Thesis advisor: Cherie McGill / Thesis advisor: Marius Stan / Seriously ill newborns are a part of a recent bioethical phenomenon that emerged during the late 1970s. With the rise of new, innovative medical technology, doctors can keep these seriously ill newborns alive, but at monumental financial and psychological costs. This thesis utilizes several economic and ethical frameworks to contextualize these newborns within our healthcare system. After all, our healthcare resources are limited. We must therefore discern between the continuation of an infant’s treatment and conversely, the withdrawal of treatment. / Thesis (BA) — Boston College, 2017. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Departmental Honors. / Discipline: Philosophy.

Tyrimo tikslas – atskleisti artimųjų, slaugiusių sunkiai sergantį šeimos narį iki jo/jos mirties namuose, patirtį. Tiriamas reiškinys – slaugymas iki mirties namuose. Tyrimo klausimai. 1) Kokia yra artimųjų slaugymo namuose sunkiai sergantį šeimos narį patirtis? 2) Kokia yra artimųjų budėjimo namuose šalia mirštančio šeimos nario patirtis? Tyrimo metodai. Kokybinis tyrimas, taikant aprašomosios fenomenologijos strategiją, pagal P. Colaizzi metodą. Duomenys rinkti taikant individualųjį giluminį interviu. Tyrimo dalyviai. 5 artimieji (1 vyras, 4 moterys). Atranka – tikslinė. Atrankos kriterijai: a) artimieji, slaugę sunkiai sergantį suaugusį šeimos narį ir budėję jo/jos mirties momentu namuose; b) artimieji, slaugę šeimos narį ir budėję jo/jos mirties momentu namuose, ne anksčiau nei praėjus vieneriems metams po mirties. Tyrimo rezultatai. Tyrime išryškėjusios temos, kurios atskleidė patirčių esmę – tiriamą reiškinį: 1) Šeimos narys: nesvarbu koks, svarbu, kad tik būtų kartu?; 2) Slaugos namuose motyvai: „namai lieka namais“; 3) Artimųjų palaikymas ir pagalba – „pats svarbiausias dalykas“; 4) Pokyčiai gyvenime: nuo momentinės pagalbos iki priežiūros 24 valandas per parą; 5) Susitaikymas ir „paleidimas“; 6) Mirties akimirka: nuo „visiška ramybė“ iki „blogiausias momentas“; 7) Sveikatos priežiūros specialistai – padedantys arba apsunkinantys esamą situaciją; 8) Sugrįžimas į gyvenimą „be artimųjų slaugymo“. Išvados. Artimieji nusprendę slaugyti sunkiai sergantį šeimos narį... [toliau žr. visą tekstą] / Reseach purpose – to reveal the family caregivers’ experience of caring a seriously ill family member till his/her death at home. Studied phenomenon – caring a seriously ill family member till his/her death at home. Research questions. 1) What kind of experience have the family caregivers got of caring a seriously ill family member till his/her death at home? 2) What kind of experience have family caregivers got while caring a dying family member? Research methods. Qualitative research, with applied descriptive phenomenology strategy, on the base of P. Colaizzi method. Data has been collected by in-depth interviewing, asking two research questions. Research participants. 5 family caregivers (1 male, 4 female). Selection – target, selection criteria: a) family caregivers who took care of a seriously ill adult family member till his/her death at home; b) family caregivers who took care of a seriously ill adult family member at home, no earlier than a year after he/she had passed. Research results. The following themes have emerged: 1) Family Member: no matter how he or she is, it is important to have one beside; 2) Home care motivation: “home is home”; 3) Family members’ assistance and support – “the most important thing”; 4) Changes in care needs: from instant help to care 24 hours a day; 5) Reconciliation and acknowledging the full reality of the loss; 6) The moment of death: from “total peace” to the “worst moment”; 7) Health care professionals – whether they help or hinder... [to full text]

O envelhecimento populacional e o aumento das doenças crônicas não transmissíveis geram uma demanda crescente por Programas de Cuidados Domiciliares em Atenção Primaria à Saúde, de capacitação de familiares cuidadores e de profissionais da saúde para lidar com a doença avançada e a terminalidade. Esta pesquisa subscreve essa realidade e objetiva compreender a visão de quem cuida de um familiar com doença avançada e os possíveis aprendizados dos cuidadores durante esse processo de cuidar de quem está morrendo. Trata-se de uma pesquisa qualitativa, de caráter etnográfico, realizada na vila Fátima-Bom Jesus, comunidade de baixa renda e baixo nível educacional. Comunidade que enfrenta cotidianamente dificuldades socioeconômicas e culturais, convivendo constantemente com o narcotráfico e a intensa violência urbana. Este estudo entrevistou 11 cuidadores familiares com mais de 18 anos, que cuidam/cuidaram de pacientes com doença avançada nos últimos 12 meses; coletou dados dos prontuários dos pacientes do Programa de Cuidados Domiciliares do Centro de Extensão Universitária Vila Fátima, da Pontifícia Universidade Católica do Rio Grande do Sul – CEUVF-PUCRS, e do diário de campo do trabalho com o Grupo de