Bakgrund: Den palliativa vårdens syfte är att lindra lidande och främja livskvalitet för patienter med obotlig sjukdom eller skada. Den ska erbjudas alla som har behov av den, oavsett kön och diagnos. Inom den allmänna palliativa vården ska sjuksköterskans utifrån patientens behov skapa en balanserad och anpassad omvårdnad. En av de viktigaste omvårdnadsåtgärderna är att främja välbefinnande och ge god smärtlindring. Syfte: Syftet var att beskriva vad patienter med cancerdiagnos tycker är viktigt i palliativ vård på sjukhus. Metod: Metoden var en litteraturöversikt med tio kvalitativa vetenskapliga artiklar som hämtades från databaserna PubMed och Cinahl Complete. Artiklarna analyserades enligt Fribergs analysmodell. Den teoretiska referensramen som användes var de 6 S:n, en modell för personcentrerad vård. Resultat: Analysen resulterade i 5 teman: (1) Sjuksköterskans roll, (2) vårdpersonalens bemötande och förhållningssätt, (3) symtomlindring och livskvalitet, (4) delaktighet i vården och (5) vårdmiljö.  Sammanfattning: Sjuksköterskans kompetens var viktig för patienterna, såväl den medicinska som kommunikativ. Det var betydelsefullt att vårdpersonalen var lyhörda för patientens önskemål och behov, att de var empatiska och kunde visa glädje. Med ett personcentrerat arbetssätt kunde vårdpersonal söka kunskap om patienten och utifrån den ge god vård. I de fall patienterna inte längre kunde vara delaktiga i sin vård skulle närstående vara beslutsfattande. / Background: The aim of palliative care is to alleviate suffering and promote quality of life for patients with incurable disease or injury. It should be offered to everyone in need of it, regardless of gender and diagnosis. In generalized palliative care, the role of the nurse is to provide a balanced nursing care tailored to the specific needs of the patient. One of the most important aspects of care interventions is to promote well-being and provide good pain relief.  Aim: The aim was to describe what patients diagnosed with cancer perceived to be important in palliative care in hospitals. Method: The method was a literature review based on ten qualitative articles selected from two databases, PubMed and Cinahl Complete. The articles were analyzed according to Friberg's analysis model. The theoretical frame of reference in this study was the 6 S, which is a model for person-centered care.  Results: The analysis resulted in 5 themes: (1) The role of the nurse, (2) treatment and approach of nursing staff, (3) symptom relief and quality of life, (4) participation in care and (5) care environment.  Conclusion: Both the medical and the communicative competence of the nurse was valued by the patients. It was important that the care staff were responsive to the patient's wishes and needs, that they were empathetic and could exhibit joy. With a person-centered approach, care staff could seek knowledge about the patient and based on that they provide good care. In cases where patients no longer could be involved relatives would be decision-makers.

Lung cancer is the leading cause of cancer mortality and morbidity. Patients with advanced lung cancer have distressful symptoms like dyspnea. It has severe negative impact on the quality of life. Airway stenting has become widespread for palliation of airway stenosis in patients with metastatic airways disease. Although it provides improvement in symptoms, actual survival benefit is limited with severe potential complications. Appropriate patient selection in terms of site of tumor, type of stent placement is needed to achieve maximum benefit for patients. Here we will discuss 2 patients with advanced lung cancer who received bronchial stent for intractable dyspnea. Although there was dramatic improvement in symptoms and quality of life, both died shortly. Was there any benefit of stenting remained unanswered.

Opioids have become the gold standard for treatment of severe pain in advanced disease, but adverse effects can affect the quality of life. Opioid-induced bowel dysfunction can lead to refractory constipation. Methylnaltrexone bromide is a peripherally acting mu antagonist and is indicated for the treatment of opioid-induced constipation in patients with advanced illness, when response to standard laxative therapy has been inefficacious. This pharmacology update will review the etiology, pathophysiology, and treatment of opioid-induced constipation, focused on methylnaltrexone as a novel treatment for refractory cases.

