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Healthcare teams can implement care initiatives to promote a positive dying experience. However, there is a lack of knowledge related to how best to care for dying patients. Nurses do not receive extensive training in nursing school to care for patients at the end of life, yet most, at some point in their careers, experience the provision of this type of care. It is important to ensure that nurses caring for dying patients have been educated about end-of-life care. The purpose of the quality improvement project was to address the lack of end-of-life care education among critical care nurses in an acute care hospital by implementing and testing the effectiveness of an end-of-life care educational program. Kolcaba's theory of comfort was chosen as the theoretical framework for the project. Registered nurses (n = 34) employed on a critical care unit participated in the one-group pretest/posttest design project. The nurses completed the Healthstream online end-of-life care education, and knowledge improvement was determined through comparison of pretest and posttest scores. Descriptive tests were completed to determine the mean score. The descriptive data analysis and tests showed that participants' level of end-of-life care knowledge improved after they completed the formalized educational program. Participants' scores increased from pretest (68% to 100% correct answers) to posttest (93% to 100% correct answers). The primary populations benefiting from the project are nurses, dying patients, and family members of dying patients. The social change implication of the findings is that if nurses receive education on end-of-life nursing, increased knowledge of appropriate care for dying patients is expected.

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: The National Cancer Association of South Africa estimates that over 80,000 of South Africans currently die from cancer each year, whilst statistics show an increase in newly diagnosed cancer cases. Despite an improvement in cure rates, cancer, because of its association with pain, suffering and death, still affects human beings in their totality. It has been demonstrated that effective psychosocial care, as provided by oncology nurses, improve the outcomes for cancer patients. Therefore, nurses’ attitudes towards caring for patients that are dying are of vital importance to the quality of care provided to these patients. Attitudes towards caring for patients that are dying may be influenced by the demographic factors of oncology nurses, such as age, workplace and years of experience in oncology. It may also depend on the degree of work satisfaction and by the nature of the work environment, particularly regarding the level of support being offered to the nurse. The purpose of this study hence was to explore the influences of demographic and work environment factors on nurses’ attitudes towards caring for patients that are dying in oncology settings in the Western Cape Metropole. The objectives of this study were to determine oncology nurses’ attitudes towards caring for patients that are dying, to determine the degree of work satisfaction experienced by these nurses, to determine the perceived supportive nature of their work environments, and to establish and examine any relationships between oncology nurses’ attitudes towards caring for patients that are dying and demographic factors, work satisfaction and a supportive work environment. This study was theoretically underpinned by Paterson and Zderad’s (quoted in Praeger, 2002) humanistic nursing theory and Peplau’s (quoted in Belcher & Brittian Fish, 2002) interpersonal relations in nursing theory, because of their relevance to palliative care. A quantitative research approach, with a descriptive design, was selected to conduct the study. The target population was all the oncology nurses, caring for patients that are dying in palliative and oncology settings in the Western Cape Metropole. A convenience sample of 127 oncology nurses was selected in three different, but typical oncology settings, namely a state hospital, a private hospital and three hospices. Data was collected by means of a selfreporting questionnaire. A pilot study was done, in order to assure the validity and reliability of the data collection instrument. Ethical approval was obtained in advance from the Ethical Research Committee of the Faculty of Health Sciences of the University of Stellenbosch. Written consent was obtained beforehand from the managers of the three oncology settings where the research was conducted, as well as from the participants. The main findings of this study were that the majority of the respondents