Contexto: a eficácia dos inibidores da 3-hidróxi-3-metilglutaril-coenzima (HMG-CoA) redutase (estatinas) na prevenção primária e secundária na doença cardiovascular é bem estabelecida na literatura. Contudo os benefícios destes fármacos na prevenção secundária de mortalidade e eventos cardiovasculares no paciente com Síndrome Coronariana Aguda (SCA), ainda não foram completamente esclarecidos. Objetivo: analisar os benefícios do uso das estatinas comparadas a placebo ou cuidados usuais nos pacientes com SCA quanto a redução de mortalidade (por todas as causas), infarto agudo do miocárdio (fatal e não-fatal), intervenção coronária percutânea, revascularização cirúrgica do miocárdio e hospitalização. Base de Dados: trata-se de uma revisão sistemática finalizada em 29 de Janeiro de 2012, cuja seleção dos ensaios clínicos controlados e randomizados (ECCR) foi realizada nas bases de dados eletrônicas PubMed/MEDLINE, EMBASE, Cochrane Central, LILACS e Banco de Teses - CAPES. Coleta de Dados: a extração das informações sobre características basais dos estudos incluídos, avaliação da qualidade metodológica e desfechos não combinados foi realizada por dois investigadores de forma independente. Resultados: foram incluídos na metanálise 18 ECCR, que envolveram 15.370 pacientes com SCA. O uso das estatinas mostrou benefício na redução da mortalidade por todas as causas, diferença de risco (rd) = -0,0066 (IC 95% -0,0121 a -0,001; P=0,8459; I2=0%) e hospitalização rd = -0,0101 (IC 95% -0,0188 a -0,0014; P=2,1496; I2=76%). Quanto aos desfechos mortalidade cardiovascular, infarto agudo do miocárdio fatal e não fatal, intervenção coronária percutânea e revascularização cirúrgica do miocárdio não houve diferença estatisticamente significante entre os grupos estatinas versus placebo ou cuidados usuais. Conclusões: as evidências disponíveis apontam que as estatinas causam redução na mortalidade por todas as causas e na hospitalização, porém não demonstram diferença quando comparadas ao placebo ou cuidados usuais em outros eventos de importante magnitude clínica e econômica no âmbito dos serviços de saúde e da sociedade. / Context: the effectiveness of inhibitors of 3-Hydroxy-3-methylglutaryl-Coenzyme (HMG-CoA) reductase (statins) in primary and secondary prevention of cardiovascular disease is well established in the literature. However, the benefits of these drugs in secondary prevention of mortality and cardiovascular events in patients with Acute Coronary Syndrome (ACS) have still not been fully clarified. Objective: to analyze the benefits of using statins compared to placebo or usual care in patients with SCA on the reduction of mortality (from all causes), myocardial infarction (fatal and non-fatal), percutaneous coronary intervention, revascularization and hospitalization. Database: this is a systematic review completed on January 29, 2012, whose selection of randomized and controlled clinical trials (ECCR) was held in electronic databases MEDLINE, EMBASE, PubMed/Cochrane Central, LILACS and Theses database-CAPES. Data collection: two researchers performed the extraction of information about Basal characteristics of included studies, evaluation of methodological quality and outcomes not independently combined. Results: were included in the meta-analysis, involving 18 ECCR 15,370 patients with SCA. The use of statins has shown benefit in reducing mortality from all causes, risk difference (rd) = -0.0066 (CI 95% -0.0121 to -0.001; P = 0.8459; I2 = 0%) and hospitalization rd = -0.0101 (CI 95% -0.0188 to -0.0014; P = 2.1496; I2 = 76%). As to cardiovascular, myocardial infarction fatal and non-fatal coronary intervention, and percutaneous revascularization mortality outcomes, there was no statistically significant difference between the groups statins versus placebo or usual care. Conclusions: the available evidence suggests that statins cause a reduction in mortality from all causes and hospitalization, but do not demonstrate difference when compared to placebo or usual care in other important events within cost-effective clinic and economic magnitude of health services and society.

