Orientador: Helmut Troppmair / Banca: Lucy Marion Calderini Philadelpho Machado / Banca: Marta Felicia Marujo Ferreira / Resumo: Entendendo-se que a sociedade humana depende, para o seu bem estar, da consideração não só dos fatores ambientais (físicos, químicos e biológicos), mas também dos parâmetros éticos e sociais, este trabalho procura analisar o significado da qualidade ambiental e da qualidade de vida sob o ponto de vista geográfico; para isso, realiza uma discussão acerca de todo o movimento que se iniciou desde a década de setenta a fim de discutir os problemas ambientais até a definição de "qualidade ambiental e de vida urbana", destaca os principais indicadores urbanos que contribuem para nos fornecer resultados referentes à boa ou má qualidade ambiental e evidencia a cidade de Várzea Paulista-SP, como estudo de caso, no que se refere a sua caracterização ambiental-social, como também o levantamento de alguns indicadores para avaliar sua qualidade de vida, destacando: a qualidade das águas da região que abrange o Município de Várzea Paulista-SP; distribuição de água encanada por bairros; situação do esgoto na cidade; relação do número de estabelecimentos comerciais e industriais e o desemprego; dados sobre saúde, educação e criminalidade. Coloca-se como um dos focos principais deste estudo à questão do adensamento do espaço urbanizado influenciando na queda da qualidade ambiental e de vida na cidade de Várzea Paulista-SP. / Abstract: Understanding that human society depends, for its well-being, of a consideration not only of environmental factors (physical, chemical and biological), but also of ethical and social parameters, this work looks for an analysis of the meaning of environmental quality and quality of life under the geographical point of view and of other sciences; for this, makes a discussion of the whole movement that started since the seventies in order to discuss the environmental problems unto the definition of "environmental and urban life qualities", foregrounds the main urban indicators that contribute to provide us with results referring to the good or bad environmental quality and makes evident the city of Várzea Paulista-SP, as a case study, in what refers to its social-environmental characterization, as well as the raising of some indicators to evaluate its quality of life, foregrounding: the quality of waters of the region that comprises the county of Várzea Paulista-SP; distribution of running water by districts; situation of sewage in the city; relation of the number of commercial and industrial establishments to unemployment; data on health, education, and criminality. It is made one of the main focal points of this study the question of the increasing density of the urbanized space influencing on the fall of environmental quality and quality of life in the city of Várzea Paulista-SP. / Mestre

Revisión por pares

Bakgrund: I Sverige är hjärt- kärl sjukdomar den vanligaste dödsorsaken, år 2016 drabbades 25 700 individer av en akut hjärtinfarkt. Efter att ha drabbats av en hjärtinfarkt medför detta förändringar i kroppen och återhämtningsprocessen kan ta tid. För att bemöta dessa patienter med en individanpassad vård behöver sjuksköterskan ha kunskap om vad som påverkar dessa patienter under återhämtningsprocessen och på så sätt hjälpa patienten i deras behov. Syfte: Syftet var att belysa patientens upplevelser och erfarenheter av att ha drabbats av hjärtinfarkt upp till ett år efter insjuknandet. Metod: En litteraturöversikt där tio kvalitativa artiklar från PsychINFO, PubMed och Cinahl complete har granskats och analyserats. Resultat: I denna litteraturöversikt framkommer tre teman: patientens upplevelser som helhet, behovet av stöd samt ett förändrad syn på livet. I dessa teman beskrivs patienternas upplevelser och erfarenheter av att ha drabbats av hjärtinfarkt samt vilka utmaningar de möter i vardagliga livet. Diskussion: Patienterna möter olika utmaningar i det vardagliga livet efter att ha drabbats av hjärtinfarkt. Dessa förändringar kan upplevas som utmaningar och medförde frånvaro av välbefinnande och hälsa. Det är inte bara kroppen som påverkas och behöver behandling, patienter som drabbas av hjärtinfarkt påverkas psykiskt och fysiskt. Teoretikern Katie Eriksson menar att människan består av kropp, själ och ande vilket  utgör kärnan för hälsoprocessen. Många patienter upplever oro och rädsla av att återigen drabbas av ny hjärtinfarkt. Resultatet visade på betydelsen av att bli informera av sjuksköterskan om vilka utmaningar som patienten möjligen kan möta, rehabiliteringens betydelse, symtom, samt vilka livsstilsförändringar som kan ha positiv påverkan på hälsan och välbefinnandet.

