Abstrakt: Beslut gällande patienters HLR-status fattas av läkare, men den process som föranleder beslutet bör involvera flera parter. I enlighet med autonomiprincipen ska patienter vara delaktiga i de beslut som berör deras egen vård. Syftet: med denna litteraturstudie var att undersöka några frågor kring HLR/ej-HLR vid vård i livets slutskede. Metoden var en systematisk litteraturstudie, baserad på tio vetenskapliga artiklar. Litteratursökningen utfördes i databaserna PubMed och CINAHL, samt manuella sökningar. Både kvalitativa och kvantitativa artiklar inkluderades i litteraturstudien. I resultatet framkom det tre olika huvudteman samt två underteman. Det tema som framkom tydligast i resultatet var; information i livets slutskede. Informationsbehovet rörande HLR, bland patienter som vårdas i livets slutskede, skiljer sig åt och bör därför individanpassas. Eftersom sjuksköterskor oftast är de som har mest kontakt med obotligt sjuka patienter, är det av stor vikt att de involveras i beslutsfattandet. Det framkom även att patientens livskvalitet är en faktor som inverkar på beslut gällande HLR. Upplevelsen av livskvalitet är individuell och kan därför vara svår för andra att bedöma. Att värna om patienters rätt till autonomi är essentiellt och speciellt gällande livsavgörande beslut. Allmänsjuksköterskans roll vid vård i livets slutskede bör därför vara, att på bästa möjliga vis tillmötesgå patienterna och därmed även underlätta de anhörigas sorgarbete. / Abstract: Decisions regarding patient’s CPR status are made by doctors, but the process that causes the decision should involve several parties. In accordance with the autonomy principle, patients should be involved in the decisions that affect their own care. The aim of this study was to examine some questions regarding CPR / DNR in the final stages of life. The method was a systematic literature review, based on ten articles. The literature search was performed in the databases PubMed and CINAHL, as well as manual searches. Both qualitative and quantitative articles were included in the literature review. The results revealed three main themes and two sub-themes. The theme that emerged most clearly in the results was: information in final stages of life. The need for information regarding CPR, among patient’s cared for at the end of life, differs and should be individualized. Because nurses often are the ones who have most contact with terminally ill patients, it is essential that they get involved in decision making. It also revealed that the patient’s quality of life is a factor influencing the decision regarding CPR. The perception of quality of life is individual and can therefore be difficult for others to judge. Protecting patients’ rights to autonomy is essential, especially regarding vital decisions. General Nurses role, when caring for patients in their final stages of life, should therefore be, in the best possible way, to accommodate the patients and by doing so also help to ease the relative’s grief.

Background: Every year in Sweden, approximately 90,000 people die. Some die due to trauma or terminal illness, while others die from natural causes. When patients are in a terminal condition, they can receive support and nursing care from nurses in their own homes. Patients' homes provide a safe environment for both the patient and their family, and many individuals express a desire to spend their final days at home. Previous research indicates that there is a significant amount of data available regarding nurses' experiences in providing end-of-life care in hospitals, but there is comparatively less data and research concerning nurses' care for patients in their own homes. Aim: The aim of this study was to describe nurses´ experiences of caring for patients in end-of-life care at home. Method: A method to contribute to evidence-based nursing with ground in analysis of qualitative research was performed to get a better understanding of nurses´ experiences. Results: Three main themes were discovered; Competence and teamwork makes a difference, need to dare to get close and assets and limitations of work while working in the patient's home. Nurses experienced many emotions, challenges and obstacles when working with patients in end-of-life care in their home. Collaboration was important with both physicians and with the family care providers to enable good care for the patients. Conclusion: When nurses worked closely with the patients in their home, they felt emotionally affected and the experience overall was both positive and negative. This study showed that nurses in home care need experience and self-confidence to give good and safe care for the patients in end-of-life care. / Denna litteraturbaserade studie beskriver sjuksköterskors erfarenheter av att vårda patienter i livets slutskede i hemmet. Resultatet grundas på analys av tio vetenskapliga artiklar med kvalitativ metod. Från analysen av datamaterialet framkom tre teman; kompetens och samarbetegör skillnad, behöver våga komma nära samt tillgångar och begränsningar med att vårda i patienternas hem. Sjuksköterskor inom palliativ vård i livets slutskede behöver ständigt hålla sig à jour om ny kunskap inom palliativ omvårdnad och palliativ medicin. Sjuksköterskorna behöver ha ett följsamt och lyhört förhållningsätt när de arbetar i patienternas hem. I hemmet träffar de även närstående som de behöver etablera en god relation med. Närstående har en nyckelroll inom vård i livets slutskede i hemmet. Utan närstående blir det svårt för sjuksköterskorna att planera omvårdnaden. Det kan uppstå situationer där sjuksköterskor upplever mycket känslor i samband med att patienterna avlider vilket de genom erfarenhet lär sig att hantera. Sjuksköterskorna upplevde jobbet som givande och utmanande.

Bakgrund Det dör cirka 5 miljoner barn globalt varje år, Forskning och litteratur påvisade att sjuksköterskans kommunikativa förmåga med såväl barnet som dess familj är av central betydelse för att kunna tillämpa kvalitativ vård vid livets slutskede. Sjuksköterskors kunskaper och färdigheter var betydelsefullt för barnet och familjen vid vård av barn i livets slutskede. Syfte Syftet med studien var att beskriva sjuksköterskors upplevelser att vårda barn i livets slutskede. Metod Examensarbetet genomfördes som en strukturerad litteraturstudie med inslag av den metodologi som används vid systematiska översikter. Resultatet baseras på 14 kvalitativa vetenskapliga artiklar. Resultat Sjuksköterskorna upplevde både positiva och negativa känslor när ett barn var i livets slutskede. Olika sorters strategier tillämpades för att sjuksköterskorna skulle kunna hantera upplevda känslor. En relation mellan sjuksköterskor, barnen och familjen skapades vid vård av barn i livets slutskede. Erfarenhet och utbildning om att vårda barn i livets slutskede upplevde sjuksköterskorna var betydelsefullt. Slutsats Det var av stor betydelse att sjuksköterskor fick adekvat support och tillfälle att bearbeta och reflektera över händelser som skett under vården av ett barn i livets slutskede. Det var även viktigt med utbildning, speciellt för nyexaminerade sjuksköterskor. En sjuksköterska ska vara medveten om den relation som har skapats med barnet och familjen och handla adekvat och professionellt utefter det. / Background Approximately 5 million children die globally each year. Research and literature have shown that the nurse's communicative ability with both the child and their family is of central importance in being able to provide quality end of life care. Nurses' knowledge and skills are significant for the child and family in end-of-life care for children. Aim The aim of the study was to describe nurses' experiences of caring for children at the end of life. Method This thesis was carried out as a structured literature study with elements of the methodology used in systematic reviews. The results are based on 14 qualitative scientific articles. Results The nurses experienced both positive and negative emotions when a child was in end of life. Different types of strategies were implemented to help nurses cope with experience demotions. A relationship between nurses, the children and the family were formed during the care of children at the end of life. The nurses found the experiences and education in caring for children in the end of life was significant. Conclusions It was of great importance that nurses received adequate supports and opportunity to process and reflect on events that occurred during the care of a child at the end of life. Education, especially for newly graduated nurses, was also important. A nurse should be aware of the relationship formed with the child and family and act appropriately and professionally based on it.

In this project, the possibility of using thermography as a non-destructive testing tool in the manufacturing process of boats and to assess the quality of end-of-life composite structures has been explored. To do so, a literature surview regarding the current applications of thermography and the techniques currently used for quality control in the boats industry has been conducted. Additionally, the set-up of the thermal camera has been improved for the testing and measurements on several composite parts have been performed. Here, the resulting images were analysed regarding different features important for the intended new application, such as existence of delamination, bonding quality, and fibre orientations. The technique appears to be well suited to evaluate the bonding quality in case of glass fibre composite plates and to detect delaminations and other defects in such. Regarding the fibre orientation more studies are needed to judge the practicality.

The alleviation of suffering lies at the core of compassionate end-of-life care, yet little is known about the lived experience of suffering. Motivated by a series of reports on poor care of older people in hospital, this study addresses suffering in older people at the end of life in an acute hospital ward in the United Kingdom. Methods were developed from a synthesis of ethnographic fieldwork and phenomenological interpretation. Data were collected using participant observation on an acute care ward for older people in a hospital in Northern England, over 186 hours between June and August 2015. Data included field notes, documents, photographs and informal interviewing. Staff and patient participants were identified using theoretical sampling. Data were analysed using a hermeneutic approach involving a continuous process of analysis, further data collection, posing of problems and questions, and interpretation. This cyclical approach to the data enabled the development of interpretive perspectives which could then be further explored in the field. Findings suggested that care for older people was shaped by competing ideologies of care and organisational regulatory processes. Particularly when there was ambiguity regarding prognosis, there was a tendency for care to default to a ‘rescuing’ acute care model. Through exploring the experiences of individual patients and placing these in the context of cultures of care, I suggest that iatrogenic suffering was a significant concern that often went unrecognised. Patient-centred goals must be more focused upon avoidance of iatrogenic suffering. Recommendations include innovations in clinical education and multiprofessional working.

Background: Despite a longstanding debate regarding personal choice towards death and dying, MAiD was legalized in Canada on June 17th, 2016. Since its integration into the healthcare system, there has been a dearth of literature surrounding providers’ experience with the procedure. Healthcare providers are uniquely positioned within the context of the MAiD experience. Aim: To explore the experiences of health care providers (nurses and physicians) caring for patients undergoing MAiD as well as to explore the relationships between the concepts, Moral Distress (MD), Professional Quality of Life (Burnout (BU), Secondary Traumatic Stress (STS) and Compassion Satisfaction (CS)), and Intent to Turnover (TO). Design: This explorative and descriptive cross-sectional study consisted of a self-reported survey that uses both scale items and open-ended questions. Setting/ Participants: The target population included all nurses and physicians who were active members of a targeted Regional MAiD Network practicing within a designated geographical location within Canada. Results: N=38 Questionnaires completed. The averages of our measured constructs include Moral Distress (Composite) x= 2.9 (SD 2.03), Moral Distress (Frequency): x= 1,18 (SD .102), Moral Distress (Intensity): x= 1.61 (SD .28) Burnout: x= 2.08 (SD 0.5), Secondary Traumatic Stress x= 2.22 (SD 0.48), Compassion Satisfaction x= 4.18 (SD 0.43) and Turnover Intent: x= 2.22 (SD 0.77). Significant positive correlations were found between inter-scale constructs of Moral Distress (Composite, Frequency, and Intensity), Moral Distress, Burnout, and Secondary Traumatic Stress, and between Burnout and Turnover Intent. Significant negative correlations were also found between Professional Quality of life Inter-Scale constructs of Compassion Satisfaction and Burnout as well as between Compassion Satisfaction and Turnover Intent. Conclusion: MAiD providers in our study expressed feelings of their work being “rewarding” and “deeply satisfying”, further reflective in their below-average rates of Moral Distress, Burnout, Secondary Traumatic Stress, Turnover Intent, and higher-than-average rates of Compassion Satisfaction. Although the procedure remains controversial, these participants expressed enjoying their work. These reported positive aspects of their roles persisted despite the challenges the COVID-19 pandemic presented.

There is little research investigating factors that facilitate or inhibit timely access to palliative care medicines from community pharmacies. Though palliative care is recognised within the UK government’s strategy and community pharmacists are considered to have a role it is uncertain to what extent this aim is incorporated into local practice. This thesis uses mixed methods to investigate the time taken to access palliative care medication from five community pharmacies in one area of England. The effect of prescription errors, stock availability and other factors is examined. Furthermore, semi-structured interviews with five community pharmacists and eleven other healthcare professionals explore medication access and the community pharmacist’s role in palliative care using the Framework method. Stock availability led to delays with one in five customers going to more than one pharmacy to get urgently required palliative care medications. Legal prescription errors were more common on computer generated prescriptions but did not lead to delays. Three subthemes were identified in accessing palliative care medicines: environment and resources; communication and collaboration; skills and knowledge. The community pharmacist’s role in palliative care was limited due to reluctance from other healthcare professionals to share information, poor access to patient records and lack of integration into the primary healthcare team. This study highlights implications for professionals, commissioners and providers to improve services for those trying to access palliative medication. Community pharmacies remain a largely untapped resource for supporting patients, relatives and carers towards the end of life in both cancer and other advanced life-limiting diseases.

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