Palliativ omvårdnad är något de flesta sjuksköterskor kommer i kontakt med under sitt yrkesverksamma liv. Syftet med litteraturstudien var att belysa upplevelser i omvårdnaden ur ett patientperspektiv.  Nio artiklar valdes för granskning, ur artiklarnas resultat framkom sex teman: Upplevelser av; omvårdnadsrelationer, kommunikation och information, vårdmiljön, symtomkontroll, tillgänglighet och självbestämmande. I resultatet framkom att en förtroendefull relation och kommunikation skapade god omvårdnad. Brister i kommunikationen kunde även förekomma. En bra sjuksköterska upplevdes som någon som lyssnade och hade bred kunskap. Patienter ville vara delaktiga i sin vård och behandling. / Palliative care is something most nurses are dealing with during their working lives. The purpose of this study was to illuminate the experiences of nursing care from a patient perspective. Nine articles were selected for review, from the articles six themes revealed: Experiences of; nursing relationships, communication and information, the care environment, symptom control, accessibility and self-determination. The result showed that a relationship of trust and communication created good nursing care. Lack of communication could also occur. A good nurse was perceived as someone who listened and had broad knowledge. Patients wanted to be involved in their care and treatment.

När patienten önskar att få avsluta sitt liv i hemmet krävs det att den avancerade vården också flyttas till hemmet. Distriktssköterskor har övergripande omvårdnadsansvar inom palliativ hemsjukvård och kan uppleva etiska, moraliska och kommunikativa svårigheter. För en god palliativ omvårdnad krävs det att distriktssköterskor är engagerade, har erfarenhet och har avancerad kompetens inom palliativ vård. Syftet med denna studie är att belysa distriktssköterskors erfarenheter av att vårda patienter i livets slutskede inom palliativ hemsjukvård. Nio distriktssköterskor intervjuades. För att analysera data användes en kvalitativ innehållsanalys med induktiv ansats. Analysen resulterade i fyra teman med tillhörande åtta underteman. Teman benämns; Kunna samarbeta och samverka i vården, Kunna vårda anhöriga, Kunna hantera negativa känslor och Skapa en god vårdmiljö. Slutsatsen blev att, ett bra teamarbete är viktigt för distriktssköterskor men att ha olika vårdaktörer kan försvåra vårdarbetet. Det är viktigt för distriktssköterskor att kunna möta anhöriga och ta emot sorg då sorgen kunde komma som missnöje. Detta kan påverka vårdpersonalen negativt. Det är viktigt att distriktssköterskor får stöd vid känsla av otillräcklighet och känslomässiga reaktioner. Fortsatt forskning kan riktas ur anhörigas synvinkel för att kunna förstå anhörigas reaktioner. / When the patient wishes to die at their own home requires that the advanced care also moved to their home. District nurses have primary care responsibilities in palliative home care and may experience ethical, moral and communicative difficulties. For a good palliative care requires that district nurses is involved, have the experience and have advanced skills in palliative care. The purpose of this study is to illuminate district nurses' experiences of caring for patients in the final stage in palliative home care. Nine district nurses were interviewed. To analyze the data, a qualitative content analysis with an inductive approach was applied. The analysis resulted in four main themes with its eight sub- themes. Main themes titled; Being able to collaborate and cooperate in care, Being able to care for relatives, Being able to manage negative emotions and Able to create a good care environment. The conclusion was that, a good teamwork is important for district nurses but having different care providers can complicate caring. It is important for district nurses to meet relatives and receive grief when grief could come as dissatisfaction. This could affect the nursing staff negatively. It is important that district nurses are supported in the sense of inadequacy and emotional reactions. Further research may be aimed at relatives ' point of view in order to understand family members' reactions.