Cuidadores. A análise comportou três alicerces: o cuidador familiar, o paciente com doença avançada e a morte. A convivência diária dos cuidadores com seus familiares em fase final de vida aproximou-os de sua própria consciência em relação à morte; essa consciência pessoal da maioria não facilitou um diálogo com o paciente sobre a morte; os cuidadores, em sua maioria mulheres, idade avançada, baixa renda e nível educacional, evidenciam alto risco para o desenvolvimento de estresse. Manifestam com intensidade a sensação de dever cumprido pelo ato de cuidar; cuidar como atitude de preocupação, de responsabilização, de envolvimento emocional e afetivo. Cuidado que possibilitou a muitos pacientes viverem mais tempo com qualidade de vida no domicílio. A opção da maioria dos cuidadores foi cuidar do familiar até a morte no domicílio, devido à solidão do paciente no hospital. A opção por morrer no hospital acontece devido à solidão do cuidador na assistência domiciliar. Os cuidadores apresentam uma trajetória de cuidados ao longo de seu ciclo de vida: na infância cuidaram de crianças, seguiram cuidando de familiares, amigos e vizinhos. Os laços afetivos existentes foram essenciais para o estabelecimento de uma relação afetuosa de cuidado. Alguns cuidadores apresentaram dificuldades em assumir seu papel, cumprir tarefas, evidenciando traços de negligência e a necessidade de intervenção da equipe. Os cuidadores demonstram aprendizados ligados aos cuidados do corpo, administração de medicações; aprendizados vinculados aos cuidados psicossociais e espirituais, empatia, compreensão, silêncio, limites, carinho. O universo do cuidar mostra-se como um mundo construído com o outro, onde não existe realidade como verdade e sim versões da realidade, uma construção de reflexão e aprendizado na interface das biografias pessoais e do meio sociocultural onde a vida ocorre. / The population's aging and the increase in non-transmissible chronic diseases have created a growing demand for Basic Home Healthcare Programs and training for family caregivers and health professionals to deal with advanced-stage diseases and terminality. This paper is aimed at understanding how people caring for a family member suffering from an advanced-stage disease see the situation and what caregivers could potentially learn during this process of taking care of someone who is dying. It is a qualitative, ethnographic study carried out in Vila Fátima-Bom Jesus, a low-income, lowschooling community. The community grapples with socioeconomic and cultural hardships on a daily basis as they are constantly surrounded by drug trafficking and intense urban violence. This study interviewed 11 family caregivers over the age of 18 who are taking/have taken care of patients suffering from advanced-stage diseases in the past 12 months. We gathered data from medical records of patients overseen by the Home Care Program run by the Vila Fátima University Extension Center of Pontifícia Universidade Católica do Rio Grande do Sul (CEUVF-PUCRS) and the field log of the work with the Caregivers' Group. Our analysis was grounded on three pillars: family caregivers, advanced-disease patients, and death. The caregivers' daily interactions with their family members nearing the end of their lives have made the former more aware of their own mortality. Such personal awareness by the majority of them has not made it easier for them to talk about death with their patients. The caregivers, most of them senior, low-income, low-schooling females, show high risk towards developing stress. They speak pointedly about their sense of accomplishment for having provided the care. Care-giving as an attitude of concern, accountability, emotional and affective involvement. Care-giving which has allowed many patients to live a longer, higher quality life at home. Most caregivers have chosen to take care of their family members until their demise at home, because of how lonely patients are in hospitals. Patients have chosen to die in the hospital because of how lonesome home caregivers become. Caregivers have had a history of caregiving throughout their lives. As children, they used to take care of other kids. Later on, they proceeded to take care of family members, friends, and neighbors. The existing emotional bonds were essential to set up a loving care-giving relationship. Some caregivers have had trouble taking on their roles and doing chores. Additionally, some betrayed signs of being neglectful and the team was required to step in. Caregivers show to have learned about taking care of the body and administering medication. They have learned about psycho-social and spiritual care, empathy, understanding, silence, limits, affection. The universe of care has proved to be a world built along with another person, where reality does not exist as truth but as versions of reality. A construction of reflection and learning in the interface of personal biographies and the socio-cultural environment where life takes place.

