Syftet med denna studie var att belysa vilka behov och önskemål som fanns hos anhöriga när deras närstående plötsligt avled samt vilka åtgärder sjuksköterskor kunde vidta för att tillgodose behoven hos anhöriga vid plötsliga dödsfall av närstående. Artiklarna i denna litteratur studie skulle vara vetenskapligt granskade och vara skrivna mellan åren 1993 och 2007. Urvalet begränsades till svensk och engelsk litteratur. Databaser som används var ELIN, Blackwell/Synergy, PubMed och EBSCO. Kvalitetsgranskning gjordes med hjälp av en modifierad granskningsmall. Anledningen till att författarna valde detta ämne var att de upplevde det svårt att bemöta efterlevande. När anhöriga drabbades av ett plötsligt dödsfall kunde deras liv vändas upp och ner och bli kaotiskt. I denna situation var det ofta sjuksköterskor anhöriga mötte först. Det framkom i flera studier att anhöriga känner ett stort behov av närhet, kommunikation, stöd och komfort. Anhöriga ville ha sanningsenlig och noggrann information om närståendes död. Många sjuksköterskor upplevde att det var svårt att bemöta anhöriga vid plötsliga dödsfall. Trots detta upplevde anhöriga att sjuksköterskor hade medkänsla och kunskap om den svåra krisen som drabbat dem. Sjuksköterskor gav information och lyssnade på anhöriga, detta bidrog till emotionellt stöd till anhöriga.

The sudden and unforeseen death of a family member is a major adjustment and traumatic crisis, characterized by loss of control, chaos and grief. Complications to a prolonged grief process include PTSD as well as other mental and somatic illness. This study aimed to describe the experience of people who have been suddenly and unexpectedly bereaved of a family member. A general literature review was conducted based on ten qualitative original articles. Thematic analysis was used to identify reoccurring elements in the results of the studies. This generated four themes; An unbearable time following the death; life forever changed – grief over time; memory preservation and social aspects. Directly following the death was a chaotic time marked by almost unbearable sorrow and pain. As time passed, the grief became more manageable for most study participants, although life would remain forever changed, and the grief became an integrated part of their new life. The occurrence of ritual-like behaviour to preserve the memory and relationship to the deceased was common both in the short and long term. Furthermore, the social aspects of bereavement experienced by the participants included both positive and negative reactions and behaviours from the surrounding network with varying effects on the participants experience of grief. The results of this study indicated that the process of grief after sudden and unforeseen loss of a family member is much like the phases of a crisis described in Cullberg’s crisis theory. The time following the death of a family member was described throughout the articles as a period of major grief and emotional turmoil. Participants learned to accept the loss with time, and although grief constantly remained present, it became increasingly manageable. Dealing with persons amidst the terrible grief of losing a family member unexpectedly is a great challenge for all health care professionals. This is evidence of a need to develop routines and guidelines on how to deliver the news of this nature.

Sammanfattning Bakgrund: Vid plötsligt dödsfall har närstående kort eller ingen tid till förberedelse. Detta kan påverka sorgeprocessen och risken för försämrad psykisk hälsa är hög. Sjuksköterskor bistår med stöd men bristande erfarenhet, otillräcklig bemanning och stressig arbetsmiljö kan försvåra stödinsatser. Syfte: Syftet var att beskriva närståendes erfarenheter av stöd från sjuksköterskor vid plötsligt dödsfall och att granska artiklarnas undersökningsgrupper. Metod: En beskrivande litteraturstudie med 13 vetenskapliga artiklar hämtade via databaserna PubMed, Cinahl samt genom manuella sökningar. Huvudresultat: Det stöd närstående efterfrågade från sjuksköterskor varierade. Informativa brister förknippades hos närstående med en ovilja hos sjuksköterskor att beröra svåra samtalsämnen. Sjukhusmiljön upplevdes främmande för många närstående, som kunde känna utanförskap. Genom gott bemötande, vägledning och inkludering av närstående i omvårdnaden skapades gemenskap. När närstående kände sig delaktiga och behövda skapades positiva känslor. När sjuksköterskor gav närstående chans att utnyttja den tid som fanns tillsammans med den döende och bistod med praktiskt stöd möjliggjordes kontinuerlig samvaro. Efter dödsfall kunde närstående känna sig övergivna. Ett avsked utan tidspress och inbjudan till uppföljning var betydelsefullt för närstående för att kunna gå vidare i livet. Slutsats: Erfarenhet av bristande information från sjuksköterskor var vanligt förekommande hos närstående, vilka även noterade om sjuksköterskor agerar undvikande i svåra situationer. Eftersom behovet av stöd varierar mellan närstående bör sjuksköterskor utgå från personcentrerade stödinsatser. Om sjuksköterskor får insikt i närståendes erfarenheter av stöd vid plötsligt dödsfall finns större möjligheter att kunna förbättra stödet för närstående i en sårbar situation. / Background: In a sudden death situation family members have little time for preparation. This can affect their process of grief and increase the risk of a negative psychological outcome. Nurses have the possibility of supporting the family, but lack of experience, shortage of staff, and a stressful environment can obstruct the support. Aim: The aim of this study was to describe family members’ experiences of support from nurses when a person dies a sudden death, and to investigate the sample groups of selected result studies. Method: A descriptive literature review, where 13 scientific articles were included. Articles were collected from the databases PubMed and Cinahl and through manual research. Main result: The type of support family members requested from nurses differed. Lack of information was associated with the nurses’ unwillingness to lift difficult topics. The hospital environment was an unfamiliar place for many family members, who could feel lost in the context. By including and guiding the family members, a feeling of becoming a team was generated. When the family members felt involved and needed, positive emotions evolved. When nurses gave practical support and created opportunities for family members to be close to the dying person, they could make use of precious time without interruption. After death occurred family members could feel abandoned. To be able to proceed in life, it was important that family members had enough time to say goodbye and were offered a follow-up meeting. Conclusion: Family members frequently experienced a lack of information from nurses and noticed if the nurse tried to avoid difficult situations. Acknowledging individual differences, makes it possible to apply person-centered support. If nurses gain knowledge of family members’ experiences of support on sudden death occasions, the nurses will have better chances of providing the support requested.