Bakgrund: Amyotrofisk lateral skleros (ALS) är ett neurodegenerativt tillstånd som successivt drabbar många olika organsystem. Omvårdnad av patienter med ALS kräver att sjuksköterskor har kunskaper inom respiratorvård, rehabilitering, nutrition, sjukdomens motoriska- och sensoriska symtom, sjukdomens olika sjukdomsstadier samt hur sjukdomen påverkar patientens psykosociala tillstånd. Syfte: Syftet var att lyfta fram sjuksköterskors erfarenheter av omvårdnad i samband med ALS.Metod: Studien genomfördes som en allmän litteraturstudie med en induktiv ansats och baserades på en innehållsanalys av en artikel med mixad metod och åtta kvalitativa artiklar. Resultat: Innehållsanalysen resulterade i följande kategorier: sjuksköterskors erfarenheter kring sociala interaktioner kopplat till omvårdnaden av patienter med ALS sjukdom, sjuksköterskors erfarenheter kring omvårdnaden av patienter kopplat till patofysiologin av ALS sjukdom och sjuksköterskors erfarenheter kring den palliativa omvårdnaden av patienter med ALS sjukdom. Konklusion: Ett positivt förhållningssätt, samverkan i vårdteamet och evidensbaserad omvårdnad utgör en förutsättning för sjuksköterskor för att kunna ge säker- och personcentrerad vård till patienter med ALS. Patientens komplexa omvårdnadsbehov kräver många olika vårdmoment och utmanar sjuksköterskors yrkeskompetens. För att kunna stödja sjuksköterskan krävs mer forskning som ger djupare insyn i sjuksköterskans erfarenhet av omvårdnad i samband med ALS / Background: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative condition that develops gradually affecting many different organ systems. Care of patients with ALS h requires knowledge in respiratory care, rehabilitation, nutrition, the disease's motor and sensory symptoms, the disease's different stages of the disease and how the disease affects the patient's psychosocial condition. Aim: The aim was to highlight nurses' experiences of nursing in connection with ALS.Method: The study was conducted as a general literature study with an inductive approach based on a content analysis of an article with a mixed method and eight qualitative articles. Results: The content analysis resulted in the following categories: nurses' experiences regarding social interactions linked to the care of patients with ALS, nurses' experiences regarding the care of patients linked to the pathophysiology of ALS and nurses' experiences regarding palliative care of patients with ALS. Conclusion: A positive attitude, collaboration in the care team and evidence based nursing are prerequisites for nurses in order to provide safe and person-centered care for patients with ALS. The patient's complex nursing needs challenge nurses' professional competence. In order to support nurses, more research is required that provides a deeper insight into the nurse's experience in connection with ALS.

At the Third Turner Resource Network Symposium, a working group presented the results of collaborative discussions about the importance of autopsy in Turner syndrome (TS). Considerable gaps in understanding the causes of death in TS can only be closed by more frequent death investigations and autopsies. The presentation included an overview of autopsy methods, strategies for utilizing autopsy, and biobanking to address research questions about TS, and the role of palliative care in the context of autopsy. This review highlights strategies to promote autopsy and tissue donation, culminating with an action plan to increase autopsy rates in the TS community.

