This scoping review contains a literature analysis regarding interventions used by health care workers to alleviate guilt in caregivers of patients during end-of-life care. During end-of-life care, many transitions and decisions are made that add to the burden of caregivers. Family caregivers experience many physical, financial, and emotional stressors during the journey of end-of-life care, and this can result in guilt. Feelings of guilt can lead to poorer health outcomes and coping in family caregivers and should be addressed by health providers. In this scoping review, a literature search was conducted using various key terms like "guilt," "hospice," "end-of-life care," "interventions," and "caregivers." The articles that fit the criteria were examined to find tested interventions to alleviate guilt in family caregivers of patients in end-of-life or hospice care. A total of 13 articles were analyzed and divided into three sections, interventions that directly influence guilt, interventions that indirectly influence guilt, and interventions recommended by caregivers and hospice workers. Main themes that emerged for tested and recommended interventions include shared decision making, increased communication with health care providers, increased education on disease process and available options, and an emphasis on caregiver self-care. This research is limited and can provide the framework for future interventions to be tested and applied to the care of family caregivers experiencing guilt while caring for or grieving their loved one.

Intensivvården är ett fält där patienter vårdas för livshotande tillstånd. Där, trots en snabb teknologisk utveckling, det inte alltid är möjligt att rädda patientens liv. De här patienterna avlider för det mesta på IVA eller annan avdelning på sjukhuset. Data från palliativa registret tyder dock på att patienter i hög utsträckning önskar dö i hemmet om det är möjligt. Möjligheten att överföra patienter från intensivvårdsavdelning (IVA) till hemmet finns i vissa delar av världen men betraktas i de flesta länder som något extraordinärt. I det aktuella examensarbetet utforskas tidigare forskning inom området. Syftet med examensarbetet var att övergripande sammanställa forskning kring hur överföring av intensivvårdade patienter till hemmet i livets slutskede beskrivs. Examensarbetet har genomförts som en integrativ sammanställning av alla återfunna studier publicerade de tio senaste åren i fyra stora databaser. Resultatet visar att perspektiv från patient, anhöriga och personal står i centrum. För patienter och anhöriga handlar beslutet om att utöva sin autonomi och på ett värdigt sätt avsluta sitt liv. Kultur är en viktig faktor. Hos personalen dominerade tankar om hur överföringen ska gå till och kring vilka patienter som var lämpliga att överföra. Arbetet visar att överföring hem från IVA sker i flera delar av världen och att de som har varit inblandade i stort är positivt inställda. Sjuksköterskan spelar en viktig roll i hela processen, från att stödja patientens autonoma förmåga, samordna resurser och även i genomförandet av själva transporten. / Intensive care is an area where patients are treated for life threatening conditions where, even if development is happening quickly, the patients’ lifes cannot always be saved. These patients usually die at the ICU or in other general hospital wards. Data from the Swedish palliative register shows that a large portion of patients would prefer to die at home. The possibility to transfer patients from the ICU to home before death exists as a practice in some parts of the world but is usually seen as something out of the ordinary. In this master thesis earlier published studies on this practice were explored. The purpose was to describe the existing research regarding transferring patients from the ICU home to die. The method has been an integrative review of all retrieved articles published in four big databases during the last ten years. The results showed that the perspectives of patients, relatives and personnel are central. For patients and their relatives, the question of personal autonomy and a dignified end of life are of importance. For ICU staff the views are dominated by more practical concerns regarding how a transfer can be made and which patients were suitable for the practice. Transfer home from the ICU to die is happening around the world and those that have been involved report positive experiences. The ICU nurse plays an important role in the whole process, from first identifying the patient’s autonomic capacity in order to make such a decision, to coordinating resources and preparation of the transfer, and even in performing the transfer.

Research shows that healthcare providers (HCPs) are not adequately prepared to provide comfort care for patients who are at the end of life. Since the 1990s, numerous legislative, research, and clinical initiatives have addressed concerns about improving care at the end of life. The purpose of this study was to describe the experiences of HCPs providing comfort for patients in the nursing home who are at the end of life. This study focused on physicians, nurse practitioners, nurses and nurses' aides at a central Florida nursing home. A descriptive qualitative design was done utilizing a focus group discussion, individual interviews, and a self-administered questionnaire. The findings indicated that a lack of facility support, inadequate staffing, inadequate end of life care education, family and patient denial of prognosis, as well as decreased primary care physician involvement affect the delivery of comfort care for patients at the end of life in the nursing home. This study supports the need for end of life education to HCPs and the need for adjustments in staffing to meet the complex needs of patients in the nursing home who are at the end of life. A new finding of this study reflects the use of an angel cart to aid in the provision of comfort care for patients at the end of life. Recommendations for future research were made based on study results

Bakgrund: Möjligheterna till palliativ vård har ökat inom sjukvårdens verksamheter och år 2010 avled ca 90 000 människor i Sverige varav 80 procent ska bedömts ha varit i behov av palliativ vård. Den palliativa vården är utformad för att vårda individer med progressiv, obotlig sjukdom eller skada, där fokus ligger på lindrande av lidande och främjande av livskvalité. Syfte: Att beskriva och sammanställa det vetenskapliga underlaget inom omvårdnad för sjuksköterskors erfarenheter av att vårda vuxna patienter under palliativ vård i livets slutskede. Metod: En litteraturstudie med en beskrivande design uppbyggd av tio artiklar av kvalitativ ansats och funna i databaserna PubMed och Cinahl. Huvudresultat: En relationsskapande vård är centralt och att det krävs att sjuksköterskan är uppmärksam, lyhörd och känslig. Kommunikation ansågs där vara grundpelaren för relationskapande vård, samt bidra till att skapa en säker och effektiv vård. Utöver detta hade sjuksköterskorna erfarenhet av att patientmötet kunde generera existentiella frågor angående sin egen mortalitet och att behöva möta andras existentiella frågor om liv och död. Sjuksköterskorna erfor att vid patientens sista tid i livet hade närstående en betydande roll för att upprätthålla en önskvärd död. Det framgick även att de fick erfara professionella och emotionella utmaningar som genererade i strategier för att hantera dessa situationer. Där de kunde konstatera att arbetet i slutändan var givande och utvecklande. Slutsats: Föreliggande litteraturstudie visar på att vårda palliativa patienter i livets slutskede är en utmaning som kräver sjuksköterskans emotionella närvaro. Utmaningarna möttes med att sjuksköterskorna skapade strategier för att öka kontrollen över de känslor och tankar som uppkommer i samband med vårdandet. Trots utmaningar och svåra känslomässiga stunder kunde det konstateras att sjuksköterskorna ansåg arbetet inom palliativ vård vara en belönande erfarenhet som erbjuder en känsla av personligt fullbordande och att de gjorde skillnad. / Background: The opportunities for palliative care have increased in the healthcare operations and in the year 2010 about 90,000 people died in Sweden, of which 80 percent are estimated to have been in need of palliative care. Palliative care is designed to care for individuals with progressive, incurable disease or injury, where the focus is on alleviating suffering and promoting quality of life. Aim: To describe and compile the scientific basis in nursing for nurses' experiences of caring for adult patients during palliative care in the end of life. Method: A literature study with a descriptive design made up of ten articles of qualitative approach and found in the databases PubMed and Cinahl. Findings: Relationship-building care is central, and it is required that the nurse is attentive, responsive and sensitive. Communication was considered the foundation for relationship-building care, and contributed to creating a safe and effective care. In addition to this, the nurses had experience that this encounter could generate existential issues regarding their own mortality and having to face other people's existential issues of life and death. The nurses experienced that at the patient's last time in life, close relatives had a significant role in maintaining a desirable death. It also emerged that they experienced professional and emotional challenges which generated strategies for dealing with these situations. Where they could state that the work was ultimately rewarding and developing. Conclusion: The present literature study shows that caring for palliative patients at the end of life is a challenge that requires the nurse's emotional presence. The challenges were met with the nurses creating strategies to increase control over their emotions and thoughts that arise in connection with care. Despite challenges and difficult emotional moments, it could be stated that the nurses considered the experience of working in palliative care rewarding and offered a sense of personal fulfillment and that they had made a difference.

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Background: The Critical Access Hospitals (CAHs) system was developed to bring health care to rural populations. Although CAHs lack equipment and resources, CAH nurses still provide end-of-life (EOL) care to critically-ill and dying patients. Objectives: To determine the largest and smallest ranked obstacles and helpful behaviors to providing EOL care to rural patients as perceived by CAH nurses. Also, to determine how CAH nurses' perceptions of obstacles and helpful behaviors to providing EOL care compare to that of their urban counterparts. Methods: A cross-sectional, nationally representative sample of nurses working in 39 CAHs were sent a questionnaire. Nurse participants were asked to rate obstacle and helpful behavior item sizes to providing EOL care to critically-ill patients. Current data were analyzed and compared with previously collected data obtained from urban-working critical care nurses. Results: Seven of the top 10 largest obstacle items were related directly to family behaviors and attitudes such as families not understanding what lifesaving measures entail and intra-family disagreements about life support. Largest helpful behavior items ranked in the top 10 included interventions which the nurse controls and items that impacted nurses having adequate time to deliver EOL care. The majority of the top 10 largest obstacle and helpful behavior items from the 2015 study, as ranked by urban critical care nurses, remained in the top 10 for the current study. Obstacle and helpful behavior items unique to CAHs such as a lack of resources and the nurse knowing the patient or patient's family fell below the top 10 largest items in ranking. Conclusion: As perceived by nurse participants, obstacles and helpful behaviors to providing EOL care remain similar despite location (rural versus urban). CAH nurses are accustomed to working without typical resources found in urban hospitals and therefore did not perceive resource deficits to be among the largest-ranked obstacles to providing EOL care. Family behaviors and attitudes remain the most dominant obstacle noted by nurses.

As the use of lithium-ion batteries exponentially increases through demand for electric vehicles and energy storage systems, so will the need for end-of-life treatment subsequently increase. Recycling the valuable materials from batteries in an efficient and extensive fashion could decrease the environmental impacts of batteries. Northvolt AB is a Swedish battery manufacturer currently constructing a Gigafactory in Skellefteå and is furthermore developing a recycling process, focused on hydrometallurgy, with full-scale recycling operations a couple of years away. In order to assess the environmental hotspots of the process, with a focus on greenhouse gas emissions, a life cycle assessment was conducted with data from Northvolt AB. This data was based on learnings from a pilot plant currently under operation but scaled up to industrial level for an ex-ante type of assessment. The industrial operations at Skellefteå represented +95% of the climate change impact, the remainder arising from a European collection point. The most significant impact driver was waste management (56,5% of the climate change impact category), specifically incineration of recovered materials and residuals. The results indicate that harnessing renewable energy in both the direct operations and the supply chain is of high importance. Chemicals (27%) and electricity (7%) had extensively smaller emissions thanks to the harnessing of renewable energy in both direct operations and the supply chain, compared to electricity mixes with large shares of fossil fuels. Furthermore, large variability was found in impacts of recovered materials depending on the chosen allocation method. The benefit of the Revolt process is likely to be affected by ongoing research projects to recycle and upgrade materials that are currently sent to incineration. For an as high environmental efficiency as possible, it is important that the process make as much use of all the recovered materials as possible, find efficient waste treatment processes, and continue to source from production using as electricity mixes with high shares of renewable energy. / Givet att användningen av litium-jon batterier ökar exponentiellt, drivet av efterfrågan på elfordon och energilagringssystem, så kommer behovet av att avfallshantera utgående batterier att öka. Att återvinna värdefulla material från batterier på ett effektivt och omfattande sätt skulle kunna minska batteriernas miljöpåverkan sett över hela dess livscykel. Northvolt AB är en svensk batteritillverkare som bygger en fabrik i Skellefteå och parallellt utvecklar en återvinningsprocess med fokus på hydrometallurgi, med fullskalig återvinning planerad. För att utvärdera vilka aspekter av processen som driver dess miljöpåverkan, med fokus på utsläpp av växthusgaser, gjordes en livscykelanalys med data från Northvolt AB.  Datainventeringen baserades på lärdomar från en pilotanläggning som för närvarande är under drift, men skalades upp till industriell nivå för en förhandsbedömning. Industriverksamheten i Skellefteå stod för +95% av klimatpåverkan, resten härrör från en europeisk insamlingsplats av utgående batterier. Den viktigaste bidragsfaktorn för klimatutsläpp var avfallshantering (56,5 % av utsläppen), särskilt förbränning av återhämtade material och restprodukter. Resultaten visar att det är av stor betydelse att utnyttja förnybar energi i både den direkta verksamheten och leverantörskedjan. Kategorierna kemikalier (27%) och el (7 %) hade betydligt lägre utsläpp tack vare att förnybar energi utnyttjades, i jämförelse med nationella elmixer med större andelar fossila bränslen.  Vidare konstaterades stor variation i resultatet av miljöpåverkan på återvunnet material beroende på vald allokeringsmetod. Fördelarna med Revoltprocessen kommer sannolikt att påverkas av pågående forskningsprojekt för att återvinna och uppgradera material som för närvarande skickas till förbränning. För minskade klimatutsläpp är det viktigt att processen i så stor utsträckning som möjligt materiellt återvinner alla utgående material, hittar effektiva avfallshanteringsprocesser och fortsätter att etablera en leverantörskedja som producerar med stora andelar förnybar energi.  Utöver att utvärderingen gjordes med preliminära data resonerades avfallshanteringen vara den enskilt största källan till osäkerhet. Framtida livscykelanalyser skulle dra nytta av uppmätt data när den industriella anläggningen är operationell, samt vidga analysen med mer utförlig datainhämtning från relevanta avfallsprocesser och återvinningstekniker.