People with advanced cancer may have significant challenges to their physical, emotional, spiritual, and social well-being. However, some individuals are able to experience an overall sense of well-being in spite of these challenges. This study sought to understand the experience of well-being from the perspective of people with advanced cancer. Guided by interpretive descriptive methodology, eight participants were interviewed and the data were analyzed using the constant comparative approach. The participants took an active role in their well-being experience and described four main themes: view of self, the fluctuating nature of well-being, choices made to enhance well-being (including choosing supportive relationships, putting one‟s own needs first, treatments, focusing on the positive, and honoring the negative), and living in ambiguity. These findings have implications for nursing practice, nursing education, and health care organizations. / Graduate

Background: When a patient suffer from a disease and is in need of palliative care, it is normal to have existential questions and thoughts. For some patients these questions can be painful and the nurse need to have knowledge about dealing with these kind of questions and thoughts to be able to relieve and/or prevent this kind of suffering. Aim: The aim was to describe how the nurse can prevent the existential suffering among patients with palliative care. Method: A literature-based study was based on eight qualitative studies. Results: The results showed that nurses meet patients in the palliative care environment which may suffer from existential problems when their questions and thoughts don´t get answered. It showed that the most important a nurse can do is to give time to these calls and build up a safe relation to the patient. This allows the nurse to read the patients existential questions and observing possibly suffering. The result is organized in two categories "To see and confirm" and " To listen and give support" and see subcategories " Use body language", " Create reliable relationship", respond to the existential questions", "Give the patient time", " take help from others in hard situations" and "to focus on other things" Conclusion: It is easy to only focus on the physical illness while caring for a patient and believe that it is creating suffering. Extensive human suffering is not shown at first sight although it is just as important to relieve.

Årligen avlider cirka 90 000 personer i Sverige, varav 80 % är i behov av palliativ vård. Den palliativa vården bedrevs tidigare till större del på sjukhus men forskning påvisar att fler idag önskar att dö i det egna hemmet. I takt med att befolkningen blir äldre ökar kraven på den palliativa vården. För att kunna ge palliativa patienter omvårdnad av god kvalitet är det viktigt att sjuksköterskan innehar fördjupad kunskap kring arbetets innebörd. Syftet med studien var att beskriva sjuksköterskors erfarenheter av att utföra palliativ omvårdnad i hemmet. En systematisk litteraturstudie genomfördes och elva kvalitativa vetenskapliga artiklar valdes ut. Resultatet mynnade ut i fyra kategorier: Vårda i någon annans hem, Samspel med patienten och dess anhöriga, Vårdorganisationens påverkan på omvårdnaden samt Stöd och teamarbete. Resultatet visade att omvårdnad i patienters hem ansågs vara ett privilegium men krävde mycket från sjuksköterskornas egna känslor. Samarbete och goda relationer mellan sjuksköterska, patient och anhöriga var viktiga faktorer för god omvårdnad. Stress och tidsbrist påverkade omvårdnaden negativt medan samarbete i team upplevdes positivt. Att få stöd ansågs även viktigt. Ytterligare forskning kring vårdformen krävs för att synliggöra de krav och utmaningar sjuksköterskan ställs inför, samt för att främja omvårdnad av god kvalitet. / Approximately 90 000 people die annually in Sweden, and 80 % are in need of palliative care. Palliative care was previously mostly conducted in hospitals. Research today shows that more people wish to die in their own homes. As the population gets older the demands for palliative care are increasing. In order to provide palliative care of good quality, it’s important that the nurse has knowledge about the meaning of the work. The aim was to describe nurses' experiences of performing palliative care in the home. A systematic literature review was conducted and eleven qualitative scientific articles were selected. The result culminated in four categories: Nursing in another person’s home, Interaction with the patient and their next-of-kins, The caring organization’s impact on the nursing care and Support and teamwork. The result showed that nursing in the patient’s home was seen as a privilege but demanded a lot from the nurses' own feelings. Cooperation and good relations between the nurse, patient and their next-of-kins were important factors for good care. Stress and lack of time affected the care negatively, while cooperating in teams was experienced positively. To get support was also seen as an important part. Further research about this caring form is required to make the demands and challenges of the nurse visible, as well as to promote care of good quality.