displayed positive attitudes towards caring for patients that are dying. In addition, most of the respondents experienced a high degree of work satisfaction and also regarded their work environments as supportive. Significant relationships were found between positive attitudes towards caring for patients that are dying and: • hospice settings; • higher age and; • rank of the professional nurse. The overall recommendation that was made was that continuing education in all aspects of palliative care be regarded as an essential strategy in maintaining and further enhancing positive attitudes amongst oncology nurses towards caring for patients that are dying. In addition, coping strategies needed to be widely implemented to help oncology nurses cope with their emotions and anxieties. / AFRIKAANSE OPSOMMING: Die Nasionale Kankervereniging van Suid-Afrika beraam dat meer as 80,000 Suid-Afrikaners huidig jaarliks aan kanker sterf, terwyl statistieke ‘n toename in die aantal nuwe gevalle van kanker toon. Ten spyte van ‘n toename in die sukses van behandeling, beïnvloed kanker, weens sy assosiasie met pyn, lyding en die dood, steeds die mens in sy totaliteit. Dit is bewys dat effektiewe psigososiale versorging deur onkologiese verpleegkundiges die uitkomstes van pasiënte met kanker verbeter. Daarom is die ingesteldhede van verpleegkundiges, jeens die versorging van pasiënte wat sterwend is, van kardinale belang in die kwaliteit van versorging wat aan hierdie pasiënte gebied word. Sodanige ingesteldhede mag deur demografiese faktore, soos ouderdom, werkplek, en jare ondervinding in onkologie, beїnvloed word. Dit mag ook van die mate van werksbevrediging en van die aard van die werksomgewing, spesifiek met betrekking tot die mate van ondersteuning wat aan die verpleegkundige gebied word, afhang. Die doel van hierdie studie was dus om die invloed van demografiese en werksomgewingsfaktore op die ingesteldhede van onkologiese verpleegkundiges, jeens die versorging van pasiënte wat sterwend is in onkologiese afdelings in die Wes-Kaapse Metropool, te ondersoek. Die doelwitte van hierdie studie was om die ingesteldhede van verpleegkundiges jeens die versorging van pasiënte wat sterwend is te bepaal, om hulle mate van werksbevrediging te bepaal, om hul persepsie van die ondersteunende aard van hul werksomgewing te bepaal, en om enige verband tussen onkologiese verpleegkundiges se ingesteldhede jeens die versorging van pasiënte wat sterwend is en demografiese faktore, werksbevrediging en die aard van ‘n ondersteunende werksomgewing te bepaal en te ondersoek. Hierdie studie is teoreties, vanweë hul relevansie tot palliatiewe sorg, deur Paterson en Zderad (aangehaal in Praeger, 2002) se humanistiese teorie en Peplau (aangehaal in Belcher & Brittian Fish, 2002) se interpersoonlike verhouding in verplegingsteorie, onderskraag. ‘n Kwantitatiewe navorsingsbenadering, met ‘n beskrywende ontwerp, is gekies om die studie mee uit te voer. Die populasie het al die onkologiese verpleegkundiges, wat sterwende en palliatiewe pasiënte in kankerafdelings in die Wes-Kaapse Metropool versorg, ingesluit. ‘n Gerieflikheidsteekproef van 127 onkologiese verpleegkundiges, in drie verskillende, maar tipiese kankerinstellings, is gekies, naamlik ‘n staatshospitaal, ‘n privaathospitaal en drie hospitiums. Datainsameling is deur middel van ‘n self-gerapporteerde vraelys gedoen. ‘n Loodsstudie is uitgevoer om die geldigheid en betroubaarheid van die vraelys te verseker. Etiese goedkeuring is vooraf vanaf die Etiese Navorsingskomitee van die Fakulteit Gesondheidswetenskappe van die Universiteit van Stellenbosch verkry. Skriftelike toestemming is ook vooraf vanaf die bestuur van die instellings, waar die navorsing gedoen is, sowel as van die deelnemers verkry. Die hoofbevindings van hierdie studie was dat die meerderheid van die respondente positiewe ingesteldhede jeens die versorging van pasiënte wat sterwend is openbaar het. Boonop het die meeste respondente ’n hoë mate van werksbevrediging ervaar en hul werksomgewing as ondersteunend beskou. Beduidende verbande is getrek tussen positiewe ingesteldhede jeens die versorging van pasiënte wat sterwend is, en: • versorging in hospitiums; • hoër ouderdom en; • rang van professionele verpleegkundige. Die algemene aanbeveling wat gemaak kon word was dat deurlopende opleiding in alle aspekte van palliatiewe sorg, as ‘n grondliggende strategie beskou moet, ten einde positiewe ingesteldhede ten opsigte van die versorging van pasiënte wat sterwend is onder onkologiese verpleegundiges te behou en verder aan te moedig. Voorts behoort strategieë geïmplementeer te word om onkologiese verpleegkundiges te help met die hantering van hul emosionale behoeftes en vrese.