Bakgrund: Cancer är en folksjukdom som kan drabba alla individer, oavsett ålder eller kön. Det finns över 200 olika former av cancer, och prostatacancer och bröstcancer är de mest vanligt förekommande formerna. När sjukdomen spridit sig och inte längre går att bota behandlas cancerpatienten inom den palliativa vården. Syftet med palliativ vård är att lindra symtomen så mycket som möjligt så patienten mår bra och är smärtfri sista perioden i sitt liv. Syfte: Syftet med examensarbetet var att sammanställa sjuksköterskors upplevelser av att vårda cancerpatienter i ett palliativt skede. Metod: En litteraturöversikt enligt Fribergs metod och en kvalitativ studiedesign valdes för arbetet. Databassökningar gjordes på Pubmed och CINAHL, därefter kvalitet granskades de med hjälp av SBU:s mall, och slutligen analyserades artiklarna utifrån Fribergs innehållsanalys. Resultat: Resultaten bestod av två huvudkategorier och sex underkategorier. Resultatet visade att sjuksköterskorna upplevde det meningsfullt men emotionellt påfrestande att vårda cancerpatienter i ett palliativt skede. Flera organisatoriska faktorer som upplevdes vara essentiella för att en personcentrerad vård skulle kunna bedrivas fungerade inte optimalt.  Konklusion: Resultatet från föreliggande litteraturstudie ger en fördjupad förståelse av sjuksköterskors upplevelser av att vårda cancerpatienter i palliativt skede. Olika former av påfrestningar kan bidra till att sjuksköterskor känner sig ensamma och utsatta i sin arbetsmiljö, men genom att belysa dessa problem och upplevelser skapas möjligheter till förbättring av arbetsmiljön vilket i sin tur kan leda till ökad patientsäkerhet. / Background: Cancer is a common disease that can affect any individual, regardless of age or gender. There are over 200 different types of cancer, but lung cancer, prostate cancer and breast cancer are the most common cancers. When the disease spreads and is no longer treatable, the cancer patient is treated palliatively until the cancer patient dies. Palliative care involves treating the symptoms and to extend life as much as possible. Aim: The purpose is to describe nurses' experience of caring for cancer patients in a palliative stage Method: A literature review according to Friberg's method and a qualitative study design was used for the degree project. Database searches were performed on Pubmed and CINAHL, then quality articles were examined according to SBU:s template and analyzed based on the Fribergs (2017) model.   Results: The results were divided into two main categories and eight subcategories. The results showed that palliative care is an emotional, meaningful care but simultaneously exhausting. In addition, it was reported that the organizational factors were essential for a functioning palliative care, but which unfortunately was deficient in several different circumstances. Conclusion: The result of this literary study provides depth in understanding nurses’ experiences of caring for cancer patients during palliative care. Nurses may experience strain from work in different ways and this contributes to the nurses feeling alone and exposed. By shedding some light upon these issues and allowing these nurses to share their experience creates room for improvement in their working environment, which also leads to safer care for patients.

Bakgrund: Palliativ vård initieras då det inte längre går att bota en patient från sjukdom och ska verka stödjande och lindrande. Inom palliativ vård är smärta vanligt förekommande symtom hos patienter. Trots att det finns en god tillgång på farmakologisk smärtlindring till personer i livets slut, blir många av dessa patienter inte tillräckligt smärtlindrad. Tidigare forskning visar att omvårdnadsåtgärder har en smärtlindrande effekt. Syfte: Syftet är att utifrån aktuell forskning kartlägga omvårdnadsåtgärder som kan lindra smärta hos patienter som får palliativ vård. Metod: En litteraturöversikt grundad på 13 vetenskapliga artiklar av kvalitativ och kvantitativ ansats. Resultat: I resultatet framkom det fyra huvudteman. Dessa var; komplementär smärtlindring, omvårdnad, stöd och kommunikation samt vårdteamet. De komplementära åtgärderna lindrade smärta. Därutöver var copingstrategier effektivt för att avleda fokuset från smärtan. Även stöd och kommunikation var effektivt. Verksamma sjuksköterskor behövde mer stöd och kunskap för att tillgodose en effektiv och individanpassad smärtlindring. Konklusion: Det föreligger flertalet omvårdnadsåtgärder som har påvisat god smärtlindrande effekt för personer som erhåller palliativ vård. Dessa bör i syfte att uppnå en optimal smärtlindring sättas in som ett komplement till läkemedelsbehandling. Vidare behövs fler studier inom ämnet för att klargöra omvårdnadsåtgärdernas effekt på smärta i livets slutskede. / Background: Palliative care is initiated when it is no longer possible to cure a patient from disease and should have a supportive and alleviating effect. Pain is a common symptom in patients receiving palliative care. Although there is a wide range of pharmacological pain relief for people at the end of life, many of these patients are not sufficiently pain relieved. Previous research shows that nursing care have a painrelieving effect. Aim: The aim is, based on current research, to determine nursing care interventions that can relieve pain in patients receiving palliative care. Method: A literature review based on 13 scientific articles of qualitative and quantitative approach. Findings: The result revealed four main themes. These were; complementary pain relief, nursing, support and communication and the care team. The complementary measures relieved pain. In addition, coping strategies were effective in diverting focus from the pain. Support and communication were also effective. Nurses needed more support and knowledge to provide effective and individual-based pain relief. Conclusion: There are several nursing care interventions that have shown a good painrelieving effect for patients receiving palliative care. These should be used as a complement to pharmacological treatment in order to achieve optimal pain relief. Further studies in this field are required to clarify the nursing care interventions effect on pain in the end-of-life stage.