Os conectores sem agulhas foram introduzidos para redução de incidência de acidentes pérfuro-cortantes nos profissionais da área da saúde e a literatura apresenta evidências irrefutáveis sobre este aspecto. No entanto, não há evidências conclusivas sobre as vantagens do conector sem agulha para o paciente, no que se referem aos índices de infecção de corrente sanguínea relacionada ao cateter venoso central. Este estudo tem como objetivo evidenciar o impacto do uso de conectores sem agulhas para sistema fechado de infusão na ocorrência de infecção de corrente sanguínea relacionada ao cateter venoso central por meio de revisão sistemática, desenvolvida conforme as recomendações propostas pela Colaboração Cochrane. A estratégia de busca nas bases de dados eletrônicas utilizou os componentes do PICO: População (estudos com pacientes em uso de cateter venoso central, independente de idade, sexo, etnia e serviço de saúde vinculado); Intervenção (uso de conectores de sistema fechado sem agulhas, não-valvulados, valvulados, com pressão positiva ou não); Comparação (uso de oclusores, conectores de sistema fechado com ou sem agulhas, não-valvulados, valvulados, com pressão positiva ou não); Outcome-desfecho (infecção de corrente sanguínea, contaminação do canhão, contaminação microbiana, infecção de corrente sanguínea relacionada ao cateter). As bases eletrônicas investigadas foram: PubMEDLINE, OVID, EMBASE, LILACS, CINAHL. Também foram avaliadas as referências bibliográficas dos estudos incluídos. Os resultados estão apresentados em três etapas: caracterização do processo de seleção dos estudos encontrados na busca; caracterização dos estudos incluídos para a revisão sistemática (RS); avaliação de qualidade e força da evidência dos estudos incluídos segundo a Escala de Jadad e a Escala de avaliação de qualidade dos estudos na área de Controle e Prevenção de Infecção de Corrente Sanguínea Relacionada ao cateter Venoso Central. A amostra desta revisão sistemática constitui-se de 14 estudos, e quatro investigaram somente conectores sem agulhas. Foram encontrados 6 ensaios clínicos controlados randomizados, 4 coortes, 3 caso-controle e 1 resultado terapêutico. A infecção de corrente sanguínea relacionada ao cateter venoso central foi o desfecho de 9 estudos. Seis apresentaram diferenças a favor do conector valvulado; 04 a favor do conector puncionável com cânula; 01 a favor do conector puncionável com agulha; 01 a favor do conector valvulado com pressão positiva e 02 a favor do dispositivo usado antes da troca. A heterogeneidade dos estudos quanto aos desenhos de pesquisa, as características das populações e os fatores de riscos controlados e os resultados, não permitem a realização de meta-análise, contudo, é possível afirmar, com base nos quatro melhores estudos encontrados, que a implantação de conectores sem agulhas, quer valvulados ou com injetor pré-furado, com manutenção de sistema fechado de infusão, apresentam impacto positivo relacionado à menor contaminação do canhão do cateter ou na ocorrência de infecção de corrente sanguínea relacionada ao cateter venoso central / Needleless connectors were introduced to reduce the incidence of needlestick injuries in health professionals and according to the literature their effectiveness is irrefutable. However, there is no conclusive evidence on the advantages of needleless connectors for patients with regard to bloodstream infection rates from the use of central venous catheters. The objective of this study was to determine the impact of the use of needleless connectors in closed infusion systems on the occurrence of bloodstream infections related to the use of central venous catheters by conducting a Cochrane systematic review. The strategy for searching electronic databases employed the components of the PICO model: Population (studies of patients using central venous catheters, regardless of age, sex, race and associated health service); Intervention (use of closed needleless connector systems, with and without valves, with and without positive pressure); Comparison (use of plugs, closed system connectors with and without needles, with and without valves, with and without positive pressure); Outcome (bloodstream infection, cannula contamination, microbial contamination, bloodstream infection related to catheter). The electronic databases investigated were: PubMEDLINE, OVID, EMBASE, LILACS and CINAHL. Bibliographical references of the studies included were also evaluated. The results are presented in three stages: characterization of selection process for studies found in the search; characterization of studies included in the systematic revision; evaluation of quality and strength of evidence for studies included according to the Jadad Scale and the scale of quality of studies in the control and prevention of bloodstream infections related to central venous catheters. The sample of this systematic review was made up of 14 studies of which 4 investigated only needleless connectors. We found 6 randomized control clinical trials, 4 cohort, 3 case-control and 1 therapeutic result. Bloodstream infection related to central venous catheters was the outcome for 9 studies. Six presented differences regarding the valved connector; 04 in favor of the puncturable connector with cannula; 01 in favor of the puncturable connector with needle; 01 in favor of the valved connector with positive pressure and 02 in favor of the device used before the change. The heterogeneous nature of the studies with regard to design, population characteristics and controlled risk factors and results prevented a meta-analysis. However, it is possible to state, based on the four best studies found, that the introduction of needleless connectors, whether valved or puncturable with cannula, coupled with a closed infusion system, presented a positive impact on lowering contamination of catheter cannulae and on the occurrence of bloodstream infection related to central venous catheters