O envelhecimento populacional e o aumento das doenças crônicas não transmissíveis geram uma demanda crescente por Programas de Cuidados Domiciliares em Atenção Primaria à Saúde, de capacitação de familiares cuidadores e de profissionais da saúde para lidar com a doença avançada e a terminalidade. Esta pesquisa subscreve essa realidade e objetiva compreender a visão de quem cuida de um familiar com doença avançada e os possíveis aprendizados dos cuidadores durante esse processo de cuidar de quem está morrendo. Trata-se de uma pesquisa qualitativa, de caráter etnográfico, realizada na vila Fátima-Bom Jesus, comunidade de baixa renda e baixo nível educacional. Comunidade que enfrenta cotidianamente dificuldades socioeconômicas e culturais, convivendo constantemente com o narcotráfico e a intensa violência urbana. Este estudo entrevistou 11 cuidadores familiares com mais de 18 anos, que cuidam/cuidaram de pacientes com doença avançada nos últimos 12 meses; coletou dados dos prontuários dos pacientes do Programa de Cuidados Domiciliares do Centro de Extensão Universitária Vila Fátima, da Pontifícia Universidade Católica do Rio Grande do Sul – CEUVF-PUCRS, e do diário de campo do trabalho com o Grupo de Cuidadores. A análise comportou três alicerces: o cuidador familiar, o paciente com doença avançada e a morte. A convivência diária dos cuidadores com seus familiares em fase final de vida aproximou-os de sua própria consciência em relação à morte; essa consciência pessoal da maioria não facilitou um diálogo com o paciente sobre a morte; os cuidadores, em sua maioria mulheres, idade avançada, baixa renda e nível educacional, evidenciam alto risco para o desenvolvimento de estresse. Manifestam com intensidade a sensação de dever cumprido pelo ato de cuidar; cuidar como atitude de preocupação, de responsabilização, de envolvimento emocional e afetivo. Cuidado que possibilitou a muitos pacientes viverem mais tempo com qualidade de vida no domicílio. A opção da maioria dos cuidadores foi cuidar do familiar até a morte no domicílio, devido à solidão do paciente no hospital. A opção por morrer no hospital acontece devido à solidão do cuidador na assistência domiciliar. Os cuidadores apresentam uma trajetória de cuidados ao longo de seu ciclo de vida: na infância cuidaram de crianças, seguiram cuidando de familiares, amigos e vizinhos. Os laços afetivos existentes foram essenciais para o estabelecimento de uma relação afetuosa de cuidado. Alguns cuidadores apresentaram dificuldades em assumir seu papel, cumprir tarefas, evidenciando traços de negligência e a necessidade de intervenção da equipe. Os cuidadores demonstram aprendizados ligados aos cuidados do corpo, administração de medicações; aprendizados vinculados aos cuidados psicossociais e espirituais, empatia, compreensão, silêncio, limites, carinho. O universo do cuidar mostra-se como um mundo construído com o outro, onde não existe realidade como verdade e sim versões da realidade, uma construção de reflexão e aprendizado na interface das biografias pessoais e do meio sociocultural onde a vida ocorre. / The population's aging and the increase in non-transmissible chronic diseases have created a growing demand for Basic Home Healthcare Programs and training for family caregivers and health professionals to deal with advanced-stage diseases and terminality. This paper is aimed at understanding how people caring for a family member suffering from an advanced-stage disease see the situation and what caregivers could potentially learn during this process of taking care of someone who is dying. It is a qualitative, ethnographic study carried out in Vila Fátima-Bom Jesus, a low-income, lowschooling community. The community grapples with socioeconomic and cultural hardships on a daily basis as they are constantly surrounded by drug trafficking and intense urban violence. This study interviewed 11 family caregivers over the age of 18 who are taking/have taken care of patients suffering from advanced-stage diseases in the past 12 months. We gathered data from medical records of patients overseen by the Home Care Program run by the Vila Fátima University Extension Center of Pontifícia Universidade Católica do Rio Grande do Sul (CEUVF-PUCRS) and the field log of the work with the Caregivers' Group. Our analysis was grounded on three pillars: family caregivers, advanced-disease patients, and death. The caregivers' daily interactions with their family members nearing the end of their lives have made the former more aware of their own mortality. Such personal awareness by the majority of them has not made it easier for them to talk about death with their patients. The caregivers, most of them senior, low-income, low-schooling females, show high risk towards developing stress. They speak pointedly about their sense of accomplishment for having provided the care. Care-giving as an attitude of concern, accountability, emotional and affective involvement. Care-giving which has allowed many patients to live a longer, higher quality life at home. Most caregivers have chosen to take care of their family members until their demise at home, because of how