Background: Home health is the fastest-growing healthcare setting in the country. Through Home Health Value-Based Purchasing (HHVBP), the Center for Medicare and Medicaid Services (CMS) provides incentives or penalties to HHAs based on outcomes. Hospitalization and emergency department use are weighted heaviest as poor outcomes. HHVBP requires HHAs to report on whether they are engaging in advance care planning (ACP) conversations. For this study, ACP was defined as a conversation held in advance of a medical crisis with a loved one and/or a health care provider about goals; values; preferences for future medical treatments; and choice of a surrogate decision-maker. Purpose: to determine whether the proportion of Black patients was correlated with robustness of HHAs’ ACP protocols and levels of acute care services use. Methods: A cross-sectional, quasi-interventional design was used. The sample size was n = 89. Electronic surveys about ACP protocols were distributed to HHAs. Existing data about demographics and acute care services use were accessed via CMS websites. Spearman’s correlation coefficient was used. Results: No relationship was found between robustness of ACP protocols and the proportion of Black population per agency. No relationship was found between overall acute care services use rates proportion of Black patients. However, a trend was found: The greater proportion of Black patients, the greater the tendency for an agency to have a higher hospitalization rate. Discussion: Results are compared to current literature and to a CMS-commissioned study’s discussion about the potential for value-based purchasing programs to exacerbate health disparities in vulnerable populations.