A sociedade, em suas múltiplas dimensões, tem estado em constante construção de uma nova realidade. Valores, ideias e paradigmas se a lternam em \"des\" e \"reconstrução\" daquilo que a sustenta e norteia. A Reforma Sanitária se torna um movimento específico, porém contextualizado num processo de redemocratiz ação política da sociedade brasileira. Esse movimento, além de representar uma luta específica pelo modelo de atenção à saúde, também é parte de uma totalidade, uma vez que consolidava, na saúde, os direitos democráticos debatidos por diversos setores da sociedade brasileira. A busca por um novo desenho do cuidado da saúde pela sociedade se dá a partir dos princípios e dire trizes fundamentais do Sistema Único de Saúde, uma vez que estes, além de garantir um novo modelo de atenção, possibilitariam as bases para um modelo de gestão mais participativo que daria condições de continuidade deste movimento. Nesse contexto, a enfermagem carece de um processo de atualização em seus conceitos e arranjos. Pr ecisa permitir que as transformações sociais colaborem na construção do perfil profissional que se necessita para que se garanta a \"continuidade\" no processo natural de mudanças das políticas públicas que requerem, dentre outras, \"flexibilidade e criatividade\" por parte dos trabalhadores. Este estudo teve como objetivo analisar a Gestão Participativa, no contexto do Sistema Único de Saúde, à luz das evidências científicas, visando a identificação de categorias relevantes na construção do processo do trabalho em enfermagem. Para atender aos objetivos deste estudo, foi realizada a revisão integrativa da lite ratura existente que propo rcionou um aprofundamento no conhecimento dessa temática e deu condições para o desenvolvimento de um conceito próprio. A leitura dos artigos selecionados seguiu a proposta da análise temática de conteúdo, segundo Minayo, e alguns temas emergiram da leitura, de modo que eles representam alguns aspectos importantes do Trabalho em Enfermagem no contexto da Gestão Participativa. Desta forma, identificou-se os seguintes temas nas amostras selecionadas: Reorientação da Prática Assistencial, Sobrecarga de Trabalho, Gestão Ética, Participação, Liderança, Administração de Conflitos, Qualificação Profissional, Formação Política e Flexibilização das Relações. Conclui-se que a enfermagem necessita de uma reorientação sistemática de seu processo de trabalho de modo que possa se alinhar com a política pública da Gestão Participativa e alcançar os benefícios desta gestão no perfil de seus trabalhadores. / The society, in its multiple dimensions, has been in constant construction of a new reality. Values, ideas and paradigms alternate in \"des\" and \"reconstruction\" of what sustains and guides. The Sanitary Reform becomes a particul ar movement, but contextualized in a process of political democratization of Brazilian society. This movement represents a struggle for specific model of health care and is also part of a totality, since consolidated in health, democratic rights debated by various sectors of Brazilian society. The search for a new design of health care by society starts from the fundame ntal principles and guidelines of the Unified Health System, since these, in addition to ensure a new model of care, would allow the foundation for a more participatory management model which would enable the continuation of this movement. In this context, nursing lacks a process to update its concepts and arrangements and needs to allow social change to collaborate in building the profile that is needed to ensure the \"continuity\" in the natural process of changing public policies that require, among other things, \"fle xibility and creativity\" by wo rkers. This study aimed to analyze the participatory management in the cont ext of the Unified Health System, in light of the scientific evidence for the identification of relevant categories in the construction process of nursing work. To meet the objectives of this study, we performed an integrative review of existing literature that provided a deeper knowle dge of thematic and gave conditions for the development of a specific concept. The reading of the articles followed the proposal of thematic content analysis, by Minayo, and some themes emerged from the reading, so that they represent some important aspects of nursing work in the context of Participatory Management. Thus, we identified the following themes in the selected samples: Reorientation of Care Practice, Work Overload, Ethics Ma nagement, Participation, Leadership, Conflict Management, Professional Qualification, Political Education, and Flexibilization of the Relations. It is concluded that nursing requires a systematic reorientation of their work process, so that it can align itself with the public policy of participatory management and achieve the benefits of this management in the profile of their workers.