lonely patients are in hospitals. Patients have chosen to die in the hospital because of how lonesome home caregivers become. Caregivers have had a history of caregiving throughout their lives. As children, they used to take care of other kids. Later on, they proceeded to take care of family members, friends, and neighbors. The existing emotional bonds were essential to set up a loving care-giving relationship. Some caregivers have had trouble taking on their roles and doing chores. Additionally, some betrayed signs of being neglectful and the team was required to step in. Caregivers show to have learned about taking care of the body and administering medication. They have learned about psycho-social and spiritual care, empathy, understanding, silence, limits, affection. The universe of care has proved to be a world built along with another person, where reality does not exist as truth but as versions of reality. A construction of reflection and learning in the interface of personal biographies and the socio-cultural environment where life takes place.

O envelhecimento populacional e o aumento das doenças crônicas não transmissíveis geram uma demanda crescente por Programas de Cuidados Domiciliares em Atenção Primaria à Saúde, de capacitação de familiares cuidadores e de profissionais da saúde para lidar com a doença avançada e a terminalidade. Esta pesquisa subscreve essa realidade e objetiva compreender a visão de quem cuida de um familiar com doença avançada e os possíveis aprendizados dos cuidadores durante esse processo de cuidar de quem está morrendo. Trata-se de uma pesquisa qualitativa, de caráter etnográfico, realizada na vila Fátima-Bom Jesus, comunidade de baixa renda e baixo nível educacional. Comunidade que enfrenta cotidianamente dificuldades socioeconômicas e culturais, convivendo constantemente com o narcotráfico e a intensa violência urbana. Este estudo entrevistou 11 cuidadores familiares com mais de 18 anos, que cuidam/cuidaram de pacientes com doença avançada nos últimos 12 meses; coletou dados dos prontuários dos pacientes do Programa de Cuidados Domiciliares do Centro de Extensão Universitária Vila Fátima, da Pontifícia Universidade Católica do Rio Grande do Sul – CEUVF-PUCRS, e do diário de campo do trabalho com o Grupo de Cuidadores. A análise comportou três alicerces: o cuidador familiar, o paciente com doença avançada e a morte. A convivência diária dos cuidadores com seus familiares em fase final de vida aproximou-os de sua própria consciência em relação à morte; essa consciência pessoal da maioria não facilitou um diálogo com o paciente sobre a morte; os cuidadores, em sua maioria mulheres, idade avançada, baixa renda e nível educacional, evidenciam alto risco para o desenvolvimento de estresse. Manifestam com intensidade a sensação de dever cumprido pelo ato de cuidar; cuidar como atitude de preocupação, de responsabilização, de envolvimento emocional e afetivo. Cuidado que possibilitou a muitos pacientes viverem mais tempo com qualidade de vida no domicílio. A opção da maioria dos cuidadores foi cuidar do familiar até a morte no domicílio, devido à solidão do paciente no hospital. A opção por morrer no hospital acontece devido à solidão do cuidador na assistência domiciliar. Os cuidadores apresentam uma trajetória de cuidados ao longo de seu ciclo de vida: na infância cuidaram de crianças, seguiram cuidando de familiares, amigos e vizinhos. Os laços afetivos existentes foram essenciais para o estabelecimento de uma relação afetuosa de cuidado. Alguns cuidadores apresentaram dificuldades em assumir seu papel, cumprir tarefas, evidenciando traços de negligência e a necessidade de intervenção da equipe. Os cuidadores demonstram aprendizados ligados aos cuidados do corpo, administração de medicações; aprendizados vinculados aos cuidados psicossociais e espirituais, empatia, compreensão, silêncio, limites, carinho. O universo do cuidar mostra-se como um mundo construído com o outro, onde não existe realidade como verdade e sim versões da realidade, uma construção de reflexão e aprendizado na interface das biografias pessoais e do meio sociocultural onde a vida ocorre. / The population's aging and the increase in non-transmissible chronic diseases have created a growing demand for Basic Home Healthcare Programs and training for family caregivers and health professionals to deal with advanced-stage diseases and terminality. This paper is aimed at understanding how people caring for a family member suffering from an advanced-stage disease see the situation and what caregivers could potentially learn during this process of taking care of someone who is dying. It is a qualitative, ethnographic study carried out in Vila Fátima-Bom Jesus, a low-income, lowschooling community. The community grapples with socioeconomic and cultural hardships on a daily basis as they are constantly surrounded by drug trafficking and intense urban violence. This study interviewed 11 family caregivers over the age of 18 who are taking/have taken care of patients suffering from advanced-stage diseases in the past 12 months. We gathered data from medical records of patients overseen