End-of-life (EOL) care decisions present a challenge for family caregivers. Despite the increasing number of terminally ill patients in need of pain management and comfort care, there is limited qualitative data about how populations in the developing world can access culturally appropriate resources and EOL support. In this phenomenological study, 17 Garifuna family caregivers in southern Belize were interviewed about their experience caring for terminally family members. The conceptual frameworks were Kübler-Ross’s hospice approach and Watson’s theory of human caring. The two theories were selected based on their significance to this process: Kübler Ross’s hospice approach and its impact on the family system during the end stage of life and Watson’s theory of human caring for its emphasis on the impact of the importance of meeting the basic needs of individuals. NVivo 12 was used to code and generate themes for further analysis. Caregivers who said they would not utilize support outside of the home were those who were committed not do so at the request of the patient. Caregivers who cared for their family member and those who could financially afford to hire caregivers in their home to assist with their relative said they would not utilize nonfamily support. All others, regardless of relationship to the patient, indicated they would have accepted care if the environment were safe, caring, and culturally sensitive. Additionally, the caregivers saw their needs as secondary and insignificant compared to the comfort and care of the patient. This study may contribute to positive social change by revealing strategies and services that could be included in the design of a health services delivery system to meet the needs of individuals facing EOL decisions.

我們的生活中免不了會有身邊親友去世的經驗，甚至每日的報章媒體也都隨處看得到有人因天災、意外、疾病等原因而死亡的消息，故說死亡的陰影是如影隨形跟著每一個人，既然每人或早或晚都得面對死亡這一關，那麼對這個人生的重大課題，值得認真去面對它、瞭解它。 而本研究採取深度訪談法，主要以正德社會福利慈善基金會的「西方蓮社」臺北分社助念志工為主，以助念經驗逾兩年以上者挑選五位作訪談之研究；另外訪問兩位承天禪寺蓮池共修會助念志工，至於其他四位受訪者各隸屬於法鼓山、諾那精舍、靈巖山念佛會、圓山念佛會，合計本文之訪談助念志工共有十一位。而本文所謂的助念，係指對臨終者的開導佛理與幫助亡者提起正念，專心念「阿彌陀佛」佛號，祈求集合眾人專心念佛的力量，幫助亡者蒙佛接引，往生西方極樂世界。 研究結果發現如下：一.助念瑞相，不可思議；二.寂滅為樂，不再輪迴；三.深信切願，念佛要深；四.風不止而樹茁壯，親不待而勤助念；五.肉體幻滅，神識仍在；六.莫存僥倖，平日勤修；七.助念志工，不與人爭；八.提起正念，安定亡靈。 關於助念志工的生命觀，為藉假修真、修行往生，生死何重、死為重矣，深信切願、必能往生。其關係圓融之研究，則分為志工團體合作默契、家人關係的圓融、鄰居關係的圓融、工作單位的關係圓融、人生觀之關係圓融等研究向度，總歸其看法為「人生如過客，有何好計較」、「修行要緊，不與人爭」、「別人都對，抱歉我錯」、「面對現實，明辨真假」、「富貴在天，不怕吃虧」。 本文並依據研究發現，對助念志工的建議為：至誠懇切、念佛要深；參透生死、自度度人；發心在剎那、恆持到永遠。對死者與家屬的建議為：生前要預立遺囑，交待後事。對社會大眾的建議為：每一個家庭最少有一兩位成員要懂得助念。對醫療體系的建議為：培訓更多志工、義工來從事臨終關懷的工作。對佛教道場的建議為：加強宣導助念的方法與功效，讓「助念」普及化。對政府機構的建議為：培訓更多宗教師等專業人士。對葬儀社的建議為：避免打斷助念流程，協助讓助念工作圓滿、助亡者往西。 關鍵詞： 助念、助念志工、生命觀、關係圓融 / We cannot avoid encountering and experiencing the death of loved ones around us in our lives. Even through media or newspaper, we read about people dying of sickness, accidents, and natural disasters, just to name a few. We can say that everyone is coupled with death. Since facing death is something one must deal with sooner or later, we can say it is one of the most important studies in our lives. It is worthy for us to think about it and understand it seriously. This study applies the in-depth interview of qualitative research. There are eleven volunteers of End-of-Life Chanting as the research population in this study, including interviewing the main study group, five volunteers from Cheng Te Western Lotus Society, Taipei Chapter, who have more than two years of End-of-Life Chanting experience, the other volunteers from different five groups. In this study, End-of-Life Chanting refers to the process of the Buddhist Chanting Assistance, including both the counseling and the last rite ceremonies, and by uniting the full will power of the End-of-Life Chanting group, chanting Amitabha’s name to help the deceased be escorted by the Buddha to reside in Western Pureland. This study concludes the following: 1. The corpse has a peaceful appearance, which is simply amazing 2. At peace with being dead, not returning back to the life of being human 3. Recite sutra sincerely and believe deeply 4. Worship the deceased parents by reciting sutra and End-of-Life Chanting 5. The spirit of the dead is still alive although the flesh no longer exists 6. Recite sutra diligently and regularly 7. Don’t argue or compete with others 8. Calm the soul of the dead The life philosophy of End-of-Life Chanting volunteers include weighing in the importance of life and death in order to know to take death seriously, reciting sutra sincerely and diligently, believing that it will bring life after death. The studies of the harmonious relationship includes researching the team spirit and team work among End-of-Life Chanting volunteers, relationships among family members, neighbors, and colleagues, and the attitudes toward life. In short, it concludes that, “life is short, why arguing with others?”“the cultivation of oneself is important, competing with others is not necessary”, “others are always right, I need to work on my mistakes”, “facing with the reality of facts, telling the right from wrong”, and “regards the wealth as a gift from God, and not being afraid to be taken advantage of”. . Based on the research findings, there are some suggestions: 1. To End-of-Life Chanting volunteers : recite sutra sincerely；believe that life is unpredictable and chanting is a good deed benefiting others and yourselves；do a good deed at one moment but maintain and support it till forever. 2. To the surviving family members: Have a will made before death in order to set up everything and let your wishes be known 3. To the society：Every family should at least have one or two members who know the work of End-of-Life Chanting ceremonies. 4. To the hospital and medical field: Educate and train more volunteers to engage in the End-of-Life Chanting ceremonies. 5. To the Buddhist temples：To publicize the method and effectiveness of the End-of-Life Chanting, make End-of-Life Chanting more popular and wide- spread . 6. To the government：Educate and train more religious professionals. 7. To the mortuary: Avoid breaking the process of End-of-Life Chanting，and assist the End-of-Life Chanting ceremonies to help the dead reach the Western Pureland. key words：a) End-of-Life Chanting，b) volunteers of End-of-Life Chanting， c) the life philosophy， d) the harmonious relationship