Introdução: A nutrição e o estado nutricional maternos na gestação relacionam-se à saúde da mãe e do recém-nascido. O selênio (Se), mineral conhecido especialmente por sua atividade antioxidante, reduz o dano oxidativo celular e tem importante papel no sistema imunológico e no metabolismo tireoidiano. Recentemente, sugeriu-se ainda sua ação como insulino-mimético. Objetivo: Avaliar os efeitos da suplementação de Se durante a gestação sobre a saúde da mulher e do recém-nascido. Métodos: Foi realizada uma revisão sistemática de literatura na qual incluíram-se estudos com qualquer tipo de desenho metodológico que avaliassem a suplementação de Se isolado em gestantes, independentemente de suas condições de saúde e nutrição, da presença de complicações ou de tratamentos medicamentosos, comparada à administração de placebo ou nenhuma intervenção. Realizou-se a avaliação da qualidade metodológica dos estudos selecionados. Os resultados dessa revisão são apresentados de forma narrativa. Resultados: Quatro estudos foram incluídos. Em três as concentrações plasmáticas ou séricas de Se foram estatisticamente maiores em gestantes suplementadas. Um estudo concluiu que gestantes suplementadas apresentaram maior atividade de glutationa peroxidase. Dois estudos referem aumento estatisticamente significante das concentrações de Se no leite materno de gestantes suplementadas e um verificou concentrações estatisticamente maiores de ácidos monoinsaturados 18:2(n-6) e 20:4(n-6) e de poliinsaturados n-6, enquanto a somatória de ácidos graxos saturados foi estatisticamente inferior. O estudo que avaliou morbidade materna, desfechos gestacionais adversos, efeitos colaterais da suplementação, peso ao nascer e escore de APGAR não encontrou efeitos estatisticamente significantes da suplementação. Conclusão: Não existem evidências robustas dos efeitos da suplementação com selênio durante a gestação sobre a saúde da mãe e/ou do recém-nascido. Mais estudos com populações menos específicas e maiores tamanhos amostrais são necessários para que se identifiquem evidências da suplementação na morbidade e mortalidade maternas e do recém-nascido / Background: Maternal nutrition and nutritional status during pregnancy are related to maternal and newborn health. Selenium (Se), a mineral well known for its antioxidant activity, reduces oxidative cell damage and plays an important role in immune system and thyroid metabolism. Moreover, an insulin-mimetic action has been recently suggested. Objective: To assess the effects of Se supplementation during pregnancy on maternal and newborn health. Methods: A systematic review of literature was carried out. Studies of any design assessing Se supplementation alone to pregnant women, regardless of their health or nutritional status, of the presence of complications or medical treatment, compared to placebo or no intervention. Methodological quality of studies was appraised. The results of this study are presented in a narrative form. Results: Four studies were included. Three of them found plasma or serum Se levels significantly higher in supplemented pregnant women. One study showed that supplemented pregnant women had significantly higher glutathione peroxidase activity. Two studies referred that Se levels in maternal milk were significantly increased in supplemented women. One study found significantly higher 18:2(n-6) and 20:4(n-6) monounsaturated and n-6 polyunsaturated fatty acid levels and significantly lower total saturated fatty acids in maternal milk. The study that assessed maternal morbidity, adverse pregnancy outcomes, side effects of the intervention birth weight and APGAR score did not find statistically significant effects of the supplementation. Conclusion: There is no strong evidence of the effects of selenium supplementation on maternal and newborn health. Further studies with less specific populations and greater sample sizes are necessary in order to identify evidence of supplementation on maternal and newborn morbidity and mortality

Bakgrund: Psykisk ohälsa är ett växande problem och ungefär 16% av världens befolkning beräknas idag lida av någon form utav psykisk ohälsa. Personer med psykisk ohälsa har ett ökat behov av hälso- och sjukvård och hälso- och sjukvårdspersonalens ansvar är att utöva vården med respekt för alla människors lika värde. Tidigare forskning visar att hälso- och sjukvårdspersonal inom den somatiska vården har negativa attityder till denna patientgrupp då de upplever dem som skrämmande, oförutsägbara och tidskrävande. Syfte: Att beskriva vilka attityder patienter med psykisk ohälsa upplever i kontakt med hälso- och sjukvårdspersonal inom den somatiska vården. Metod: Studien genomfördes som en litteraturöversikt och baseras på 15 vetenskapliga artiklar med kvalitativ och kvantitativ ansats. Databassökningar genomfördes i databaserna PsycINFO och Cinahl med sökord som motsvarade syftet. De inkluderade artiklarna var etiskt godkända och resultatet sorterades in i teman samt subteman.  