Submitted by Gustavo Gomes (gustavolascasas@gmail.com) on 2013-09-03T11:44:36Z No. of bitstreams: 2 Estimativas de expectativa de vida livre de e com incapacidade funcional.pdf: 402198 bytes, checksum: 3cd06b701823474394a0826182cf3dcf (MD5) license_rdf: 23599 bytes, checksum: 9e2b7f6edbd693264102b96ece20428a (MD5) / Approved for entry into archive by Roger Guedes (roger.guedes@fjp.mg.gov.br) on 2013-09-03T15:33:29Z (GMT) No. of bitstreams: 2 Estimativas de expectativa de vida livre de e com incapacidade funcional.pdf: 402198 bytes, checksum: 3cd06b701823474394a0826182cf3dcf (MD5) license_rdf: 23599 bytes, checksum: 9e2b7f6edbd693264102b96ece20428a (MD5) / Made available in DSpace on 2013-09-03T15:33:29Z (GMT). No. of bitstreams: 2 Estimativas de expectativa de vida livre de e com incapacidade funcional.pdf: 402198 bytes, checksum: 3cd06b701823474394a0826182cf3dcf (MD5) license_rdf: 23599 bytes, checksum: 9e2b7f6edbd693264102b96ece20428a (MD5) Previous issue date: 2004 / Funda????o Jo??o Pinheiro / A popula????o idosa tende a apresentar, proporcionalmente, um maior n??mero de doen??as cr??nicas que, conseq??entemente, levam a maior preval??ncia de incapacidade funcional e depend??ncia. Considerando esta realidade, o objetivo do presente estudo foi medir, para os idosos da cidade de S??o Paulo, em 2000, por sexo e idade, a expectativa de vida livre de e com incapacidade funcional. No ??ltimo caso, foram mensurados os anos a serem vividos com e sem depend??ncia. Para estimar a expectativa de vida em cada condi????o de sa??de, foi utilizado o m??todo de Sullivan, combinando a t??bua de vida, com experi??ncia de mortalidade corrente na popula????o em 2000, e a preval??ncia de incapacidade funcional e de depend??ncia. As informa????es empregadas foram obtidas a partir de tr??s fontes de dados: Projeto SABE, Funda????o SEADE e Censo Demogr??fico. Os resultados indicaram que, em 2000, ao atingir os 60 anos, os homens paulistanos podiam esperar viver, em m??dia, 17,6 anos, dos quais 14,6 (83%) seriam vividos livres de incapacidade funcional. J?? entre as mulheres, apenas 16,4 anos (73,7%), dos 22,2 anos remanescentes, seriam vividos livres de incapacidade funcional. Nesse mesmo contexto, entre os homens, 1,55 ano (8,8%) seria vivido com incapacidade funcional e depend??ncia contra 2,5 anos (11,1%) das mulheres. Adicionalmente, pode-se observar que, apesar de em termos absolutos a diferen??as entre os sexos diminu??rem com o avan??ar da idade, em termos relativos as diferen??as se ampliam, com maior desvantagem feminina. Concluiu-se este trabalho ressaltando que, apesar das mulheres idosas paulistanas apresentarem maior expectativa de vida, em rela????o aos homens, a propor????o de anos vividos livre de incapacidade funcional ?? menor. Al??m disso, nas idades mais avan??adas, essas passar??o um n??mero maior de anos com incapacidade funcional e depend??ncia. / The elderly population shows a higher number of chronic illnesses compared to any other age group and, therefore, a higher prevalence of functional disabilities and dependence. Given that, the aim of this study was to estimate, for the elderly of the Municipality of S??o Paulo in the year 2000, for each sex and age, the life expectancy free of functional disability and with functional disability, using the Sullivan???s Method. In this latter case, the remaining years to be lived with and without dependence were also estimated. Data came from three sources: the SABE database, Population Censuses, and mortality statistics (from SEADE Foundation). The main results are as follows: at age 60, men could expect to live an additional 17.6 years. Out of these, 14.6 were expected to be free of functional disabilities. For women, these figures were 22.2 and 16.4, respectively. For men, 1.55 year could be expected to be lived with functional disability and dependence, and for women this figure was higher, 2.5 years. Another finding was that in absolute numbers the sex-difference is shortened with age, but in relative terms this trend is reversed, and there is a female-disadvantage. In conclusion, even though women show a higher life expectancy, the percentage of years free of functional disability, compared to men, is smaller. Also women will live a higher number of years with functional disability and dependence. / Sa??de