Syftet med litteraturöversikten var att belysa kommunikationen inom den palliativa vården samt vilka copingstrategier sjuksköterskan använder sig av. Studien genomfördes som en litteraturöversikt där resultatet baseras på 15 artiklar genomförda i totalt åtta olika länder. Artiklar söktes i databaserna CINAHL, PubMed, Vård i Norden och PsykINFO. Teman som framkom i resultatet var kommunikation och copingstrategier följt av fyra respektive fem subteman. Resultatet visar att kommunikationen är central i den palliativa vården. Utbildning var grunden till att sjuksköterskan utvecklade ett bra förhållningssätt inom kommunikation och copingstrategier. Tidigare erfarenheter påverkade copingstrategier och kommunikationsfärdigheter i den palliativa vården. Tid för reflektion var något som sjuksköterskor tyckte var viktigt i bearbetningen av svåra situationer. Sjuksköterskan bör vara medveten om copingstrategier och dess påverkan för en god empatisk omvårdnad samt för sin egen hälsa. Tid för reflektion tillsammans med kollegor bör appliceras på varje arbetsplats inom hälso och sjukvården.

Šiame darbe pirmą kartą šalyje moksliškai siekiama ištirti paliatyviųjų onkologinių ir širdies ligomis sergančiųjų fizinius, psichologinius, socialinius sutrikimus bei jų ryšį su dvasingumo pokyčiais ligos metu. Darbo tikslas - nustatyti ir įvertinti paliatyviųjų pacientų sergančių onkologinėmis ir širdies ligomis fizinės, socialinės, psichinės ir dvasinės sveikatos sutrikimus ir jų sąsajas su dvasingumu. Tyrimas atliktas 5 stacionaruose, teikiančiose paliatyvią pagalbą. Tyrimas atskleidė, kad onkologinėmis ligomis sergantiems paliatyviesiems pacientams dažniausias pasireiškia: skausmas, nuovargis, fizinis silpnumas, energijos stoka, apetito sumažėjimas, svorio kritimas. Širdies ligomis sergantiems paliatyviesiems pacientams dažniausiai pasireiškia: fizinis silpnumas, dusulys, kojų tinimas, energijos netekimas, skausmas krūtinėje, nemiga. Onkologinė liga dažniau stresą sukelia jaunesnio amžiaus pacientų šeimoms. Sergantieji širdies ligomis dažniau jaučiasi izoliuoti nuo šeimos. Didžiajai daugumai onkologinių ir širdies ligomis sergančių paliatyvių pacientams nustatytas nerimastingumas ir depresiškumas, kurie nepriklauso nuo lyties, amžiaus ir išsimokslinimo. Dauguma onkologinių pacientų jaučia Dievo buvimą, viliasi išganymo iš Jėzaus Kristaus, meldžiasi už sergančius ir jaučia gilią vidinę ramybę. Moterys intensyviau išgyvena Dievo buvimą ir laikosi bažnyčios dvasinių dorybių. Dauguma sergančiųjų širdies ligomis taip pat jaučia Dievo buvimą, tačiau teigia, kad Dievas su jais... [toliau žr. visą tekstą] / There are numerous articles in the scientific literature that describe the quality of life of palliative care patients at the physical, psychological, and social levels and that mainly analyze the impact of pain control and other somatic symptoms on quality of life. However, the studies being carried out confirm that a problem in palliative care appears to be multidimensional. Most investigators emphasize only particular aspects of this problem, mostly physical, and the impact of spiritual disorders on patients’ physical symptoms as well as social and psychological health problems has not been sufficiently addressed. Spiritual health disorders often remain unrecognized due to the lack of healthcare professionals’ knowledge, or no attention at all is paid to spiritual health disorders. Thus, spiritual support is necessary in order the patient could manage a crisis and improve quality of life. The lack of such a universal theory confirms the need of further interdisciplinary holistic research, addressing not only physical, psychological, and social health problems, but spiritual health aspects as well. Therefore, it is very important to scientifically ground what physical, psychological, and social demands are and what association between them and spiritual demands is, how the patient evaluates suffering and life, whether a religious belief helps while being ill, and what the patient’s attitude toward God and hope is. This research was the first in Lithuania to analyze physical... [to full text]