Background: There are approximately 45 000 people in the ages over 65 years dies outside the health facilities of the hospitals in Sweden in every year. Previous research has shown lacking knowledge in taking care of the next of kin during and after a sudden death. However, conducted research has emphasized that ambulance nurses often are the next of kin’s first contact with the health care system during sudden death at home. Research has also shown that the mourning of the next of kin is affected by the ambulance nurses’ way of announcing the next of kin when someone close dies. This is also affecting the ambulance nurses’ possibilities of moving on after the event. Aim: To describe ambulance nurse’s experiences of factors that affects the care of next of kin during sudden death at home. Method: A qualitative study using one focus group with convenience sample including seven participants. Inclusion criteria were that participants should be professional nurses with specialist training in prehospital care. All study participants should also have experience in the care of next of kin during sudden death at home. A manifest content analysis was used to analyze the data. Results: A total of five categories emerged; perceived demands and expectations, having experience and knowledge, to face mourning reactions of the next of kin, to be affected emotionally and finally the support from colleagues. Data indicated that the mourning of the next of kin is complex. However, data revealed that the ambulance nurse is affected by experience, knowledge and the support from colleagues. In the beginning of the career, the ambulance nurse experiences some uncertainty concerning the expectations of the next of kin. The emotional affection was dependent on personal experiences in the past and also on the specific circumstances with the next of kin and the deceased. Conclusion: This study revealed that the care of the next of kin during sudden death at home is highly affected by the experience and knowledge of the ambulance nurse. The emotional affection is dependent on past personal experiences and on the support from colleagues. The participants agreed on the importance of a respectful manner in the care of the patient and the next of kin.

Bakgrund: ​Akutsjukvården innebär speciella förutsättningar där hastiga beslut tas och medicinska prioriteringar måste göras. En familjemedlems plötsliga dödsfall kan få allvarliga konsekvenser för de anhöriga och de behöver rätt stöd i det akuta skeendet. Personcentrerad vård och dialog med anhöriga är en del av sjuksköterskans omvårdnadsansvar och etiska ansvar. Vårdpersonalen upplever i många fall organisatoriska hinder för att möta de anhöriga på ett adekvat sätt. Ovanstående gör det angeläget att undersöka hur kontakten med akutsjukvården upplevs för de anhöriga. Syfte: Syftet var att beskriva anhörigas upplevelse av akutsjukvården i samband med en familjemedlems plötsliga dödsfall. Metod: En litteraturöversikt baserad på tio vetenskapliga artiklar gjordes. Artikelsökningen gjordes i databaserna Cinahl Complete och Pubmed som innehåller artiklar relaterad till vårdvetenskap, medicin och hälsa. Resultat: ​Löpande information under det akuta skeendet värderades högt och var ofta bristfällig. De anhöriga var känsliga för vårdpersonalens tonfall, kroppsspråk och ansiktsmimik samtidigt som de hade svårt att ta in information och overklighetskänslor var vanligt. Det fysiska rummet spelade också roll. Akutmottagningen upplevdes som en kaosartad plats som många gånger inte var lämplig för ett värdigt farväl efter dödens inträffande. Slutsats: Att förstå de anhörigas upplevelser och behov är essentiellt för att kunna möta dem där de befinner sig i dessa extrema situationer. Brist på information, hur kommunikationen såg ut, att bevittna återupplivningar och vårdmiljön var alla framträdande aspekter av de anhörigas upplevelser. Dessa bör vårdpersonal vara uppmärksamma på i mötet med de anhöriga för att de ska kunna bli delaktiga och för att möjliggöra ett värdigt avslut. / Background: ​Emergency medical care and emergency departments constitute an environment where rapid decisions and medical priorities need to be made. The sudden death of a family member can have great consequenses on the bereaved. Person-centered  care and dialog with the family is a part of the nurse‘s professional and ethical responsibility. Health personnel often experience organizational obstacles for providing adequate care for the family members. The above mentioned makes it relevant to explore how the contact with the emergency medical service and emergency departments is experienced by the surviving relatives.​ Aim: The aim was to describe relatives’ experiences of emergency medical care and emergency departments when a family member died suddenly. Method: A litterature review based on ten academic journals was made. Studies were searched from Cinahl Complete and Pubmed which contain academic journals within the topics of nursing, medicine and health. Results: Ongoing information during the acute phase was important but often not given to a satisfactory degree. They were highly sensitive to a sundry of signals such the tone of voice, body language and facial expressions of the health personnel at the same time as being unable to process information adequately and often described feelings of dissociation from reality. The physical space also weighed in. The emergency department was perceived as a chaotic place not suited for a dignified last goodbye to the deceased family member. Summary: Understanding the experiences and needs of the relatives is essential to be able to meet them where they are in these extreme situations. Lack of information, the way communication is expressed, witnessing resuscitation as well as the physical sorroundings were all prominent aspects of the relatives’ experiences. Health personnel should be attentive to these aspects in order to be able to enable participation and to make a dignified last goodbye possible for the relatives.