Chronic pancreatitis (CP) is characterised by chronic, frequent, disabling abdominal pain. It often leads to exocrine and endocrine insufficiency resulting in malabsorption and diabetes mellitus respectively. The incidence of CP is 5-10 per 100,000 population worldwide and is on the rise in UK. Alcohol (70%) is the commonest aetiologic cause, idiopathic (20%) and others (10%) being second and third respectively. There are various medical and surgical treatment options available depending on clinical characteristics and the stage of disease. In spite of wide spectrum of therapeutic options, pain control still remains a challenging problem to the clinicians. Surgical treatments for chronic pancreatitis, broadly classified into resectional and drainage procedures, may offer relief of symptoms. These surgeries are associated with severe morbidity and high mortality. In addition, our comprehensive review of surgery in chronic pancreatitis demonstrated lack of criteria for baseline assessment of patients with CP; resulting in lack of standardization, variation in indication and comparability in published literature on surgical treatment of chronic pancreatitis. These factors have collectively forced the medical fraternity to look for other non or minimally invasive options. Oxidative stress and deficiency of anti-oxidants have long been implicated in pathogenesis of CP. Our review of literature on oxidative stress and antioxidants has highlighted the shortcomings and inadequacies from the previously published reports. These reports were underpowered and not all included patients had chronic pancreatitis. This in turn led us to propose a well designed randomised, double blind, placebo controlled trial of antioxidant therapy in CP. Considering the loss of time and productivity, it is necessary to undertake Qol as an outcome measure in any intervention related to CP. Our study assessed the suitability and feasibility of validated quality of life indices in patients with painful chronic pancreatitis. After correction for disease duration, the outcome of contemporary quality of life assessments showed that patients with CP taking Antox had better scores than controls. Cytokines, a group of proteins and glycoproteins that act in regulation of immunity, inflammation and haematopoiesis are implicated in oxidative stress related pathogenesis of chronic pancreatitis. They are broadly classed as pro-inflammatory and anti-inflammatory. There have been few experimental studies suggesting that antioxidants ameliorate cytokine response in chronic pancreatitis. However our study has failed to demonstrate a significant effect on cytokine levels after six months of antioxidant therapy. Similarly, on the clinical front, a randomised, double blind placebo controlled study (referred to as ANTICIPATE TRIAL) has shown no benefit of antioxidant therapy in painful chronic pancreatitis, irrespective of age, gender, aetiology or operative intervention. So we are afraid to say that until we discover any novel treatment in management of intractable painful chronic pancreatitis, surgery and interventional endoscopy might be the only viable options.

Objectives: Available studies largely and consistently indicate that children with Attention Deficit Hyperactivity Disorder (ADHD) experience significantly impaired quality of life (QoL). More research is required to enable an enhanced understanding of factors which contribute to the QoL of children with this diagnosis. In relation to children with ADHD, this thesis had two main aims: to review the extent to which children and their parents agree in their assessments of the child’s QoL; and to examine the impact of parent stress on the child’s QoL from both parent and child perspectives. Method: A systematic review of studies reporting matched parent-proxy reported and child self-reported quantitative QoL measures is described in journal article 1. Journal article 2 presents the findings from a cross-sectional, quantitative study involving a matched sample of 45 children with a diagnosis of ADHD, and their parents. Correlation and multiple regression analyses examine the relationship between parent stress and each of the informants’ ratings of the child’s QoL. Results: The findings of the systematic review indicated that in a clear majority of studies, children rated their QoL more highly than their parents. However, cautious interpretation is required as some of the studies were of poor methodological quality. In the empirical study, parent stress emerged as a significant predictor of parent proxy-ratings of child QoL, but not of self-rated QoL. Parents who rated their child’s QoL lower that their children had higher perceived stress than parents who rated their child’s QoL higher than their children. There were no significant differences in self-rated or parent-rated QoL between children with ADHD and children with a learning disability or with an Autism Spectrum Disorder. In line with some previous research, agreement was poorer on psychosocial domains than physical domains. However, due to the relatively small sample size, the empirical study requires replication. Conclusions: The results of the systematic review suggest that parent and child ratings of the child’s QoL are not interchangeable in the context of ADHD. Possible explanations for this trend are discussed. The empirical study suggests that parent stress negatively impacts on children with ADHD, and that it is likely that children’s self-reports are affected by their impaired reflective capacity. Clinical implications and recommendations for future research are discussed in relation to both articles.