by the Home Care Program run by the Vila Fátima University Extension Center of Pontifícia Universidade Católica do Rio Grande do Sul (CEUVF-PUCRS) and the field log of the work with the Caregivers' Group. Our analysis was grounded on three pillars: family caregivers, advanced-disease patients, and death. The caregivers' daily interactions with their family members nearing the end of their lives have made the former more aware of their own mortality. Such personal awareness by the majority of them has not made it easier for them to talk about death with their patients. The caregivers, most of them senior, low-income, low-schooling females, show high risk towards developing stress. They speak pointedly about their sense of accomplishment for having provided the care. Care-giving as an attitude of concern, accountability, emotional and affective involvement. Care-giving which has allowed many patients to live a longer, higher quality life at home. Most caregivers have chosen to take care of their family members until their demise at home, because of how lonely patients are in hospitals. Patients have chosen to die in the hospital because of how lonesome home caregivers become. Caregivers have had a history of caregiving throughout their lives. As children, they used to take care of other kids. Later on, they proceeded to take care of family members, friends, and neighbors. The existing emotional bonds were essential to set up a loving care-giving relationship. Some caregivers have had trouble taking on their roles and doing chores. Additionally, some betrayed signs of being neglectful and the team was required to step in. Caregivers show to have learned about taking care of the body and administering medication. They have learned about psycho-social and spiritual care, empathy, understanding, silence, limits, affection. The universe of care has proved to be a world built along with another person, where reality does not exist as truth but as versions of reality. A construction of reflection and learning in the interface of personal biographies and the socio-cultural environment where life takes place.

This qualitative thesis uses discourse analysis to examine parental resistance towards medical treatment of critically ill children. It is an investigation of the ‘mobile and transitory’ discourses at play in instances of resistance between parents, physicians and nurses within health care institutions, and an examination of the consequences of resistance through providing alternative ways of perceiving and therefore understanding these disagreements. The philosophical perspectives, methodology and methods used in this thesis are underpinned by selected ideas taken from the works of Michel Foucault and Pierre Bourdieu and supported by relevant literature in the fields of media, law, children, parenting, caring, serious childhood illness, medicine and nursing. The thesis obtains information from a variety of texts that includes established literature (such as medical, sociological, legal, academic and philosophical), newspaper articles, radio or television interviews, internet sources, court reports and proceedings, legal experts and other commentators – and 15 interview based texts, where the focus is on analyses of narratives of parents, doctors and nurses. In the texts gathered for this thesis, there are noticeable differences between the personal experience discourses of parents, the ‘in-between’ discourses of nurses, and the disciplined discourses of physicians. This thesis brings these discourses into conversation with each other suggesting that parental resistance does not occur because of an infrequent and unusual set of circumstances where a few socially isolated and/or ‘difficult’ parents disagree with the treatment desires of paediatric physicians. Instead, it is argued that from an examination of interview based texts, parental resistance is an omnipresent but transitory occurrence that affects many of the interactions between the parents of seriously ill children and clinical staff. It is maintained that within these interactions, the seeds of this resistance are sown in both critical decision making situations and in everyday occurrences between doctors, nurses and parents within healthcare institutions. Contributing factors to parental resistance include the use of power games by staff, the language of medicine, forms of symbolic violence, the presence or absence of trust between parents and medical staff, the effects of medical habitus, and challenges to the parental role and identity. Overall, it is proposed in this thesis that parents who resist treatment for their seriously ill child are not exceptions to the normative patient-physician relationship. Instead an analysis of their discourses and practices is able to illuminate the complex interactions between patients and medical conventions. It is therefore possible to see parents who resist medical advice not as peripheral to the medical encounter but as examples of how patient-physician relationships come to be codified, constructed and crafted through everyday discourses and practices within health care settings.