Den palliativa vården även kallad vård vid livets slutskede, innebar stora omställningar för patienter, vilket skapade ett intresse att belysa copingstrategier patienter använder sig av i palliativ vård. Målet med problemformuleringen var att utreda hur patienter upplever sina copingstrategier och hur sjuksköterskor bäst kan stödja patienter med sina copingstrategier. Syftet med föreliggande litteraturstudie var att belysa patienters copingstrategier i palliativ vård. Som en metod utfördes en systematisk litteraturstudie, innehållande 12 vetenskapliga artiklar. Resultatet framhöll copingstrategierna: undvikande, att känna hopp och tro, samt  behovet av stöd. Några patienter undvek relationer med närstående och vänner, som ett sätt att hantera sin situation. Andra kände hopp med hjälp av positiva tankar och positiv energi från andra människor. Den spirituella delen hade en betydelsefull roll för patienter vid livets slutskede. Sjuksköterskornas stöd var viktigt och patienterna behövde samtalshjälp för att utveckla copingstrategier och hantera de känslor och tankar som uppstod. Resultatet visade också att sjuksköterskorna inte alltid lyckades förstå och hjälpa patienterna på bästa sätt. Vidare forskning i ämnet kan utveckla kunskapen om hur sjuksköterskor bäst kan hjälpa patienter med sina copingstrategier. / Palliative care is also called care at the end of life, meant great changes for the patients, and thereby the interest fell in how patients handled coping strategies in the palliative care. The formulation of the problem was aimed at investigating how patients experienced their coping strategies and how nurse`s could best support patients with their coping strategies. The aim of the present study was to illustrate patients coping strategies in the palliative care. The method was a systematic literature review with 12 scientific articles. The results pointed to the coping strategies: avoidance, to have hope and faith, and the need for support. Studies showed that some patients avoided relationships with the family and friends, it was a way to cope with their situation. Others could feel hope through positive thoughts and positive people and that the spiritual path was shown to have an important role for patients at the end of life. Nursing support was important and patients needed supportive conversations to develop their coping strategies, and manage the emotions and thoughts that arose. The results also showed that nurses did not always managed to understand and help the patients in the best way. Further research on the topic can develop knowledge about how nurses can best help patients with their coping strategies.

Although the curative model of medical care is predominant it is necessary to consider the palliative strategies at the end-of-life. The inter-relation of dying children, their families and pediatric palliative care teams are seldom analyzed outside Palliative Care. However, it is important to ethnographically think about the disturbing experiences of body and subject disintegration while people are directly experiencing them, even when the person is a child or a newborn baby. A central topic in this study is how personhood, body formation and disintegration, and childhood can be understood within the context of unevenly constructed and shared palliative communication with and without words. Hence, I analyze in this study how a Palliative Care Team in the city of Buenos Aires provides care, communicates, and ultimately produces a particular companionship to dying children and their families. This work is built on qualitative information gathered and produced during my four-month fieldwork with the Palliative Care Team. The ethnographic techniques (participant observation, non-participant observation and open-ended semi-structured interviews) I conducted show that their strategies of care and communication have as the main goal the process of companionship at the end of children’s lives. It is necessary to understand how patients, parents, and other family members are situated in this field of tensions between restorative and palliative medicine, and brought into this culture of Palliative Care in a public children’s hospital. My research asks, in what ways are pediatric Palliative Care practices exclusive to the social and cultural contexts of Buenos Aires? This work has three main sections: 1. care, 2. communication, and 3. companionship. In section one I focus on the clinical and non-clinical aspects of care involving the professionals’ and volunteers’ practices of giving care. In section two I concentrate my attention on the verbal and non-verbal aspects of the Palliative Care Team communication with children and families. In section three I consider the professional production of ‘companionship’. In this thesis I will demonstrate the significance of this concept according to the Palliative Care Team members and how care and communication are the base for the ‘production of companionship.’

Lic.-avhandling (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 2 uppsatser.