Denna uppsats har som syfte att undersöka om musik används i palliativ vård i Sverige och hur det i så fall beskrivs, motiveras och dokumenteras. Det är en kvalitativ intervjustudie med hermeneutisk förståelseansats. Intervjuer har genomförts med fem personer med olika yrkesprofession inom palliativ vård (sjuksköterska, sjukgymnast, arbetsterapeut, kurator och överläkare). Kontakt med de intervjuade har upprättats genom ett upprop i ett nyhetsbrev som ges ut av Svenskt Palliativt Nätverk, SPN. I uppsatsen ges en teoretisk bakgrund om palliativ vård, kris, etik, död, existentiella frågor, musik, musikterapi samt musikterapi i palliativ vård. Resultatet visar att de intervjuade använder musik i sitt vårdarbete men ingen är professionell musiker eller utbildad musikterapeut. Musikanvändningen beskrivs av informanterna genom konkreta exempel från vårdsituationer och den motiveras dels utifrån personliga erfarenheter av musikupplevelse dels med allmänna reflektioner över musikens olika möjligheter till påverkan fysiskt, psykiskt och socialt i livets slutskede. / This thesis aims to examine whether music is used in palliative care in Sweden and how it is described and justified. It is a qualitative study with hermeneutic approach. The survey consists of interviews with five different professionals working in palliative care (nurse, physiotherapist, occupational therapist, counselor, physician). Contact with the interviewees is established by a proclamation of a newsletter published by Swedish Palliative Network, SPN. The thesis provides a theoretical background of palliative care, crisis, death, ethics, music, music therapy and music therapy in palliative care. The result demonstrates that music is used in care situations and is justified by concrete experiences of how music can affect people physically, mentally and socially in the final stages of life.