Background: Each year approximately 700 children are affected by type 1 diabetes in Sweden. This chronic disease has an impact on the whole family but especially the parents who have the responsibility as a caregiver. Parents are therefore in need of support from friends and family as well as help from the nurse to deal with the situation. The nurse can provide support with a family focused care and will therefore include the whole family and use their strengths and resources. Aim: The aim of this study was to describe parents' experience of living with a child with type 1 diabetes. Method: The method used was a literature study with the aim to contribute to evidence based care with an analysis based on qualitative research. Ten scientific articles were analyzed. Three themes and seven subthemes emerged. Results: Three main themes and seven subthemes emerged during the analysis that responded to parents' experience living with a child with type 1 diabetes. The main themes were the stress that parents are exposed to, need of help and the unique community. Conclusion: Parents experienced a change in everyday life for the whole family. Therefore, the nurse needs to be responsive and adapt the nursing care to the parents, so they can support the child in a better way. / Studien beskriver föräldrars upplevelser av att leva med ett barn med typ 1 diabetes. Typ 1 diabetes är den mest förekommande autoimmuna sjukdomen hos barn i hela världen. Sjukdomen innebär att kroppen har slutat producera hormonet insulin, vilket medför en förhöjd blodsockernivå som kan leda till komplikationer. Studiens resultat baseras på tio vetenskapliga artiklar. Dessa söktes fram via två databaser. Genom analys och sammanställning av artiklarna framkom en beskrivning av föräldrarnas upplevelser. Detta redovisas som teman och subteman i resultatet. I resultatet beskrivs föräldrarnas omställning från att leva med ett friskt barn till att leva med ett barn med kronisk sjukdom och vilka känslor som uppstår vid bearbetningen samt det förändrade föräldraansvaret. Resultatet beskriver också de förhållanden som underlättar föräldrarnas bearbetning. Resultatet lyfter även fram de krav och förväntningar som föräldrarna har på vårdpersonal och personer i omgivningen samt den saknade förståelsen från människor runt föräldrarna.  Typ 1 diabetes påverkar barnens rätt att vara som andra och relationen med andra barn. Även relationen mellan barnet och föräldrarna påverkas. Sjukdomen drabbar inte bara barnet utan hela familjen. Sjuksköterskan är ansvarig för att ge familjen en god familjefokuserad vård och för att ge individanpassat stöd till föräldrarna i den förändrade livssituationen. Denna studie kan ge sjuksköterskor mer kännedom om vilka omvårdnadsbehov som föräldrarna har.

Utilising an interpretive descriptive approach, this qualitative study explores and identifies how spouses and partners of stroke survivors sustain their own health and wellness. Recent literature has mainly focused on identifying psychological coping strategies thought to assist in adapting to the caring role. As a consequence, there is limited knowledge regarding the experiences of how spouses and partners attend to their own health and well-being. This study aimed to explore how spouses and partners sustain their own health and wellness while supporting a stroke survivor. Purposive and theoretical sampling strategies were used to guide recruitment. Semi-structured interviews were carried out with seven spouses and partners who were living with, and supporting a stroke survivor. A central theme with three sub-themes became apparent when examining spouses and partners’ experiences. The theme of Meeting Needs connects the three sub-themes, in that spouses’ and partners’ health and wellness appeared to be influenced by and intertwined with attending to the stroke survivors’ needs. The context of Being in a Relationship provided a rationale for prioritising the stroke survivors’ needs and was the first sub-theme. Secondly, Living Both Lives explains how spouses/partners were busy thinking and attending primarily to the stroke survivor’s daily requirements whilst also trying to attend their own needs. The third sub-theme, Uncertain Health encompasses how a spouse’s and partner’s well-being is connected to the stroke survivors’ health and their future concerns about being able to provide care if they themselves become sick. Therefore, these circumstances shaped their ability to attend to their own health and well-being. Whilst attending to the stroke survivor was at the forefront of their minds there were some strategies which spouses/partners utilised to support their own health and well-being. These were: creating time and space for themselves; talking with others; and comparing own lives against others who were seen to be worse or better off, in order to support their own emotional well-being. This study found that the participants struggled to prioritise and attend to their own health and well-being, as most of them was busy primarily attending to the stroke survivor’s needs. Overall, results suggest that exploring what spouses/partners think and do within the relationship could be valuable for health practitioners. Given that it is the intimate nature of being in a relationship that is the foundation for spouses/partners supporting the stroke survivor, it could also be important for services and health professionals to consider the well-being and needs of the couple, not just the stroke survivor.

