Background: Caring for an elderly person at the end of life means a complex care situation for healthcare professionals. There are several factors to consider in this regard; the patient's, relatives and healthcare staff as described in this work from the nurse. Aim: The purpose of the study was to describe municipality nurses' experiences of caring for older people in the final stages of life. Method: The study had a descriptive design with a qualitative approach. Data were collected through eight interviews and analyzed using a qualitative manifest content analysis, whereas five categories and ten sub-categories emerged. Results: The result is that the nurse practitioners saw this work as meaningful but also emotional stress. Feelings like insufficiency, participation, adequacy and existential issues were raised at the nurse's nurse. The palliative care complexity was visualized as the patient's self-determination, relatives, and nursing staff's needs were made visible and met. Conclusion: Palliative care is a person-centered care based on patient needs, which proved to be complex. Corresponding to these expectations and implementing the required care creates experiences, good and less good, with nurses who consciously or not, affect them regardless of patient or care opportunity and give a chance of reflection, further experience and opportunity to grow as a person and in profession. Keywords: C aring, end-of-life care, elderly care, nurses’ experience, palliative care

Withdrawal of life support therapy involves controlled removal of life support modalities including artificial respiration and circulation with intent to provide a comfortable death. Withdrawal of life support therapy is necessary prior to procedures such as organ donation after cardio-circulatory death, but remains poorly explored in current literature. To enhance the current evidence, we conducted a thorough structured review, an observational study, and a qualitative comparison of components comprising withdrawal of life support therapy in both donor and non-donor patient groups. At all stages, we considered how results impacted donation after cardio-circulatory death. Withdrawal of life support therapy processes vary between countries, hospitals, practitioners, and patients. Variability in practice impacts care and outcomes for both donor and non-donor patients. Improved definitions and consensus about the process of withdrawal of life support therapy may improve patient care, success of organ donation after cardio-circulatory death, and uptake of donation protocols.

Bakgrund: Palliativ vård går ut på att främja patientens autonomi, förbättra livskvaliteten och lindra lidandet för patienten och hens anhöriga ända fram till livets slutskede. Den palliativa vården bygger på de fyra hörnstenarna: symtomlindring, närståendestöd, teamarbete och kommunikation. Sjuksköterskans omvårdnad utgår från dessa hörnstenar där patienten och dess anhöriga ska ses som en helhet utifrån fysiska, psykiska, sociala och existentiella behov.  Syfte: Syftet är att beskriva sjuksköterskans upplevelse av att vårda patienter i livets slutskede. Metod:Litteraturöversikten är baserad på åtta vetenskapliga kvalitativa artiklar tagna från databasen CINAHL Complete och som analyserats utifrån Fribergs analysmetod. I denna litteraturöversikt användes Benners teori som teoretisk utgångspunkt.   Resultat:Sjuksköterskans upplevelser och erfarenheter inom palliativ vård presenterades i denna litteraturöversikt i fyra huvudteman: Mötet med döden och döende patienter, Sjuksköterskans upplevelser av eget lidande att vårda döende patienter, Sjuksköterskans behov av stöd och relationsskapande. Diskussion: I litteraturöversiktens diskussion har resultatet diskuterats i tre huvudteman: erfarenhetens betydelse, kollegialt stöd och närhet och distans. Detta utifrån Benners teori, som talar om sjuksköterskans utveckling från novis till expert. / Background: The essence of palliative care is to promote patients autonomy, improve the life quality, and relieve suffering of the patient and their family until life’s finiteness. Palliative care consists of four cornerstones: symptom relief, relative support, teamwork, and communication. These cornerstones set the foundation for nursing care where patients and their families are seen as an entirety in terms of the physical, physiological, social, and existential needs. Aim: The aim of this literature review is to describe nurse´s experience of caring for patients in the end of life. Method: The literature review is based on eight qualitative studies taken from the CINAHL Complete database and was analyzed using Friberg’s analysis method. In this literature review Banner’s theory was used as the theoretical starting point. Results: Nurse´s experience within palliative care was described in four main themes: facing death and dying patients, nurse´s experience of own suffering from caring for dying patients, nurse´s need for support, and creating a relationship. Discussion: During the discussion of the results in this literature review three main themes emerged: importance of experience, collegiate support, and closeness and distance. Benners theory was used that describes nurse´s progress from novice to expert.