Du fait des récentes avancées thérapeutiques, de plus en plus de jeunes se trouvent actuellement en rémission complète de cancer. Cette période entre les traitements et la guérison est pourtant peu évoquée dans la littérature. Elle s’accompagne assez souvent de séquelles iatrogènes, de difficultés de réinsertion sociale ou de troubles psychopathologiques. (Oeffinger et Wallace, 2006). Cette étude a pour principal objectif d’appréhender l’expérience spécifique de la rémission complète par l’adolescent et ses parents. Notre hypothèse principale est qu’ils connaissent des difficultés psychosociales durant cette période.Notre recherche a été menée auprès de 38 dyades parents- adolescents en rémission complète de cancer hématologique au sein des hôpitaux de Toulouse, Montpellier et Bordeaux. Nous avons évalué les représentations de santé, l’anxiété, les stratégies d’adaptation, les relations familiales, le soutien social perçu, les relations avec le corps médical et la qualité de vie chez l’adolescent et son parent. Nous avons mené des entretiens semi-directifs auprès de l'adolescent ainsi qu'un de ses parents avec un suivi longitudinal au cours de trois temps de la rémission : lors du bilan de fin des traitements, lors de la première visite de rémission, lors de la troisième visite de surveillance. L’adolescent et les parents ont rempli trois questionnaires respectifs: l ’Ok-Ado, le QLACS, et le STAIC pour l’adolescent ; et pour le parent: le GHQ-28, le QSSP et le STAI.Le bilan de fin de traitements est un moment anxiogène pour l’adolescent et ses parents qui ont surtout des représentations négatives de la maladie et des perceptions plus positives de la rémission et du suivi médical. Les représentations de la santé et l’anxiété de l’adolescent varient peu au cours du temps aussi bien pour les adolescents que les parents. Lors de la première visite de surveillance, les adolescents sont en majorité dans le refus de parler de leur maladie, avec une désillusion de la rémission et de la surveillance médicale. Ils connaissent une diminution de leur qualité de vie avec une plus grande insatisfaction vis-à-vis du soutien parental, un repli sur soi et un recours à l’hypervigilance. Des attitudes parentales de surprotection et d’hypervigilance vis-à-vis des adolescents perdurent. Les parents souffrent d’une diminution de leur soutien familial. La troisième visite est marquée par une importante dénégation de la maladie des adolescents qui s’accompagne d’un épuisement émotionnel. Les adolescents et les parents ont des représentations négatives du suivi médical. Les parents sont plus dans le contrôle émotionnel et connaissent une diminution de leur qualité de vie. La dyade évoque plus les troubles physiques à ce stade. Le bilan de fin de traitements semble être un temps propice pour exprimer et évaluer leurs représentations de la maladie, de la rémission, de la santé qui influent sur les niveaux d’anxiété. Nous pouvons souligner un contre- coup pour l’adolescent lors de la première visite de surveillance où il semble prendre conscience des risques de santé. Ce temps est l’occasion pour les parents de s’autoriser à exprimer leur détresse émotionnelle, ce qui améliore leur qualité de vie. Un dispositif de sortie de maladie intégrant la possibilité d’un soutien psychologique pourrait permettre un dépistage et une prise en charge des difficultés post traitements des adolescents et de leur famille. / Due to recent therapeutics progress, more and more young people are now in complete cancer remission. However, this period between treatment and healing is rarely mentioned in the literature. This period often goes with iatrogenic sequelae, rehabilitation difficulties or psychopathological disorders (Oeffinger and Wallace, 206).This study has for main objective to apprehend the specific experience of complete remission for the adolescent and his parents. Our principal hypothesis is that psychological difficulties are important during this period.Our study included 38 dyads (parents-adolescents) with total remission of hematologic cancer from Toulouse, Montpellier and Bordeaux hospitals. We have assessed health representations, anxiety, coping strategies, family relationships, perceived social support, relationships with medical profession and quality of life for the adolescent and his parent. We have led semi-directed interviews with the adolescent and one of his parent on a longitudinal follow-up within three steps of remission: during end treatment check-up, during first remission visit, then for the third monitoring visit. Adolescent and his parents have filled out three questionnaires: the Ok-Ado, the QLACS, and the STAIC for the adolescent; and for the parent: the GHQ-28, the QSSP and the STAI.The consult which take place at the end of treatment is an anxious moment for the adolescent and his parents. Indeed their representations of the disease are negatives, while their representation of the medical follow-up and their remission are more positive. Representations of health and anxiety vary little over time both for adolescents and parents.During the first consult after treatment, majority of adolescents don’t want to talk about their disease. Disillusion about remission and medical follow up are important. They’re facing decrease in quality of life with a major dissatisfaction with parental support, a withdrawal and tendency to increase their vigilance. Parents suffer from a decrease of their family support.During the third visit, denial of the disease is considerable and often associated with moral exhaustion. Adolescents and parents have negative representations of medical follow-up. Parents are more into emotional control and experience a decrease of their quality of life. At this stage, the dyad shows mostly physical disorders.End treatment checkup seems to be the perfect time to evaluate their representations of the disease, of remisssion and health which contribute to anxiety. We can underline repercussions for the adolescent during first surveillance visit where he seems to take conscience about health risks. This consult is the opportunity for the parents to express their emotional distress, which improve their quality of life. A psychological follow-up ending illness organized at the end of treatment would ensure to screen and to take care of the difficulties encountered by the patient and his family.