The work is engaged in research, whether seriously ill and dying have in their suffering a mission. The theoretical part process knowledges especially of Catholic theology, plus the view of psychology and personal experiences in helping workers and volunteers from hospice care. The practical part deals with the analysis of qualitative research in a sample population of the Czech Republic. The comparative part compares results of the theoretical part with the practical part, analyzes the similarities and differences and examines what it means for pastoral work. After the evaluation is outlined, how could the pastoral work capacitate seriously ill and dying in the acceptance of their mission in suffering. The result of this work is the finding that the majority of a sample of Czech respondents (56 %) of the total 128 respondents - mission of seriously ill and dying sees, 10 % do not knows, 14 % never thought about it and 20 % sees any mission. The most important task, according to Catholic theology is {\clq}qreconciliation with himself, with others and with God.`` Practical research showed that the greatest sense of the suffering of seriously ill and dying brings benefit for surrounding people, specifically in the {\clq}qawareness of the price of life and health, their mortality, rearrange values`` Most preferred {\clq}qspiritual sense of suffering``, according to the public lies in the {\clq}qsacrifice of suffering on the intention``. Results of comparison mean for the pastoral work the challenge to help find seriously ill and dying people the mission in their suffering, specifically in their participation on the saving suffering of Christ. Another important task of the pastoral workers is to help society acquire a dignified view of man in suffering and have genuine compassion with him, expressed also by deeds of charity.

Bakgrund: Barns hälsa och mående kan påverkas negativt när en förälder är allvarligt sjuk och de har behov av stöd. Barn som har en allvarligt sjuk förälder har enligt svensk lag rätt till stöd, råd och information av sjukvården. Trots detta visar tidigare forskning att barn och föräldrar inte upplever att sjukvården ger det stödet. Det behövs därför mer kunskap om sjuksköterskors upplevelser av att möta och stödja barn till allvarligt sjuka patienter. Syfte: Att belysa sjuksköterskors erfarenheter av att möta och stödja barn som anhörig till en allvarligt somatiskt sjuk förälder. Metod: Litteraturstudien baserades på åtta empiriska kvalitativa vetenskapliga artiklar. Databassökningarna genomfördes i PubMed och Cinahl. Analysprocessen genomfördes med inspiration av Popenoes innehållsanalys vid litteraturstudie.  Resultat: Analysen resulterade i sju underkategorier och tre kategorier. Kategorierna var: ”Att skapa en vårdrelation”, ”Att ha tillräcklig kompetens” och ”Att söka stöd inom organisationen”. Konklusion:  Det finns behov av utbildning, riktlinjer och stöd för sjuksköterskor som möter barn till allvarligt sjuka patienter. För att utforma och implementera evidensbaserade åtgärder krävs mer forskning. / Background: Childrens health and wellbeing is negatively affected when a parent is seriously ill, and they need support. Children that have a seriously ill parent has, according to the Swedish law, a right to information, support, and advice from health services. Parents and children are however, according to earlier research, not experiencing this support from the healthcare. Because of this there is a need for more knowledge about nurses’ experience of meeting and giving support to children of seriously ill patients.  Aim: To illustrate nurses experience of meeting and supporting children of seriously somatic ill parent.  Methods: A literature study based on eight empirical qualitative scientifical articles. The database searches were conducted in PubMed and Cinahl. The analyzation process was inspired by Popenoe.  Results: The analysis resulted in seven subcategories and three categories. The categories were: “Building caring relationships” “Having sufficient skills” and “Seeking support within the organization”.  Conclusion: Nurses who meet children to seriously ill patients need education, guidelines, and support. To design and implement evidence-based measures there is a need for more research.

No description available.