Bakgrund: Sjuksköterskan har många olika arbetsuppgifter och att vårda döende patienter, är något som en del sjuksköterskor kommer att träffa på någon gång under sin karriär. Att vårda döende patienter påverkar sjuksköterskan, särskilt de som inte har varit med om detta tidigare. Syfte: Syftet med denna studie var att sammanställa tidigare kvalitativa empiriska studier om hur sjuksköterskan upplever och hanterar mötet med döende patienter. Metod: En litteraturstudie utfördes med tio kvalitativa empiriska intervjustudier som beskriver sjuksköterskans perspektiv på att vårda döende patienter. Datan insamlades genom databaserna CINAHL och PubMed och de relevanta artiklarna granskades av en mall från statens beredning för medicinsk utvärdering (SBU). De valda artiklarna till resultatet analyserades genom datakategorisering. Resultat: Fyra teman identifierades; Att känna emotionell stress, Att använda copingstrategier, Existentiella tankar hos sjuksköterskan och En önskan att vara expert. Under temat “Att använda copingstrategier”, uppkom fyra subteman; Att ha någon att prata med, Att skydda sig själv, att kunna koppla av och Att ha en andlig tro. Konklusion: Sjuksköterskan upplever att arbetet med att vårda döende patienter är påfrestande. De känner sig stressade i mötet med dessa patienter och det kunde ibland leda till utbrändhet. Detta var mer frekvent hos oerfarna sjuksköterskor. Därför har många sjuksköterskor nyttjat olika copingstrategier, som; stöd från familj, kollegor och vänner, andlig tro, gränssättning och genom att sjuksköterskan utvecklade sina kompetenser inom vård av döende patienter. Detta minskade risken för emotionell stress. / Background: Caring for patients in the final stage of life, is something that some nurses will encounter at some time during their career. This has certain effects on nurses who have not previously been involved in this type of situation. Aim: The purpose of this study is to compile previous qualitative empirical studies on how the nurse experience and manage the meeting with dying patients. Methods: A litterature review was conducted with ten qualitative emperical interviews that described the nurse´s perspective of caring for patients in the final stages of life. The data was collected through the databases: CINAHL and PubMed. The relevant articles were reviewed by Swedish agency for health technology assessment and assessment of social services. The selected articles were analysed by data categorization. Results: Four themes were identified; To feel compassion fatigue, Taking on coping strategies, Existential thoughts of the nurse & Wishing on becoming an expert. Under the theme of “Taking on coping strategies”, four subthemes emerged; To have someone to talk to, To be able to protect yourselves, To be able to relax and To having spiritual beliefs. Conclusion: Nurses experience that caring for patients in the final stage is stressful and could sometimes lead to burnout. This was more common with inexperienced nurses. Therefore, many nurses used coping strategies, such as; support from family, colleagues and friends, spiritual beliefs, boundaries and developing nurses skills in care of the final stage of life. This reduced the risk of developing compassion fatigue.

Background: End-of-life palliative care is provided to individuals who have a progressive and incurable disease or injury. The meaning of palliative care is to promote quality of life and to alleviate the relief of patients but also those close to them. Previous research shows that patients in palliative care have a limited everyday life and that they become more dependent on nurses, which in turn leads to reduced autonomy. There was also a lack of communication among nurses and relatives. Method: Systematic literature study with a descriptive summary, 13 care science articles were analysed, all of which have a qualitative approach. Aim: The aim of the thesis is to describe nurses' experiences of caring for patients at the end of life. Results: The analysis revealed two themes; experiences of challenges in care and experiences of being present in care. The first theme included three subthemes; to understand the importance of communication, to experience a lack of knowledge and experience and to be affected emotionally, which was about the communication difficulty and challenges those nurses encountered. The second theme in turn included two subthemes; to experience the care as rewarding and meaningful and to promote good relationships in the care, which were about how nurses were personally affected in the care of patients at the end of life and in the treatment of relatives. Conclusion: The nurse experienced gratitude in caring for the patient at the end of life. The nurse experienced the care as rewarding and satisfying when they promoted good relationships with the patient and relatives. However, the nurse experienced challenges in care due to lack of knowledge and experience. This led to the nurse experiencing an obstacle to meeting the patient's needs.