Atualmente, poucos estudos avaliam o impacto que as doenças bucais, assim como as reabilitações protéticas, desempenham sobre a qualidade de vida geral dos indivíduos. O objetivo desta pesquisa foi investigar a relação entre variáveis clínicas de saúde bucal com os domínios físico, psicológico, de relações sociais e de meio ambiente da qualidade de vida geral. Neste estudo transversal, 720 indivíduos entre 50 e 74 anos residentes de três distritos sanitários de Porto Alegre, sul do Brasil, participaram da pesquisa, sendo selecionados através de amostragem proporcional de múltiplos estágios. As entrevistas e exames clínicos foram realizados nos domicílios dos sujeitos por 4 duplas de examinadores e anotadores previamente treinados e calibrados. Os dados foram coletados seguindo duas etapas: 1) Entrevista usando questionário estruturado sobre dados sociodemográficos e o World Health Organization Abbreviated Instrument for Quality Of Life Assessment (WHOQOL-BREF) para avaliação da qualidade de vida; 2) Exame clínico bucal sob luz artificial, utilizando-se índices e critérios recomendados pela Organização Mundial da Saúde (OMS) e complementados pelo Levantamento Epidemiológico SB/Brasil 2000. Para efeito de análise os escores de qualidade de vida foram categorizados em: baixo (≤ mediana) e alto (> mediana). A associação entre os desfechos e os fatores em estudo foi analisada através de Regressão de Poisson múltipla, com ajuste para variância robusta, e função svyset programada seguindo os estágios da pesquisa. Um maior escore no domínio físico foi associado ao uso de prótese superior e com nível educacional. No domínio psicológico, um escore mais elevado foi associado ao nível educacional. Um maior escore no domínio de relações sociais esteve associado ao CPOD, gênero e nível educacional. Por fim, no domínio meio ambiente, maiores escores estiveram associados ao uso e necessidade de prótese inferior, idade e nível educacional. Pode-se concluir que nesta população a qualidade de vida geral está associada a variáveis clínicas de saúde bucal como CPOD, uso e necessidade de prótese. / Currently, there are few studies assessing the impact of oral diseases and prosthetic rehabilitation on the general quality of life of individuals. The objective of this study was to investigate the relationship between oral health clinical variables and the following domains of general quality of life: physical, psychological, social relations, and environment. This cross-sectional study involved 720 individuals between 50 and 74 years living in three health districts of Porto Alegre, southern Brazil. The subjects were selected using multi-stage proportional sampling. The interviews and clinical examinations were performed at home by four pairs of researchers previously trained and calibrated. Data were collected following two steps: 1) interview using a structured questionnaire on demographic data and the World Health Organization Abbreviated Instrument for Quality of Life Assessment (WHOQOL-BREF) to assess quality of life; 2) oral clinical examination under artificial light, using rates and criteria recommended by the World Health Organization (WHO) and complemented with the Epidemiological Survey SB/Brazil 2000. For the analysis, the scores of quality of life were categorized as low (≤ median) and high (> median). The association between the outcomes and the factors studied was analyzed using Poisson Multiple Regression, with adjustment for robust variance, and svyset function following the stage of the study. A higher score in the physical domain was associated with the use of upper prosthesis and with higher educational level. In the psychological domain, a higher score was associated with the educational level. A higher score in the social relations domain was associated with the DMFT, gender and educational level. Finally, in the environment domain, higher scores were associated with use and need of lower prosthesis, age and educational level. Finally, in the environment domain, higher scores were associated with use and need of lower prosthesis, age and educational level. It was concluded that this population's quality of life is associated to oral health clinical variables such as DMFT, use and need of prosthesis.