Resultat: Patienter med psykisk ohälsa upplevde stigmatiserande attityder i form utav att de fick en markering i journalen samt att de endast sågs utifrån sin diagnos. Patienterna upplevde även diskriminerande attityder i form av att de blev misstrodda och inte tagna på allvar samt upplevelser av att ses som ett objekt istället för självständiga individer. Slutsats: Attityderna som patienterna med psykisk ohälsa upplevde påverkade dem så pass negativt att de i viss mån undvek att söka vård. Dessa attityder från hälso- och sjukvårdspersonalen uppfyller inte intentionerna för Diskrimineringslagen, Hälso- och sjukvårdslagen eller Patientlagen som anger att alla människor har rätt lika vård och alla människors lika värde ska respekteras. / Background: Mental illness is a growing problem and approximately 16% of the world's population is currently expected to suffer from some form of mental illness. People with mental illness have an increased need for health and medical care and the responsibility of the healthcare staff is to practise care with respect for all people's equal value. Previous research shows that healthcare professionals in the somatic care have negative attitudes to this patient group as they experience them as frightening, unpredictable and time-consuming. Purpose: To describe which attitudes patients with mental illness experience in contact with healthcare professionals in the somatic care. Method: The study was conducted as a literature review and is based on 15 scientific articles with qualitative and quantitative approach. Database searches were performed in the databases PsycINFO and Cinahl with keywords that corresponded to the purpose. The included articles were ethically approved and the result was sorted into themes and subthemes. Result: Patients with mental illness experienced stigmatizing attitudes in the form of having a mark in the journal and that they were only seen on the basis of their diagnosis. The patients also experienced discriminatory attitudes in the form of being distrusted and not taken seriously, and experiences of being objectified instead of independent individuals. Conclusion: The attitudes experienced by the patients with mental illness affected them so negatively that they to some extent avoided seeking care. These attitudes from the healthcare staff do not meet the intentions of the Discrimination Act, the Health and Medical Care Act or the Patient Act, which states that all people have the right equal care and all people's equal value shall be respected.

Bakgrund:  Symtomkontroll är en viktig del i den palliativa vården. Sjuksköterskan har en central roll i denna vård. Fokus inom tidigare forskning har legat på smärthantering och därför gjordes denna litteraturöversikt som belyser vikten av hantering av illamående i palliativ vård.  Syfte: Att undersöka förekomsten av illamående hos palliativa patienter samt sammanställa sjuksköterskans kunskap kring hantering av dessa patienters illamående inom hälso- och sjukvård.  Metod: Litteraturöversikt som inkluderar 16 artiklar.  Resultat: Förekomsten av illamående hos palliativa patienter i litteraturöversikten var mellan 7-40 %. Resultatet visar att sjuksköterskor tycker att de har god kunskap för att kunna symtomskatta, behandla och utvärdera behandling av illamående i palliativ vård. Det visade även en skillnad av sjuksköterskors upplevda kunskap kring palliativ vård beroende på arbetslivserfarenhet.  Det framkom i resultatet att symtomskattning inte alltid utfördes och att validerade skattningsinstrument för illamående inte alltid användes. En del palliativa patienter är medicinskt underbehandlade och utvärdering av behandling av illamående förekom inte alltid hos palliativa patienter i hälso- och sjukvården. Resultatet visade även på skillnader i hantering av illamående utifrån kön och ålder.  Konklusion: Sjuksköterskorna hade mer kunskap om symtomhantering desto mer erfarenhet de hade. Det behövs mer utbildning för att hantera illamående, både på grundnivå inom sjuksköterskeprogrammet men även fortsatt utbildning på arbetsplatserna. Det behövs mer forskning inom detta för att identifiera mer exakt vilken kunskap sjuksköterskor saknar. Det behövs även mer forskning för att undersöka hur sjuksköterskan fastställer illamåendets orsak. / Background: Symptom management is an important part in palliative care. Nurses have a central role in this care. Previous research highlights pain management, this literature review aims to shed light on the importance of nausea management in palliative care.  Aim: To examine the prevalence of nausea in palliative patients and to compile nurses’ knowledge about management of these patient’s nausea in healthcare.  Method: A literature review based on 16 articles.  Result: Prevalence of nausea in palliative patients in the literature review was between 7-40%. The result shows that nurses rate their knowledge high when it comes to symptom estimation, treating symptoms and evaluate treatment of nausea in palliative care. Nurses knowledge of palliative care differed depending on their work experience. It also showed that symptom estimation doesn’t always occur and validated tools to estimate nausea are not always used. Some palliative care patients are medically undertreated for nausea and evaluation of nausea-treatment isn’t always done. The result also showed discrepancies of treatment between gender and age.  Conclusion: Nurses’ had more knowledge about symptom management the more work experience they had. There is a need for further education in how to manage nausea both in nursing school and at the workplace. Additional research is needed to identify exactly what knowledge nurses’ lack. There is also a need for research that examines how nurses determines the cause of nausea.