Sammanfattning Bakgrund: Vård i livets slutskede är krävande för såväl familj som sjuksköterskor, men många sjuksköterskor erfar trots det att de får någonting tillbaka av att vårda de döende. Cancersjukdomar är vanligt och både överlevnaden och prognosen skiftar mycket beroende på vilken typ av cancer en person blir diagnostiserad med. Det är därmed viktigt att sjuksköterskor har kunskap och förståelse om grundläggande palliativ vård samt vård i livets slutskede för att kunna erbjuda den bästa vården för såväl patient som dennes anhöriga. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter i vårdandet av patienter med cancer i livets slutskede på sjukhus. Metod: Examenarbetet utgick enligt en systematisk litteraturstudie med beskrivande syntes. Resultat: Utifrån 11 artiklar analys framkom två tema: Etiska utmaningar i vårdandet och sjuksköterskans utveckling. Dessa innefattar fem subteman som beskriver sjuksköterskors erfarenheter att vårda i livets slutskede. Slutsatser: Det framkom att sjuksköterskor blir utmanade av känslomässig involvering med patienter, tidsbrist, mängden information sjuksköterskor bör ge sina patienter samt att kunna vara i ett existentiellt samtal. Sjuksköterskorna erfor att de har utvecklats mycket av att vårda patienter i livets slutskede, både personligt och professionellt. Däremot erfor sjuksköterskorna också att de saknade kunskap i att ge vård i livets slutskede. / Background: To give care in the end of life is a demanding process for both family members and nurses, but the nurses experiences that in spite this, they gain a lot in return to care for the dying. Cancer is common and the survival and prognosis differs depending on what type of cancer a person is diagnosed with. It is therefore important for the nurse to have knowledge and understanding in basic palliative care and end-of-life care to be able to offer the very best care for both the patient and their family. Aim: This study describes the experiences that nurses have in the care of patients with cancer in end-of-life care in a hospital. Methods: A systematic literature study with descriptive synthesis was used. Results: After 11 articles were analyzed two themes emerged: Ethical challenges in caring and nurses’ development. These include five subthemes that describes the nurses experience in end-of-life care. Conclusions: Results showed that nurses were challenged by the emotional involvements with their patients, the lack of time, how much information to give their patients and how to be in existential conversations with their patients. The nurses experienced that they developed a lot by caring for patients in the end of life. However, the nurses experienced that they lacked knowledge in providing end-of-life care

Bakgrund: Sjuksköterskans grundläggande ansvarsområde är omvårdnad. Vård i livets slutskede handlar om att bevara bästa möjliga livskvalitén under tiden som är kvar av livet. Patienters upplevelse av vård i livets slutskede är varierande från individ till individ. Många patienter upplever rädsla och oro inför slutet. Patientens familj kan känna sig hjälplösa vid vård i livets slutskede när de behöver ta viktiga beslut. Syfte: Syftet med denna litteraturstudie är att beskriva sjuksköterskors upplevelse av att vårda patienter i livets slutskede. Metod: En beskrivande litteraturstudie. Huvudresultat: Studiens resultat visade att vård i livets slutskede var en utmaning för sjuksköterskorna, men det upplevdes även som en meningsfull process. Flera sjuksköterskor nämnde att de har fått en ny syn på livet och döden efter att de har vårdat döende patienter. Att bygga en relation med sin patient gav sjuksköterskorna styrka och meningsfullhet. I studien så framkom det även att brist på kunskap kunde påverka omvårdnaden negativt. Slutsats: Den föreliggande litteraturstudie visar att sjuksköterskor upplever vård i livets slutskede som en känslosam utmaning. Att vara professionell i mötet med döende patienter är svårt för sjuksköterskorna. För att öka de positiva upplevelserna och minska de negativa upplevelserna vid vård i livets slutskede anser författarna att det krävs fortsatt forskning inom området.