Esta dissertação se caracteriza como uma problematização da qualidade de vida enquanto uma importante questão que atravessa de diversos modos nossa atualidade. Essa questão é trabalhada no texto em três momentos distintos e complementares, em cada qual se busca compor e decompor uma pergunta que atue como chave de acesso a um nível de complexidade específico e possibilite saltos de compreensão de um momento ao outro. No primeiro momento a qualidade de vida é apresentada como uma expressão de uso comum e generalizado, de modo que o texto se movimenta em um percurso descritivo dos distintos usos e significados dessa expressão. No segundo momento essa falação sobre qualidade de vida é tensionada para que se tornem visíveis alguns enunciados que circulam, se repetem e se transformam num campo aberto de disputas, em função do qual essa qualidade de vida é produzida como uma questão que importa. No terceiro momento essa produção da qualidade de vida como uma questão que importa e que precisa ser gerida é pensada a partir do conceito de dispositivo, e o texto caminha assim como um percurso analítico por entre as distintas linhas que compõem esse dispositivo de qualidade de vida até alcançar as linhas de subjetivação, como limite do dispositivo, como resistência e criação. Após esses três momentos, o texto salta para um interstício poético-filosófico composto por fragmentos de aforismos nietzscheanos que tocam o tema da grande saúde, na busca por uma perspectiva que explore linhas de fuga e de criação pelas quais seja possível pensar e experimentar outros lugares e outros modos para uma vida com qualidades. Ao fim do percurso o texto é apresentado em um pequeno ensaio, que pode ser lido tanto no fim quanto no início da dissertação, no qual é esboçado um contraste entre a qualidade de vida e uma vida com qualidades. / This dissertation is characterized as a problematization of the quality of life as an important issue that permeates in many ways our actuality. This issue is analyzed in the text in three different moments, in each the effort is to build up and down a question that works as an access key to specific complexity levels and that allows jumps in understanding from one moment to another. At the first moment the quality of life is presented as a widely used expression, and the text goes as a description of different uses and meanings of this expression. At the second moment this discourses about quality of life are tensioned to render visible some statements that circulates, are repeated and transformed within an open field of disputes, in relation to which this quality of life is produced as an issue that matters. At the third moment this production of quality of life as an issue that matters and that needs to be managed is thought through the concept of dispositif, and the text goes as an analytical route through the distinct lines that composes this dispositif until it reaches the lines of subjectification, as the limit of the dispositif, as resistance and creation. After this discussion in three moments, the text jumps to a poetic-philosophic interstice made of fragments of some nietzschean aphorisms that touches the theme of great health, in a search for some perspective that explores some possible lines of escape and creation by which it is possible to experiment another places and modes for a life with qualities. At the end of this track the text is presented through a little essay, that can be read both at the end or at the beginning of the text, in which it is sketched a contrast between the quality of life and a life with qualities.

TITLE: Palliative Care: Viewpoints from Nurses Palliative Care has been described as care that includes the physical, intellectual, emotional, social, and spiritual needs of an individual when they are diagnosed with a serious or life-limiting illness. The ultimate goal of palliative care is to promote the best quality of life possible. Palliative care should be implemented across the lifespan and across different health care settings. The purpose of this study was to describe the perceptions, impact, and meaning of palliative care from the viewpoint of nurses who provide basic palliative care to patients and their families. This study used a qualitative design to investigate the meaning, experiences, and feelings of nurses who provide palliative care in small or critical access hospitals and other agencies in this rural area. Three focus groups and eleven interviews were conducted with nurses working in a variety of agencies from October 2015 to February 2016. The four themes that emerged from the data included inconsistencies, knowledge deficits, communication issues, and emotional responses and rewards to providing palliative care. The themes focused on the need for clarification of the meaning of palliative care, more education on the topic and better communication. The nurses shared that it was rewarding to provide palliative care but identified barriers that they felt should be addressed. Nurses participating in the study did not perceive that they had palliative care at their agencies. Recommendations included that more health education about palliative care be provided to healthcare professionals, the community, and individuals with life-limiting illnesses and their families. Key words: palliative care, quality of life, life-limiting illness, nursing