Utilising an interpretive descriptive approach, this qualitative study explores and identifies how spouses and partners of stroke survivors sustain their own health and wellness. Recent literature has mainly focused on identifying psychological coping strategies thought to assist in adapting to the caring role. As a consequence, there is limited knowledge regarding the experiences of how spouses and partners attend to their own health and well-being. This study aimed to explore how spouses and partners sustain their own health and wellness while supporting a stroke survivor. Purposive and theoretical sampling strategies were used to guide recruitment. Semi-structured interviews were carried out with seven spouses and partners who were living with, and supporting a stroke survivor. A central theme with three sub-themes became apparent when examining spouses and partners’ experiences. The theme of Meeting Needs connects the three sub-themes, in that spouses’ and partners’ health and wellness appeared to be influenced by and intertwined with attending to the stroke survivors’ needs. The context of Being in a Relationship provided a rationale for prioritising the stroke survivors’ needs and was the first sub-theme. Secondly, Living Both Lives explains how spouses/partners were busy thinking and attending primarily to the stroke survivor’s daily requirements whilst also trying to attend their own needs. The third sub-theme, Uncertain Health encompasses how a spouse’s and partner’s well-being is connected to the stroke survivors’ health and their future concerns about being able to provide care if they themselves become sick. Therefore, these circumstances shaped their ability to attend to their own health and well-being. Whilst attending to the stroke survivor was at the forefront of their minds there were some strategies which spouses/partners utilised to support their own health and well-being. These were: creating time and space for themselves; talking with others; and comparing own lives against others who were seen to be worse or better off, in order to support their own emotional well-being. This study found that the participants struggled to prioritise and attend to their own health and well-being, as most of them was busy primarily attending to the stroke survivor’s needs. Overall, results suggest that exploring what spouses/partners think and do within the relationship could be valuable for health practitioners. Given that it is the intimate nature of being in a relationship that is the foundation for spouses/partners supporting the stroke survivor, it could also be important for services and health professionals to consider the well-being and needs of the couple, not just the stroke survivor.

Background: There are 2,2 million children living in Sweden and every day about one child is diagnosed with cancer. Nurses have an important role in nursing the sick child and comforting it´s families. Little is known about the nurses´ experiences in working with this severely ill children. Aim: The aim of this study was to highlight nurses´ experiences of caring for children with cancer. Method: A method to contribute to evidence-based nursing with the ground in analysis of qualitative research was conducted. An analysis of fourteen qualitative articles was carried out. The analysis resulted in four main themes and eleven subthemes. Result: Four main themes emerged; The adequate knowledge needed, Difficulties in ethical stance, Caring relationships where the child is in the centre, Emotional contrasts. The results of the study showed that the nurses experienced that they were not fully-trained and that the knowledge was not sufficient when they were new to childhood cancer. The nurses experienced a lot of emotions caring for children with cancer and felt it valuable to use coping to deal with the upcoming emotions and prevent emotional burn-out. Conclusion:More knowledge in childhood cancer is needed for nurses caring for children sick with cancer. It is important for the nurses to see the child's best, but also to work family-centered. The work is emotionally stressful and requires coping strategies to prevent emotional burnout.