Bakgrund: Palliativ vård ges i livets slutskede och syftar till att lindra lidande och öka livskvaliteten hos patienten. Det ställer krav på vårdpersonalen att arbeta teambaserat med god kommunikation, personcentrerat samt stödjande för både patient och närstående. Behovet av palliativ vård vid livets slutskede är stort och patienterna vårdas många gånger inom den allmänna palliativa vården på sjukhus. Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av att vårda döende patienter på sjukhus. Metod: En litteraturstudie genomfördes baserad på nio kvalitativa originalartiklar som återfanns i databaserna CINAHL och PubMed. Artiklarna kvalitetsgranskades och analyserades med hjälp av Fribergs femstegsmodell. Resultat: Analysen resulterade i tre teman och nio subteman. Temana var; Strävan att göra gott, Personlig och professionell utveckling samt Otillräckligheter i organisationen. Konklusion: Det finns brister inom den palliativa vården på sjukhus, främst inom organisationen samt bristande kommunikation och samsyn i teamet. Sjukhusmiljön behöver anpassas för att möta döende patienters och närståendes behov samt de krav som ställs på den palliativa vården idag. Att vårda döende patienter är krävande och sjuksköterskor behöver erbjudas stöd och utbildning inom palliativ vård. / Background: End-of-life care aims to alleviate suffering and increase quality of life. The staff needs to work team-based, person-centered and supportive for both patients and relatives. There is a great need for end-of-life care and patients are often cared for in general palliative care in hospitals. Aim: The aim of the study was to describe nurses' experiences of caring for dying patients in hospitals. Methods: A literature review was conducted based on nine qualitative original articles found in the databases CINAHL and PubMed. The articles were reviewed according to quality and analyzed using Friberg's five-step model. Results: The analysis resulted in three themes and nine subthemes. The themes were; Striving to do good, Personal and professional development and Inadequacies in the organization. Conclusion: There are shortcomings in end-of-life care in hospitals, mainly within the organization, and a lack of communication and consensus in the team. The hospital environment needs to adapt to meet the needs of dying patients and relatives and the demands placed on palliative care today. Caring for dying patients is demanding and nurses needs support and training in palliative care.

Bakgrund: Palliativ vård innebär en helhetsvård som ska lindra lidande och främja hälsa trots sjukdom. Sjuksköterskan ska arbeta personcentrerat och utgå utifrån “de fyra hörnstenarna” som innehåller: symtomlindring, samarbete, kommunikation och stöd till anhöriga. Metod: Den valda metoden var en litteraturöversikt av elva kvalitativa vetenskapliga artiklar som svarade på syftet. Syfte: Syftet var att belysa sjuksköterskors upplevelse av palliativ vård i hemsjukvård och i särskilt boende. Resultat: I studien framkom fyra teman och åtta underteman. Resultatet visade att sjuksköterskan upplevde vikten av ett gott samarbete med kollegor, patient och anhöriga som avgörande för en god palliativ vård. Erfarenhet har också visat sig vara viktig både i den nuvarande vården och för framtida vård av palliativa patienter. Många känslor uppkom i vårdandet och var både positiva och negativa. Konklusion: Att vårda patienter i ett palliativt skede kräver kunskap och erfarenhet och många faktorer påverkade hur vården utfördes / Background: Palliative care means comprehensive care that is intended to alleviate suffering and promote health despite illness. The nurse must work person-centered and start from the "four cornerstones" that contain: symptom relief, cooperation, communication and support for relatives. Method: The chosen method was a literature review of eleven qualitative scientific articles that answered the purpose. Aim: The aim was to shed light on nurses’ experince of palliative care in home care and in special housing. