Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-07-21T18:06:14Z No. of bitstreams: 1 jorgececiliodaherjunior.pdf: 3997005 bytes, checksum: 5cd16f8d9e7c45ac7f4ee338f307c068 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-07-22T15:35:32Z (GMT) No. of bitstreams: 1 jorgececiliodaherjunior.pdf: 3997005 bytes, checksum: 5cd16f8d9e7c45ac7f4ee338f307c068 (MD5) / Made available in DSpace on 2016-07-22T15:35:32Z (GMT). No. of bitstreams: 1 jorgececiliodaherjunior.pdf: 3997005 bytes, checksum: 5cd16f8d9e7c45ac7f4ee338f307c068 (MD5) Previous issue date: 2016-05-20 / Introdução: A hipótese da autonomia da consciência em relação ao cérebro é um tema controverso sobre o qual há uma longa história de investigações científicas. Entretanto, ainda não se realizou uma análise sistematizada das publicações sobre esse tema, que possibilite conhecer o estado da arte nesse campo e determinar lacunas e limitações metodológicas. Objetivos: Fazer um levantamento bibliométrico das publicações que investigaram experiências habitualmente associadas à possibilidade da existência da consciência independente do cérebro nas principais bases de dados científicos. Métodos: Avaliaram-se todos os artigos contidos no Pubmed, Web of Knowledge, PsycINFO, Science Direct e Scopus até 31/12/2015, através de operadores booleanos, envolvendo os seguintes campos: Experiências de quase morte(NDE), Experiências fora do corpo(OBE), Experiências de final de vida(ELE), Possessão(POS), Memórias sugestivas de vidas passadas(PLM), Mediunidade(MED), transcomunicação, detecção de “espíritos” e relação mente-cérebro. Foram excluídos artigos científicos fora do tema ou de outras áreas, publicações não científicas, referências de livros e capítulos de livros. Resultados: Dos 9065 artigos encontrados, 1954 artigos foram incluídos (598 NDE, 223 OBE, 56 ELE, 224 POS, 244 PLM, 565 MED, 44 outros). Ao longo das décadas, notou-se um aumento na quantidade de artigos em todos os campos avaliados, com exceção dos estudos em Mediunidade, no qual houve um declínio no final do sec XX e uma retomada no sec XXI. Em relação aos tipos de artigos, com exceção de Past-life memories e End-of-life experiences (predominando estudos originais), os demais campos possuíram predomínio de artigos de revisão. Os artigos foram publicados em periódicos com fator de impacto médio comparável com outras áreas da ciência, como por exemplo psicologia positiva e reabilitação cardiovascular. Conclusão: De forma geral as pesquisas sobre sobrevivência da consciência têm aumentado nas últimas décadas, em revistas com fator de impacto semelhante ao de outras áreas, porém com predomínio de revisões. A identificação dessas lacunas pode auxiliar na elaboração de novas pesquisas na área. / Introduction: The hypothesis of autonomy of the consciousness in relation to the brain is a controversial subject with a long history of scientific investigations. To date, however, no systematic analysis of the publications on this topic, establishing the state of art in this field and identifying methodological gaps and limitations, has been conducted. Objectives: To conduct a bibliometric search of publications investigating experiences commonly associated with the possibility of the existence of a consciousness independent of the brain held on the main scientific databases. Methods: A search of all articles held on the Pubmed, Web of Knowledge, PsycINFO, Science Direct and Scopus databases up to 31/12/2015 was performed with boolean operators involving the following fields: Near-death experiences (NDE), Out-of-body experiences (OBE), End-of-life experiences (ELE), Possession (POS), Memories suggestive of past lives (PLM), Mediumship (MED), transcommunication, detection of “spirits” and mind-brain relationship. Scientific articles unrelated to the topic or on other areas, unscientific publications, book references and book chapters were all excluded. Results: Of the 9065 articles retrieved, 1954 were included (598 NDE, 223 OBE, 56 ELE, 224 POS, 244 PLM, 565 MED, 44 others). Over the decades, there was an evident increase in the number of articles on all the fields, with the exception of studies on Mediumship which showed a decline during the late twentieth century and subsequent rise in the early twenty-first century. Regarding the types of articles found, with the exception of Past-life memories and End-of-life experiences (mostly original studies), publications were predominantly review articles. The articles were published in journals with an average impact factor similar to other areas of science, such as positive psychology and cardiovascular rehabilitation. Conclusion: Overall, publications of studies on survival of the consciousness have tended to increase over recent decades in journals with similar impact factors to other areas, although these studies were predominantly review articles. Identifying gaps can help guide future studies in the area.

Bakgrund: Palliativ vård syftar till att stödja patienter att åstadkomma bästa möjliga livskvalité i livets slut. Målet med palliativ vård är att lindra smärta och symtom för att patienten ska uppleva välbefinnande. Som sjuksköterska är det betydelsefullt att arbeta utifrån ett personcentrerat arbetssätt. De 6:sn är en vårdmodell som ingår i de personcentrerade arbetssättet och syftar till att lindra lidande, främja välbefinnande och stödja närstående före och efter döden. Syftet med studien är att beskriva sjuksköterskans upplevelse av att vårda palliativa patienter i livets slutskede på sjukhus. Metoden som användes var en litteraturöversikt och elva kvalitativa artiklar låg till grund för resultatet. Resultatet presenterades i tre huvudteman; betydelse av god kommunikation, närståendes betydelse och aspekter som försvårar den palliativa vården. I resultatet framkom det att sjuksköterskor upplever att faktorer som brist på tid, kunskap och erfarenhet hindrar en god palliativ vård medan en god kommunikation till patient och närstående medför en trygghet. Konklusion: Sammanfattningsvis visade detta examensarbete att många faktorer spelade in för att kunna ge en god palliativ vård i livets slutskede. / Background: Palliative care aims to support the patient to achieve the best possible quality of life toward the end of life. The purpose of palliative care is to relieve pain and symptoms so that the patient will be more comfortable. As a nurse it’s important to work by a personalized care. The 6:s is a care model that is included in the personalized care and aims to relieve suffering, to promote well-being and support the family before and after death. Aim: The purpose of the study is to describe the nurse's experiences in taking care of palliative patients toward the end of life at hospital. The method that was used was a literature review and the result was based on eleven qualitative articles. The results are presented in three main themes; the meaning of good communication, the importance of close relatives and aspects that complicate palliative care. The results shows that nurses find that factors such as lack of time, knowledge and experience prevent good palliative care, while good communication with patients and close relatives brings safety. Conclusion: The conclusion is that this thesis shows that many factors are important in order to provide a good palliative care in the end of life.

The operation and maintenance phase of a complex technical system may deal with strategicdecisions for asset retirement and end-of-life management. When a fleet of aircraft reachesthe retirement phase, the operation of remaining fleet should still be kept at a defined level ofavailability. Obviously, the provisioning of spares is a key issue to support the maintenanceand operation of the remaining fleet. The best practice within the aviation industry is to re-usethe spares of retired aircraft to support the operational fleet. This is referred to parting-out.The purpose of the research conducted for this thesis has been to develop decision supportmethodologies, models and tools for the management of a sustainable part-out-based sparesprovisioning for an aircraft fleet during its retirement period. The proposed methodology willbe used to support the retirement process of aircraft fleet and enhance the organisation’scapability of making efficient and cost-effective decisions concerning the re-use of spare partsduring the retirement period. To achieve the purpose of this research, literature studies, casestudies, algorithm development and simulations have been conducted. Empirical data havebeen collected through document studies, interviews, and the perusal of archival records fromSaab Support and Services AB. The data analysis performed for this research has been basedon theories and methodologies within reliability analysis, cost modelling, spares forecasting,stock provisioning and decision making, in combination with the best practices implementedby the aviation industry for the end-of-life management and retirement of aircraft.In the present thesis, part-out-based spares provisioning (PBSP) program is proposed to utiliseretired aircraft units effectively as spare parts. The proposed approach is illustrated andverified through a case study performed on the “Saab-105” military aircraft fleet withinSwedish air force fleet. A PBSP programme is proposed, associated management activitiesare described, the key decision criteria are presented, and a functional framework for aneffective PBSP is suggested. The proposed PBSP program provides a foundation for furthermeasures and tasks to be performed within the retirement period, such as terminatingmaintenance contracts, discarding internal maintenance capabilities, reviewing stocks, scalingdown administrative processes (e.g. spares procurement and obsolescence monitoring), etc.An important part of the PBSP programme is the reliability analysis of multiple repairableunits, and this has been investigated, using parametric and non-parametric reliabilityapproaches. The aim is to identify a practical approach for estimation of the future sparedemand at fleet level. Furthermore, a set of computational models and search algorithm havebeen developed for the identification of applicable termination times, of both the parting-outprocess and the maintenance and repair actions performed on the units. This includestermination of the parting-out process (PO), the sending of parted-out units directly to storage(POS), and repair actions performed on the units received at the repair shops owing tocorrective (CM) and preventive (PM) maintenance, as well as the parted-out units that need tobe repaired (POM). The feasible termination alternatives are compared with regard to theirrespective costs and the most cost-effective solutions are identified.The results of the research study show that a PBSP programme can yield large reductions inmaintenance and spares procurement costs, while supporting operation of existing fleet athighest required availability. It also contributes positively to implement a green supply chainduring the retirement phase. The methodology and approaches introduced within the thesiscan be applied in other civil applications, such as energy, mining, process industry andtransportation sectors.

This dissertation aims to examine and analyse the current South African position with regard to voluntary euthanasia. An examination is made from constitutional law, common law, case law and statutory law perspectives, including the legislation proposed by the South African Law Commission (project 86). The writings of prominent authors are considered. Once the South African position is examined, a comparative study is undertaken concerning relevant aspects in the Dutch law. The most important findings are that the South African Constitution may allow, and perhaps even demand, the legalization of voluntary euthanasia in South Africa, provided that sufficient safeguards can be established to effectively and sufficiently minimize the risk of abuse. Should this be impossible, the proscription of euthanasia may be reasonable and justifiable in an open and democratic society based on human dignity, equality and freedom. Finally, some recommendations are made for changes to the South African Law Commission’s Final Draft Bill. / Dissertation (LLM (Medical Law))--University of Pretoria, 2008. / Public Law / unrestricted

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2016-06-01T19:06:09Z No. of bitstreams: 1 Carlos Roberto Franzini Filho.pdf: 953434 bytes, checksum: ad55f7d0771d38a54591c6a4aa6da6b2 (MD5) / Made available in DSpace on 2016-06-01T19:06:09Z (GMT). No. of bitstreams: 1 Carlos Roberto Franzini Filho.pdf: 953434 bytes, checksum: ad55f7d0771d38a54591c6a4aa6da6b2 (MD5) Previous issue date: 2015-03-31 / Currently in Brazil and the worldwide, the "end of life vehicles" (ELV) has been considered as a serious problem to environment. It is considered as an ELV the vehicle that concluded his life cycle or vehicle damaged due accidents. Unlike countries where recovery ELV happens because of specific ELV laws, recovery of ELV parts in Brazil has been guided by profit in reason of the possibility to reselling parts with highest market value after the first phase of use. The aim of this study was to identify what are necessary steps to propose a framework to implementation of reverse logistics process to ELVs in Brazil. The methodology used to achieve the aim was a theoretical / conceptual research from bibliometric review of the literature available in five databases (CAPES, EBSCO, PROQUEST, SCIENCE DIRECT, GOOGLE ACADÊMICO) and documentary research in Unions and class Associations. A content analysis from collected data allowed the identification of the main aspects and activities related to reverse logistics to ELV. Considering the current scenario for ELVs in Brazil and the data obtained from the literature during the content analysis, a framework was proposed with the required steps to implement the reverse logistics to ELV in Brazil. In reason of a theoretical study, there are limitations because of the different realities from researched countries: changing regulatory, social structures, political systems, laws, economic systems and also the level of development from the country. / Atualmente no Brasil e no mundo, os “Veículos em Final de Vida” (VFV) têm sido um grande problema para o meio ambiente. É considerado como VFV o veículo que chegou ao final de seu ciclo de vida útil ou o veículo que teve o seu ciclo de vida útil interrompido prematuramente em razão de acidentes. Diferentemente dos países onde a recuperação de VFV acontece em razão de obrigações legais especificas, no Brasil a recuperação das peças constituintes dos VFV têm sido impulsionada pela possibilidade de obtenção de lucro com a revenda destas peças para reuso, remanufatura ou reciclagem. Neste contexto, o presente trabalho tem como objetivo propor um framework com as etapas necessárias para a implementação do processo de logística reversa para VFV no Brasil. A metodologia utilizada para atingir o objetivo proposto foi uma pesquisa teórico/conceitual a partir de revisão bibliométrica da literatura em cinco bases de dados disponíveis (CAPES, EBSCO, PROQUEST, SCIENCE DIRECT, GOOGLE ACADÊMICO) e uma pesquisa documental em órgãos de classe do setor automotivo. Uma análise de conteúdo feita nos dados coletados permitiu a identificação dos principais aspectos e atividades relacionadas ao processo de logística reversa para VFV. Foram apresentados os principais estimuladores e barreiras identificadas na literatura para a implementação da logística reversa para VFV. Considerando o atual cenário para VFV no Brasil e as os dados apurados na literatura durante a análise de conteúdo, foi proposto um framework com as etapas necessárias para a implementação do processo de logística reversa para VFV no Brasil. Por tratar-se de um estudo teórico, as limitações deste estudo se devem ao fato das diferentes realidades entre os países pesquisados: diferentes regulamentações governamentais, estruturas sociais, sistemas políticos, sistemas econômicos e também o nível de desenvolvimento do país.

La relation médecin-malade a évolué au cours des dernières décennies vers un rôle croissant du patient dans les décisions médicales. Dans le domaine de la fin de vie, deux lois en dix ans sont venues renforcer l'autonomie des malades. L'accroissement des capacités et des pouvoirs de la médecine a conduit à créer des situations inédites. Dans certaines de ces situations, l'ensemble des possibilités médicales sont déployées pour une prolongation artificielle de la vie, sans que le bénéfice pour le patient ne soit clair alors que les nuisances peuvent être insoutenables. On parle alors d'obstination déraisonnable ou d'acharnement thérapeutique. Cette évolution globale de la médecine se retrouve pour les traitements médicaux des cancers. L'évolution récente des thérapeutiques médicales a été considérable faisant naître puis croître une forte demande de prolongation de vie et de guérison chez les patients. Pourtant, la plupart des cancers en situation métastatique demeurent incurables et sont fréquemment mortels. Le parcours du malade incurable en cancérologie, du diagnostic à la fin de vie, va comporter de nombreuses décisions pour lesquelles différents arguments peuvent être mis en balance. La prise de décision dans ce contexte est souvent complexe et difficile. Des études internationales montrent un niveau élevé de soins agressifs en fin de vie et ce phénomène s'amplifie au cours des dernières années. Le contraste est saisissant entre d'un côté la demande de la société civile se traduisant par les évolutions législatives récentes renforçant les droits des malades en fin de vie, et de l'autre côté le haut niveau d'agressivité dans le soin en fin de vie ainsi que son augmentation. Ce contraste témoigne d'une tension persistante dans le processus décisionnel, y compris en fin de vie. Cette tension est particulièrement forte en cancérologie où les décisions médicales en fin de vie sont nombreuses. Cette thèse, dans le cadre d'une démarche éthique, explicite le cadre du soin et les spécificités de la cancérologie puis cherche à définir et à caractériser l'obstination déraisonnable en cancérologie. Les études réalisées proposent des moyens de lutter contre l'obstination déraisonnable. D'abord en renforçant la place du patient dans les décisions en fin de vie dans le cadre de discussions anticipées. Puis en limitant le risque d'erreur dans le processus décisionnel du cancérologue grâce à une médecine intégrée. Enfin, une action sur le discours du cancérologue, semble être une voie de recherche prometteuse. / The patient-doctor relationship as evolved during the past decades toward a more important role of patients in medical decisions. In France, two laws were passed in the last ten years, reinforcing patients' autonomy at the end-of-life. In the same time, the improvement of medical capacities and abilities have created new situations. In some of them, all medical abilities are deployed leading to an artificial prolongation of life, with no clear benefit for the patient while toxicity can be unbearable. Oncology has particularly been concerned by this global evolution of medicine. Recent evolutions in treatments have raised a strong demand for life prolongation and cure. Nevertheless, most cancers when at the metastatic stage are incurable and fatal diseases. In this setting, the path from diagnosis to end-of-life implies numerous and important decisions for which different arguments can be balanced. Decision making in this context is often complex and difficult. International studies report a high level of aggressiveness in the end-of-life care of oncology patients. Moreover, this phenomenon has increased in the past years. The contrast is striking between, on the one hand the demand of the society translating into laws reinforcing the patients' rights at the end-of-life, and on the other hand the high level in the aggressiveness of end-of-life care. This contrast gives evidence of a persistent tension in the decision making process, including at the end-of-life. This tension is particularly important in oncology, where many decisions are to be made at the end-of-life. In this manuscript, following an ethical approach, we describe the setting of care in oncology and characterize an excessive aggressiveness in end-of-life care. The studies presented suggest resources to avoid or decrease this aggressiveness of care. First with advanced discussions, allowing to reinforce the role of patients in end-of-life decisions. Second with an integrated medicine approach, resulting in a limitation of the risk of error in the oncologist decision making process across incurable-cancer care. Finally, acting on the oncologist communication may reveal essential.

Bakgrund: Antalet äldre personer i befolkningen ökar. Många äldre i livets slutskede har ofta komorbiditet vilket ställer krav på hög kompetens hos sjuksköterskor i omvårdnadsarbetet. Det är oundvikligt att nyutexaminerade sjuksköterskor träffar äldre i livets slutskede inom slutenvården, men studier visar att de dock inte har tillräckligt med kunskap att vårda denna patientgrupp. Forskningen inom området är dock begränsad och så även svenska studier. Syfte: Syftet med studien var att belysa nyutexaminerade sjuksköterskors erfarenheter av att vårda äldre personer i livets slutskede inom slutenvård. Metod: En intervjustudie genomfördes med elva nyutexaminerade sjuksköterskor på tre medicinavdelningar. Intervjuerna transkriberades och analyserades med en kvalitativ innehållsanalys inspirerade av Elo och Kyngäs (2008). Resultat: Resultatet av studien presenterades i fyra huvudkategorier: Mötet med anhöriga, vikten av teamarbete, behovet av kunskap och vårdmötet med den döende patienten. Resultatet visade att nyutexaminerade sjuksköterskor upplevde att det var svårt att bemöta anhöriga och samtala med dem om döendeprocessen. Nyutexaminerade sjuksköterskor uttryckte att de saknade tillräcklig kunskap, tid och erfarenheter att vårda äldre i livets slutskede. En förutsättning för att den döende patienten skulle få en värdig död var ett välfungerande teamsamarbete. Slutsats: Genom mer träning med erfarna sjuksköterskor och internutbildning på avdelningarna kan nyutexaminerade sjuksköterskor få bättre förutsättningar och skaffa sig erfarenhet och därmed öka sin kompetens inom vård av äldre i livets slutskede. / Background: The number of older people in the population is increasing. Many elderly people at the end of life often have comorbidity, which requires high levels of expertise among nurses in nursing work. It is inevitable that newly graduated nurses will meet the elderly at the end of life in the hospital, but studies show that they do not have enough knowledge to care for this patient group. However, research in this area is limited and so are even Swedish studies. Aim: The aim of the study is to illustrate newly graduated nurses´ experiences of caring for elderly people in the final stages of life in the hospital. Method: An interview study was conducted with eleven newly graduated nurses at three medical departments. The interviews were analyzed with qualitative content analysis inspired by Elo and Kyngäs (2008). Results: The results of the study were presented in four main categories: the meeting with family members, the importance of teamwork, the need for knowledge and the care meeting with the dying patient. The result showed that newly graduated nurses found it difficult to meet family members and talk to them about the dying process. The newly graduated nurses expressed that they lacked sufficient knowledge, time and experience to care for the elderly at the end of life. Prerequisite for the dying patient to receive a dignified death was well-functioning team collaboration. Conclusion: Newly graduated nurses can have a better opportunity to increase their skills in the care of the elderly at the end of life through more training with experienced nurses and internal education in the medical department about how to care for the elderly at the end of life.

Människor lever längre och det innebär att de allra flesta som dör i Sverige är äldre. Vårdfilosofin palliativ vård definieras som en helhetsvård, där patienten och anhöriga ska göras delaktiga i omvårdnaden. Enligt svensk lag har sjuksköterskan en skyldighet att göra patienten delaktig i sin vård. Vården i livets slutskede blir allt mer avancerad och det är viktigt att patienten görs delaktig, för att främja en god död. Samband i form av delaktighet och en god död har påvisats. Sjuksköterskan kan skapa förutsättningar för patientens delaktighet genom att vara lyhörd och lyssna samt se till att patientens delaktighet finns dokumenterad. Studiens syfte var att beskriva sjuksköterskans upplevelse och möjlighet att göra den äldre patienten delaktig vid vård i livets slutskede inom kommunens hemsjukvård. En kvalitativ intervjustudie med en induktiv ansats genomfördes. Deltagarna var åtta sjuksköterskor med erfarenhet av vård i livets slutskede i kommunens hemsjukvård. Kvalitativa innehållsanalysen gav ett resultat med fyra huvudkategorier: sjuksköterskans roll, teamets betydelse, anhörigas roll samt etiska dilemman. Slutsatsen är att det behövs mer dokumentation om den äldres delaktighet i kommunens hemsjukvård. / People live longer and that means that the vast majority of people who die in Sweden are older. Care philosophy, palliative care is defined as a holistic care, where the patient and relatives must be involved in the care. According to Swedish law, the registered nurse has an obligation to involve the patient in their care. The end of life care is becoming more advanced and it is important that the patient becomes involved in their care, as it can lead to a good death. Relationships in the form of participation and a good death have been demonstrated. The registered nurse can create conditions for the patient's participation by being responsive and listening, and ensuring that the patient's participation is documented. The aim was to describe the registered nurse's experience and opportunity to involved the older patient in care at the end of life within the municipality's home health care. A qualitative study with an inductive approach was conducted. Eight registered nurses with experience in end of life care in municipality's home care. The qualitative content analysis a resulted in four main categories: the registered nurse's role, the importance of the team, the role of relatives and ethical dilemmas. The conclusion is that more documentation is needed about older patient´s participation in municipality's home health care.

Bakgrund: Palliativ vård i livets slutskede inträder i övergången då patienten närmar sig livets slut och kännetecknas av en helhetssyn på människan. Vården utförs i syfte att lindra lidande och främja livskvaliteten för alla patienter med progressiv, obotlig sjukdom eller skada. Anhöriga ska också erbjudas att delta i den palliativa vården. Forskning visar att ungefär 10 procent av efterlevande riskerar att få sorgerelaterade psykiska besvär. Syfte: Syftet med studien var undersöka anhörigas upplevelser av palliativ vård vid livets slutskede. Metod: Litteraturöversikt med tio artiklar. Nio kvalitativa artiklar och en artikel med mixed-method som analyserades enligt Fribergs metod. Resultat: Huvudtemana som växte fram var kommunikation, information, anhörigstöd och delaktighet i den palliativa vården. Huvudtemana delades var för sig upp i underkategorierna kommunikation som mottogs väl, kommunikation som brast, information som förmedlades bra, undermålig information, emotionellt stöd, avsaknad av emotionellt stöd, andligt stöd, tillfredställande delaktighet, när anhöriga inte blev delaktiga. Slutsats: Anhöriga upplevde brister beträffande både kommunikation, information, delaktighet och emotionellt stöd i den palliativa vården. Detta medförde ett onödigt lidande och försämrad livskvalitet. Bristerna fick dem i värsta fall att känna sig förringade och avvisade. Anhöriga behövde en kommunikation som genomsyrades av empati och engagemang. Informationen behövde vara lättförståelig och upprepas. Anhöriga upplevde att de hade behov avemotionellt stöd i form av att bli förstådda och bekräftade i sin sorg. De upplevde också ett behov av att få delta i vården och upplevde den palliativa vården som mer positiv om de erbjöds att delta. / Background: Palliative care in the final stages of life enters the transition when the patient approaches the end of life and is characterized by a holistic view of man. The care is performed in order to alleviate suffering and promote the quality of life for all patients with progressive, incurable disease or injury. Relatives must also be offered to participate in palliative care. Research shows that about 10 percent of survivors are at risk for grief-related mental illness. Aim: The purpose of the study was to investigate relatives' experiences of palliative care at the end of life. Method: Literature overview with ten articles. Nine qualitative articles and one article with mixed method. Results: Main themes emerged were communication, information, family support and participation in palliative care. Main themes were divided separately into the sub-categories communication well received,communication broken, information conveyed well, substandardinformation, emotional support, lack of emotional support, spiritual support, satisfactory participation, when relatives did not participate. Conclusion: Relatives experienced shortcomings in terms of communication, information, participation and emotional support in palliative care. This led to unnecessary suffering and deteriorating quality of life. In the worst case, the shortcomings made them feel degraded and rejected. Relatives needed a communication that was permeated by empathy and commitment. Information needed to be easy to understand and repeat. Relatives felt they needed emotional support of being understood and confirmed in their grief. They also experienced a need to participate in care and experienced palliative care as more positive if they were offered to participate.

Bakgrund: Palliativ vård utförs i hela världen och det är viktigt att utveckla och följa upp den typen av vård. Palliativ vård utgår från fyra hörnstenar och skall involvera mer än det fysiska i omvårdnaden. Det är viktigt att också lägga märke och ta hand om det psykiska, sociala och andliga. Ett stort mörkertal och brister har identifierats inom den palliativa vården som måste förbättras.  Motiv: 2018 vårdades ca 19% av palliativa patienter i sitt eget hem. Många patienter som är hemma i livets slutskede skickas mellan sjukhus och hemmet för att tillslut dö på sjukhuset trots att deras vilja kanske var att dö hemma. Därför är det viktigt att se hur nöjd distriktssköterskan eller sjuksköterskan på vårdavdelningar samt i hemsjukvården är med sitt arbete och vad som kan förbättras.  Syfte: var att kartlägga och jämföra hur nöjda distriktssköterskor och sjuksköterskor i hemsjukvård samt på vårdavdelning är angående sin insats i palliativ vård.  Metod: En kvantitativ jämförelsestudie med stratifierat urval. En enkätundersökning skickades ut till åtta vårdavdelningar och till femton kommuners hemsjukvård. Deltagarna var distriktssköterskor och sjuksköterskor i norra Sverige, totalt deltog 83. Insamlad data analyserades i Jamovi och presenteras med Chi square test samt Fischer’s exact test.  Resultat: En signifikant skillnad där distriktssköterskor alternativt sjuksköterskor i hemsjukvården är mer nöjd med symtomlindring vad gäller oro/ångest (p=0.038) samt smärta (p=0.021) upptäcktes. Vid jämförelse mellan hemsjukvård och vårdavdelning kring hur nöjd distriktssköterskan eller sjuksköterskan är med sin egna insats framkom en signifikant skillnad där de på vårdavdelningen var mindre nöjd.  Konklusion: En påvisad skillnad kan ses mellan distriktssköterskor och sjuksköterskor i hemsjukvården eller på vårdavdelning vad gäller symtomlindring, vidareutbildning samt läkarkontakt. Fler studier behöver utföras för att få ett mer rättvist resultat.