Bakgrund: Röntgensjuksköterskan måste på kort tid bilda en förståelse för patienten och dennes behov för att kunna tillämpa ett gott omhändertagande. Det finns många delar inom omhändertagandet som måste appliceras för att kunna säkerställa en patientsäker vård. Syfte: Syftet med litteraturstudien var att belysa röntgensjuksköterskans erfarenheter av omhändertagande av patient i samband med röntgenundersökning.   Metod: En litteraturstudie innehållande nio kvalitativa studier. Sökningarna genomfördes i Pubmed, Cinahl och Scopus.  Resultat: Analysen resulterade i tre kategorier och sex underkategorier. Kategorierna bestod av: Medvetenhet om ansvaret, Känna krav på att vara och Hantera utmaningar. Konklusion: Hur röntgensjuksköterskan kommunicerar med patienten har en stor betydelse för hur mottaglig patienten blir mot den information som delges. Att ta sig tid att läsa av individen och dennes behov kan bidra till ett bättre omhändertagande. En tydligare beskrivning inom området som kan ge en vägledning vid olika patientmöten skulle kunna vara en tillgång för nyutexaminerade.  Nyckelord: erfarenheter, radiografi, röntgenundersökning, omhändertagande, röntgensjuksköterska / Background: The radiographer must in a short time form an understanding of the patient and his or her needs in order to be able to apply good care. There are many parts of care that must be applied to be able to ensure patient-safe care. Aim: The purpose of the literature study was to illuminate the radiographers’ experiences of the care of patients in connection with an diagnostic imaging examination. Method: A literature study containing nine qualitative studies. The searches were conducted in Pubmed, Cinahl and Scopus. Result: The analysis resulted in three categories and six subcategories. The categories consisted of: Awareness of responsibility, Feel the need to be effective and Handle challenges. Conclusion: How the radiographer communicates with the patient is of great importance for how receptive the patient becomes to the information provided. Taking the time to read the individual and his needs can contribute to better care. A clearer description in the area that can provide guidance at various patient meetings could be an asset for recent graduates. Keywords: experience, radiography, diagnostic imaging examination, caring for, radiographer

22 pp. / Private horse ownership is not for everyone; owning a horse comes with many responsibilities. You must properly house and care for the horse. This care includes the horse's feeding, health care, and hoof care, but these are only part of the equation. You must also provide housing facilities, transportation, and riding equipment. This booklet is an introductory guide to the proper care and cost of owning and maintaining a pleasure horse in Arizona. We discuss how to feed and care for a horse as well as all of the associated costs to expect whether you board your horse or house and care for it privately. The publication has two major sections: (1)maintaining and caring for a horse, and (2) budgeting for the costs of ownership and care. There is also an introduction to getting started and a list of additional resources at the end.

Background: Each year about 480 children in Sweden receive palliative care and a child’s death has a great impact on everyone involved with the child. Nurses have a responsibility to ensure that the child remains comfortable and experiences dignity until end of life. Caring for children in a palliative stage has shown to be overwhelming for nurses and there is of great importance to determine the nurses own experiences. Aim: The aim of this study was to describe nurses’ experiences of caring for children in a palliative stage. Method: The method used was a literature study with the aim to contribute to evidence based care with an analysis based on qualitative research. Twelve scientific articles were analyzed and three themes and nine subthemes emerged. Results: Relationships were created between the nurses, the children and their families. These relationships made it difficult for the nurses to maintain professional boundaries, which resulted in an emotional impact both during the care and after the child’s death. There were occasions when differences of opinion arose between the nurses and the guardians about the best interests of the child and during these circumstances the nurses needed to advocate for the child. Lack of resources and difficulties in symptom management was also challenging for the nurses during the end-of-life care. Support and additional knowledge was significant to enable further work within the area. Conclusions: Caring for children in a palliative stage is emotionally demanding which makes it difficult for nurses to remain professional. Since nurses have a responsibility to advocate for the children, differences in opinions will occur. Guardians need to be fully informed to make decisions based on the best interests of the child. There is also a need of resources, knowledge and support.