issues and emotional needs. Conclusion: Experience is central in palliative care. More knowledge about palliative care is needed in the nurse's basic education.