Bakgrund och problemformulering: Vård i livets slutskede innebär att vården övergår från att vara livsförlängande till att vara lindrande. Vården kan pågå från dagar till månader och det är viktigt att sjuksköterskan anpassar vården utifrån patientens hälso- och livssituation. Sjuksköterskan ska erbjuda patienten en säker och evidensbaserad vård som utgår från patientens aktuella behov och önskemål. Syfte: Syftet är att belysa sjuksköterskans erfarenheter av vård i livets slutskede i hemmet. Metod: En litteraturöversikt enligt Friberg gransknings- och analysmetod. Resultat: Resultatet presenteras i två teman och fem subteman. Teman som identifierades var att skapa en vårdande relation vid vård i livets slutskede och sjuksköterskas roll vid vård i livets slutskede i hemmet. Slutsats: Det krävs att sjuksköterskan har kompetens, kunskap och engagemang för att kunna erbjuda patienten en god vård i livets slutskede. Trots att vård i hemmet blir allt vanligare inriktar sig den aktuella grundutbildningen för sjuksköterskor i stor utsträckning från att vårda på sjukhus. / Background and problem formulation: Care in the final stages of life means that the care transitions from being life-extending to being palliative. The care can last from days to months and it is important that the nurse adapts the care based on the patient's health and life situation. The nurse must offer the patient safe and evidence-based care based on the patient's current needs and wishes. Aim: The aim is to illustrate the nurse's experiences of end-of-life care at home. Method: A literature review according to Friberg's review and analysis method. Results: The results are presented in two themes and five sub-themes. Themes that were identified were to create a caring relationship in end-of-life care and the role of nurses in end-of-life care at home. Conclusion: It is required that the nurse has the competence, knowledge and commitment to be able to offer the patient good care in the final stages of life. Despite the fact that home care is becoming more common, the current basic education for nurses largely focuses on nursing in hospitals.

The overall aim of this thesis was to study palliative end-of-life care outside specialist palliative care settings, from an organizational perspective and from professionals’ and relatives’ experiences. In Study I 174 individuals were identified retrospectively from nursing records and palliative care identification forms as being in a palliative phase. Data were analyzed with descriptive and analytic statistical methods. In Study II a total of nine nurses working in primary home care, community care, and hospitals were interviewed. Phenomenological methodology was used to analyze data. In Study III 17 enrolled nurses, who worked in community or primary care and in a sitting service organization, participated in four focus group interviews. Data were analyzed with qualitative content analysis. In Study IV seven relatives from four families were interviewed twice. They had each cared in the private home for a dying family member who had received sitting service. Direct interpretation and categorical aggregation were used to analyze data. The results highlight challenges in palliative care, vulnerable situations, and a need of support (I–IV). Individuals’ needs for both palliative care and sitting service were identified, including those of a smaller part of the population who actually received the sitting service. (I). Registered nurses’ responsibilities included care at the same time for individuals in both palliative and curative phases. This created vulnerable situations for the nurses, since their ambitions concerning the care did not correspond to available resources (II). The enrolled nurses’ task was to manage ongoing life and dying in different care settings, to meet individual needs and still provide equivalent care. Despite experiences of vulnerable situations, they felt safe (III). Relatives experienced care situations differently, related to differences in families, the illness trajectory, the need for support, and the support offered. Without sufficient support, vulnerable situations occurred, which made the relatives feel insecure (IV). Thus, care situations in palliative end-of-life care can be experienced in different ways, with different levels of vulnerability. One implication of the research might be to suggest that professional caregivers, to supplement the relatives’ own resources with support tailored to the individual’s and the family’s needs

The aim of the study is, based on the staff’s perspective, to describe and analyse the existential needs of elderly in end-of-life living in nursing homes. The aim was also to examine how the staff perceive working with elderly in end-of-life care. Three qualitative focus groups were conducted by interviewing nursing home staff. The analysis is based on Weisman’s the appropriate death, Tornstam’s gerotranscendence and Hasenfeld’s human service organizations. The main findings were that the term ‘existential needs’ is described as wide and hard to define. Uneasiness and anxiety were common in the end-of-life and it was hard for the staff to meet the existential needs. The staff also described that the “little things” matter, such as holding one’s hand, as well as being present with the elderly. The relationship between the elderly and the staff was vital in order for the elderly to have as good an end-of-life and death experience as possible. The staff felt sorrow when the elderly had passed away and had little time to grieve. In difference to earlier research the staff did not request further education nor tutoring, however they wanted more time to grieve and process the deaths of the elderly.

This research focuses on improving the remanufacturing process efficiency by estimating the workstation utilization through identifying percentage of %Blocking and %Waiting on individual workstations within a remanufacturing flow line. It attempts to achieve this aim such that improved use of methods to overcome the effect of variability can be employed. Extensive literature review revealed the requirement of strategies to recover End of Life products due to the introduction and implementation of legislative directives demanding manufacturers to recover the End of Life resources. Upon analyzing the range of product recovery strategies, End of Life product remanufacturing has emerged as an appropriate and suitable strategy to be used since it extends the operational life of existing products without the need for the new resources required when making products. Remanufacturing is a process in which a product is disassembled to component level. Each of the components will be thoroughly examined for defects. Upon identifying defects, they will either be repaired or components will be replaced. This process in turn increases the product life span. However, remanufacturing is not widely used process applied into various industry sectors due to the fact that it is labour intensive and expensive process compared to new products. Although remanufacturing process is in infancy where small number of industry such as Automotive and Aerospace are deriving benefit from it by making effective use of remanufacturing. Ideally, the suitable manufacturing methods i.e. flow processing system, should be used to remanufacture products. However when flow processing is deployed, it is found that there are a number of factors affecting the process that if not tackled, will result in poor performance and poor efficiency of the overall remanufacturing system. This inefficiency is primarily due to the number of sources of variation found in terms of supply, product design, parts specification, operation and demand variability. Further investigation led to the characterizing the remanufacturing variability and identified ways the effect of this variability can be removed or reduced using Lean principles e.g. Single Minute Exchange of Dies and use of an appropriate manufacturing system. Based on the information revised in literature and experimental design, novel equations were developed along with a set of rules that accurately measures the workstation utilization in terms of %Blocking and %Waiting on individual workstation.

Music therapy plays an integral role in end-of-life care, positively impacting emotional, social, physical, cognitive and spiritual health. The purpose of this integrative review was to collect and compile studies (N= 55) between 2000 and 2016 on the topic of music therapy interventions in end-of-life care, in order to provide both music therapy students and therapists access to the most recent and commonly used music therapy interventions and goals. Results of the integrative literature review indicate that the most common intervention for all age groups in end-of-life care is songwriting and composition, with the most common therapeutic goal being emotional expression and catharsis. Details of music therapy interventions, goals and song details are written in tables for readers to refer to as a guide. Further research is needed with each specific age group and setting, in order to provide refined results beyond what is revealed through this review. Additionally, evaluating therapeutic outcomes of the interventions and goals obtained through this integrative review is another step that can be taken for future research.

Bakgrund: Specialistsjuksköterskans uppgifter på en barnintensivvårdsavdelning (BIVA) är att vårda barn och det innefattar även att vårda barn i livets slutskede. Av de barn som vårdas på en barnintensivavdelning avlider cirka två procent. Att vårda barn och familjen i en situation där fortsatt vård och överlevnad för barnet är utsiktslöst är en tung och ansvarsfull uppgift. Syfte: Studiens syfte var att belysa specialistsjuksköterskors upplevelser av att ha vårdat ett barn vid livets slutskede på en BIVA. Metod: Som datasamlingsmetod användes semistrukturerade intervjuer med sju specialistutbildade sjuksköterskor. Intervjuerna genomfördes med hjälp av en intervjuguide bestående av en huvudfråga och därefter följdfrågor. Data bearbetades utifrån kvalitativ innehållsanalys med en beskrivande ansats. Resultat: Resultatet presenteras i tre kategorier och tio subkategorier. De tre kategorierna var följande: Att känna sig trygg och erfaren i att vårda ett döende barn, familjen i fokus samt upplevelsen av stöd och strategier i det komplexa vårdandet. Diskussion: Trots att upplevelsen av att vårda barn i livets slut är en tung och känslomässig uppgift ansåg samtliga informanter det som en ansvarsfull och positiv uppgift där de kunde göra föräldrarnas sista stund med sina barn till ett fint och ljust minne. / One of the caring tasks that specialist nurses, working in the (PICU) perform, and have to face in the daily profession is to care for children who are facing the end of life in Sweden. Approximately two percent of all the children being cared for in the PICU dies. To care for children and their families when further treatment is futile is a heavy surrounding life and death. The goal of this study was to investigate the experiences of specialist nurses caring for children at the end of life. Qualitative content analyze were used as a method. Seven semi-structured interviews, with a descriptive approach, were transcribed to condensed meanings. Finally, the meaning was coded into ten subcategories within three main categories. Conclusion of this study indicated that pediatric intensive care nurses indicated their work heavy emotionally. The nurses play a vital role to the family´s final time whit their children. It is in the hands of the nurses to support and make the final time as valuable and beautiful as possible for the family.

Bakgrund: Sjuksköterskor behöver möta närstående till personer som vårdas palliativt. Sjuksköterskan kan skapa meningsfulla relationer med närstående och använda denne som en resurs för patienten. Närståendestöd är en av hörnstenarna inom den palliativa vården. Sociala relationer är en av de 6 S:n som används vid personcentrerad palliativ vård, då närstående kan tillföra fler dimensioner till patientens livsberättelse. Syfte: Syftet med denna litteraturstudie var att beskriva sjuksköterskans erfarenheter av att möta närstående till patienter inom palliativ vård. Metod: Metoden var en litteraturöversikt där tolv vetenskapliga artiklar inkluderades. Artiklarna hämtades från databaserna CINAHL Complete och Pubmed och analyserades med hjälp av Fribergs analysmetod. Resultat: Två teman identifierades: yttre och inre förutsättningar för sjuksköterskan. Yttre förutsättningar för sjuksköterskan delades in subteman såsom tidens betydelse, vårdmiljöns inverkan och när närstående har en annan åsikt. I inre förutsättningar för sjuksköterskan framkom sjuksköterskans förmåga att involvera närstående, sjuksköterskans förmåga att utveckla sin kompetens i mötet med närstående, kommunikationens betydelse och förutsättningar att skapa teamarbete. Diskussion: Med de 6 S:n som teoretisk utgångspunkt har litteraturöversiktens resultat diskuterats utifrån bakgrund och annan relevant litteratur. Närstående behövs i vården kring patienten men det är inte alltid som närståendes vilja är densamma som patientens eller vårdgivarens. För att sjuksköterskan ska kunna använda närstående som en resurs krävs tydlig kommunikation och stöd från sjuksköterskan i arbetet mot ett gemensamt mål för palliativ vård. / Background: Nurses need to face next of kin to people who receive palliative care. The nurse can create meaningful relationships with the next of kin and can use them as a resource for the patient. Support for the next of kin is a cornerstone in palliative care. Social relations are one of the 6 S:s used for person-centered palliative care when next of kin can add more dimensions to the patient's life story. Aim: The purpose of this study was to describe nurses' experiences in meeting next of kin to patients in palliative care. Method: The method was a literature review where twelve scientific articles were included. Articles were taken from the databases CINAHL Complete and Pubmed and analyzed using analysis of Friberg. Results: Two themes were identified: external and internal conditions for the nurse. External conditions for the nurse divided into subthemes such as time significance, the care environment impact and when the next of kin has a different opinion. The internal conditions for the nurse came up as the nurse's ability to involve next of kin, nurses' ability to develop their skills in the meeting with next of kin, the importance of communication and the ability to create teamwork. Discussion: With the 6 S:s as a theoretical basis, this literature review has been discussed from the basis of the background and other relevant literature. Next of kin are needed in the health care around the patient but it is not a guarantee that the next of kin`s wishes is the same as the wishes of the patients or the caregivers. For the nurse to use next of kin as a resource it requires clear communication and support from the nurse in the work towards a common goal of palliative care.