Bakgrund: I Sverige drabbas cirka 10 000 personer av plötsligt hjärtstopp varje år. Även om överlevnaden har ökat det senaste decenniet så överlever endast cirka 600 personer av dessa 10 000. Hjärt-och kärlsjukdomar är den störst bakomliggande orsaken till dödsfall hos både män och kvinnor i Sverige. Dock behöver inga bakomliggande symtom existera för att drabbas av ett plötsligt hjärtstopp, det kan drabba vem som helst, när som helst. Enligt Aaron Antonovskys omvårdnadsteori KASAM handlar hälsa och livskvalité om att innefatta en god begriplighet, hanterbarhet och meningsfullhet vid olika situationer, som exempelvis vid ett hjärtstopp. Syfte: Syftet är att beskriva patienters upplevelser av livskvalité efter att ha överlevt ett hjärtstopp. Metod: En litteraturöversikt baserat på 15 stycken vetenskapliga artiklar. Resultat: Sammanfattningsvis visar resultatet tre huvudfynd som har delats upp i tre kategorier. Dessa kategorier är: upplevelser av en nedsatt kognitiv förmåga och dess bidragande påverkan på livskvalitén, upplevelser av det psykiska måendet och dess bidragande påverkan på livskvalitén samt upplevelser av att återfå livet, existentiella tankar samt dess påverkan på livskvalitén. Slutsats: I litteraturöversikten framgår det att patienter som har överlevt ett hjärtstopp upplever flertal förändringar i livet. Aspekter såsom nedsatt kognitiv förmåga, psykisk ohälsa samt tankar om det existentiella och att återfå sitt liv var mest uttalat av patienterna. I de flesta fall hade dessa upplevelser en negativ påverkan på patienternas livskvalité. Många av patienterna upplevde att eftervården var bristfällig och ett stort behov av stöd från hälso- och sjukvårdpersonal uttrycktes. / Background: In Sweden, approximately 10,000 people are affected by sudden cardiac arrest each year. Although survival has increased over the past decade, only 600 people out of these 10,000 survive. Cardiovascular disease is the leading cause of death in both men and women in Sweden. However, no underlying symptoms need to exist to suffer a sudden cardiac arrest, it can hit anyone, at any time. According to Aaron Antonovsky's nursing theory KASAM, health and quality of life are about including good comprehensibility, manageability and meaningfulness in different situations, such as a cardiac arrest. Aim: The purpose is to describe patients' experiences of quality of life after having survived a cardiac arrest. Method: A literature review based on 15 scientific articles. Result: In summary, the results show three main findings that have been divided into three categories. These categories are: experiences of a reduced cognitive ability and its contributing influence on the quality of life, experiences of mental health and its contributing influence on the quality of life and experiences of regaining life, existential thoughts and its impact on quality of life. Conclusion: The literature review shows that patients who have survived a cardiac arrest experience several changes in life. Aspects such as impaired cognitive ability, mental illness and thoughts of the existential and regaining life were most pronounced by the patients. In most cases, these experiences had a negative impact on the patients' quality of life. Many of the patients felt that the aftercare was inadequate and a great need for support from health personnel was expressed

Bakgrund: Palliativ vård kallas förhållningssättet man arbetar efter när botande behandling inte längre har en positiv verkan utan vården övergår till att lindra symtom. Sjuksköterskors grundläggande ansvar är att främja hälsa, förebygga sjukdom, återställa hälsa och lindra lidande. Existentiella frågor kan handla om meningen med livet, döden, tiden man har kvar på jorden och liknande grundläggande villkor för mänskligt liv. Syfte: Att beskriva sjuksköterskors upplevelser av existentiella samtal med palliativa patienter. Metod: En litteraturöversikt utfördes. Datainsamling skedde i databaserna CINAHL och PubMed och en sekundärsökning utfördes. Artiklar granskades kritiskt av båda författarna och kvalitetsgranskades. Datainsamlingen resulterade i 16 artiklar av kvalitativ, kvantitativ och mixad metod som sedan utgjorde resultatet. Resultat: Resultatet redovisas i fem teman: Sjuksköterskors upplevda positiva känslor, sjuksköterskors upplevda negativa känslor och otillräcklighet, sjuksköterskors strävan att upprätthålla existentiell vård, sjuksköterskors upplevda brist på utbildning och erfarenhet samt sjuksköterskors behov av bearbetning och återhämtning. Undertema: upplevda hinder för upprätthållande av existentiell vård. De tydligaste resultaten visar att sjuksköterskor kände att de i sin yrkesroll i den palliativa vården var priviligierade, trots att känslomässiga påfrestningar ingick i arbetet. För att delta i existentiella samtal var utbildning och yrkeserfarenhet förutsättningar för sjuksköterskorna. Diskussion och reflektion med arbetskollegor var essentiellt för att bearbeta egna känslor och intryck från samtalen. En förutsättning för att bearbeta egna upplevelser i mötet med patienter i livets slut var återhämtning på fritiden. Slutsats: Sjuksköterskor upplevde sig ha en privilegierad roll då de fick äran att höra patienternas innersta tankar och livshistorier. Att vara den som patienterna anförtror sig till kan dock vara emotionellt krävande och det var av vikt att sjuksköterskorna fick reflektera med kollegor och återhämta sig för att orka med. Sjuksköterskornas osäkerhet och upplevda kunskapsbrist resulterade i att de önskade mer utbildning i existentiella samtal. Osäkerheten hos sjuksköterskorna, tidsbrist och personalbrist beskrevs vara faktorer som kunde göra att samtalen uteblev. Sjuksköterskorna upplevde att existentiella samtal var viktigt och att det hörde till deras yrke och den holistiska filosofin. / Background: Palliative care is when curing treatment no longer has a positive efficacy, instead the care merges into relieving symptoms. Nurses fundamental responsibility is to facilitate health, prevent disease, restore health and ease suffering. Existential questions could be about the meaning of life, death, time left on earth and similar fundamental terms for human life. Aim: To describe nurses experiences of existential conversations with palliative patients. Method: A literature review was performed. Data collection took place in the databases CINAHL and PubMed and a secondary search was performed. The articles were critically reviewed by both authors and quality assessed. The data collection resulted in 16 articles with qualitative, quantitative and mixed method that then produced the result. Results: The result is reported in five themes: Nurses’ experiences of positive emotions, nurses’ experiences of negative emotions and inadequacy, nurses’ endeavor of maintaining existential care, nurses’ experiences of lack of education and experience, and also nurses may need processing and recovery. Subtheme: Perceived obstacles to the maintenance of existential care. The most distinct results show that nurses felt that they were privileged in their professional role in palliative care, although emotional stresses were part of the work. To participate in existential conversations, education and professional experience are prerequisites for the nurses. Discussing and reflecting with work colleagues was essential for processing their own feelings and impressions from the conversations. A prerequisite for processing of own experiences in meeting with patients in the end of life was through recreation in leisure time. Conclusion: Nurses experienced themselves to have a privileged role as they had the honor of hearing patients' inner thoughts and life stories. To be the person patients entrusted to can be emotionally demanding and it was important that the nurses got to reflect with colleagues and recover to be able to cope. Nurses insecurity and perceived lack of knowledge made them want more education in existential conversations. The insecurity of the nurses, lack of time and lack of staff described to be factors that could default the conversations. The nurses experienced nonetheless that existential conversations were important and that it was a part of their work and the holistic philosophy.

Bakgrund: Delaktighet syftar till att öka patientens ställning och rättigheter i vården och har även bevisats medföra goda hälsoeffekter hos patienten. Trots sjuksköterskans förordningsstyrda roll och ansvar i att utöva ett personcentrerat förhållningssätt och främja delaktigheten hos patienten visar tidigare forskning att det finns svårigheter med att implementera delaktighet i vården. Denna implementering har försämrats trots uppdaterade förordningar. Syfte: Att beskriva patienters upplevelser av delaktighet i omvårdnaden på slutenvårdsavdelningar på sjukhus. Metod: En litteraturöversikt baserad på 13 vetenskapliga kvalitativa artiklar. Artikelsökning gjordes i databaserna CINAHL och Pubmed. Resultat: Tre huvudkategorier identifierades; Information om patientens tillstånd, Upplevelser av delaktighet relaterade till personalen och Upplevelser av delaktighet relaterade till patienten. Patienter beskrev att en förutsättning för att kunna vara delaktig i sin omvårdnad var att få information om sitt tillstånd samt vara en del i överrapporteringar där dennes preferenser framgick. En förmyndaraktig attityd hos sjuksköterskan, stress på avdelningen och situationer där sjuksköterskan inte bjöd in patienten till att delta upplevdes hindra delaktighet. Patienter upplevde att deras hälsotillstånd och ålder både främjade och hindrade delaktighet. Vidare menade patienter att en otillräcklig medicinsk kunskap och en önskan att vara passiv i vården hindrar delaktighet, men att familjens deltagande i vården möjliggjorde delaktighet. Slutsats: Resultatet visar att det finns svårigheter i vården avseende patienters delaktighet. Ett flertal faktorer påverkar möjligheten till patientdelaktighet så som patientens ålder, hälsotillstånd och medicinsk okunskap. Sjuksköterskan har huvudansvar i att möjliggöra ett klimat där patienten känner sig delaktig i sin vård. Ett första steg mot att arbeta mot en ökad patientdelaktighet är att i vården av patienter uppmärksamma de delar som påverkar deras delaktighet. / Background: Participation aims to increase the patient's position and rights in healthcare and has also been proven to bring good health effects for the patient. Despite the nurse's ordinanceregulated role and responsibility in exercising a person-centered approach and maintaining the patient's participation, it is shown that there are difficulties in implementing participation in healthcare. This implementation has also been proven to be deteriorated despite updated regulations. Aim: To describe patients' experiences of participation in nursing care in inpatient wards in hospitals. Method: A literature review based on 13 qualitative articles. The databases CINAHL and Pubmed was used for article research. Result: Three main categories were identified; Information about the patient's condition, Experiences of participation related to staff and Experiences of participation related to the patient. Patients described that a prerequisite for being involved in their nursing care was getting information about their condition and being part of over-reporting where preferences emerged. A guardian attitude at the nurse, stress on the department and situations where the nurse did not invite the patient to attend was found to prevent participation. Patients experienced that their health and age both promoted and hindered participation. Furthermore, patients believed that insufficient medical knowledge and a desire to be passive in care prevent participation, but that the family's participation in healthcare enabled participation. Conclusion: The result shows that there are difficulties in the care of patients' involvement. Several factors influence the possibility of patient participation such as the patient's age, health status and insufficient medical knowledge. The nurse has the main responsibility in enabling a climate where the patient feels involved in their care. A first step towards working towards an increased patient participation is to pay attention to the parts that affect their participation in the care of patients.

Bakgrund: Det råder stor brist på sjuksköterskor. Nyutexaminerade sjuksköterskor är en grupp som löper hög risk att drabbas av utbrändhet och upp till var femte sjuksköterska överväger att lämna yrket inom sina första fem år. Många av de nyutexaminerade sjuksköterskorna känner sig oförberedda inför sjuksköterskeyrket och flera studier påvisar glappet mellan teori och praktik. Syfte: Att beskriva utmaningar den nyutexaminerade sjuksköterskan upplever under det första yrkesverksamma året. Metod: Studien har genomförts som en litteraturöversikt. Med hjälp av sökdatabaserna CINAHL och PubMed ligger totalt 20 artiklar till grund för resultatet. Resultat: Ett flertal faktorer beskrivs av nyutexaminerade sjuksköterskor som utmaningar. Däribland glappet mellan teori och praktik, bristen på stöd och handledarskap, kunskapsbrist, dålig arbetsmiljö, bemanningsbrist samt en allt mer komplex vård med multisjuka patienter som kräver en expertis som den nyutexaminerade sjuksköterskan omöjligt kan besitta. Slutsats: Utmaningarna som presenteras i litteraturöversiktens resultat är välkända och globala problem men också påverkbara. Fokus bör ligga i både att tillsätta nya sjuksköterskor men framförallt i att värdera och ta vara på de som redan finns. Nyutexaminerade sjuksköterskor behöver bättre stöd när de äntrar arbetslivet samt att utbildningen ses över för att motsvara verkligheten och förbereda inför arbetslivet så bra som möjligt. / Background: There is a great shortage of nurses. Newly graduated nurses are a group at high risk of being burned out and up to every fifth nurse is considering leaving the profession within its first five years. Many of the newly graduated nurses feel unprepared for the nursing profession and several studies show the gap between theory and practice. Aim: Describing challenges the newly graduated nurse experiences during the first year of working. Method: The study has been conducted as a literature review. With the help of the search databases CINAHL and PubMed, a total of 20 articles form the base for the result. Result: Several factors are described by newly graduated nurses as challenges. This includes a theory-practice gap, the lack of support and mentoring, a lack of knowledge, poor work environment, staff shortages and an increasingly complex care with patients have multiple ilnesses who require an expertise that the newly graduated nurse cannot possibly possess. Conclusion: The challenges presented in the literature review's results are well-known and global problems, but also influential. The focus should be on both appointing new nurses but more importantly valuing the ones already employed/working. Newly graduated nurses need better support when they enter the workplace, much also indicates that the education should be looked over in order to match the reality and prepare the students for work life as well as possible.