Bakgrund: I takt med att andelen cancerfall ökar, ökar också andelen personer som vårdas palliativt. Palliativ vård syftar till att bibehålla en god livskvalité för patienten när den vårdas i livets slutskede. Sjuksköterskorna bidrar till detta genom att bilda en nära relation med patienten för att lättare kunna uppfylla eventuella önskningar som i sin tur bidrar till en värdig död. Vårdandet av palliativa cancerpatienter är alltså något som de flesta sjuksköterskor kommer att uppleva någon gång under sin verksamma tid, men som förknippas med många känslor hos vårdpersonalen. Därför kan det vara värdefullt att förbereda sig genom att lära av litteraturen.  Syfte: Att sammanställa sjuksköterskors upplevelser av att vårda patienter med en cancerdiagnos i ett palliativt skede.  Metod: Föreliggande studie är en litteraturstudie med kvalitativ ansats. Litteratursökningar genomfördes i Cumulative Index to Nursing and Allied Health Literature, PubMed och PsycInfo där studier valdes vilka kvalitetsgranskades och analyserades med Fribergs femstegsmodell.  Resultat: Totalt tio studier inkluderades. Analysen resulterade i tre huvudkategorier; Att sträva efter en värdig död, Att ha den unika patienten i centrum och Att värdesätta en nära relation. Huvudkategorierna består av sex subkategorier.  Konklusion: Sjuksköterskornas upplevelser av att vårda patienter med en cancerdiagnos palliativt påverkas av många faktorer. Positiva känslor och känslan av att vara uppskattad uppnåddes när patientens önskningar blev uppfyllda. Däremot upplevdes en inre stress och sorg när sjuksköterskorna kände att de misslyckades med detta. Dessa känslor kunde påverkas av hur nära relation sjuksköterskorna hade med patienterna. Personliga värderingar och tankar var något som frekvent nämndes påverka sjuksköterskorna under vårdandet av palliativa patienter. / Background: As cancer cases increases, so does the patients in palliative care. Palliative care aims to maintain a good quality of life for the patient when it is cared for at the end of life. The nurses contribute to this by forming a close relationship with the patient in order to be able to more easily fulfill any wishes which in turn contributes to a dignified death. The care of palliative cancer patients is thus something that most nurses will experience at some point during their active time, but which is associated with many emotions in the care staff. Therefore, it can be valuable to prepare by learning from the literature. Purpose: To review the literature on nurses’ experiences of caring for patients with a palliative cancer diagnosis. Method: The present study is a literature review with a qualitative approach. Literature searches were made in Cumulative Index to Nursing and Allied Health Literature, PubMed and PsycInfo where studies were chosen to be reviewed and analyzed using Fribergs five step-model. Results: The result were formed by three main categories; To strive for a dignified death, To have the unique patient in the center and To value a close relationship, consisting of six subcategories. Conclusion: Nurses' experiences of caring for patients with a palliative cancer diagnosis are affected by many factors. Positive emotions and the feeling of being appreciated were achieved when the patient's wishes were fulfilled. However, an inner stress and sadness was experienced when the nurses felt that they had failed with this. These feelings could be influenced by how close the nurses' relationship was with the patients. Personal values ​​and thoughts were something that was frequently mentioned to influence the nurses during the care of palliative patients.

In parallel with medical developments, the debate on euthanasia has gained new momentumin the Western world. Many countries have now legalized various forms of euthanasia, whileothers are investigating the issue. Euthanasia has been described as a difficult issue with manydimensions and worldwide there is no consensus among philosophers. The question ofeuthanasia may be relevant in the various cases where patients suffer and experienceunnecessary pain due to various diseases. The consequence of a bodily pain can lead toexistential thoughts about the meaning of life in these people. People who cannot find ameaningful continuation with their lives can express a wish to end their lives througheuthanasia. A literature review has been undertaken and various databases have been used inorder to search for scientific articles, debates and philosophical books. The purpose of thisthesis is to describe the state of knowledge about euthanasia and whether we should alloweuthanasia in Sweden. Four main arguments for and against euthanasia have been identified:1) the right to life, 2) the principle of autonomy, 3) the patient's best interests, and 4)euthanasia as a substitute for palliative care and the slippery slope argument.It is true that euthanasia poses a direct threat to the right to life and the sanctity of life. At thesame time the right to life can also be interpreted as having self-determination to end one's lifeat any time. A ban on euthanasia may benefit the right to life but it could mean an unwantedlife for many patients who suffer. A ban could also lead to a violation of personal integrity ofthe patient where they may experience not being taken seriously.There are, of course, several concerns and criticisms directed to a legalization of euthanasia.For example, patients who request euthanasia may be in a vulnerable position due to theirillness and/or lack of social or economic resources and therefore choose euthanasia. It canalso be that people would be pressured to request euthanasia. Another concern is that thelegalization of voluntary euthanasia could risk leading to the legalization of non-voluntaryeuthanasia, which means including other people in the euthanasia decision without their ownconsent. These risks are worth reflecting on and it is always difficult to balance the benefitsagainst risks concerning euthanasia. The best interests of the patient should be a guidingprinciple in decision-making in euthanasia and one should always try to reduce unnecessarysuffering.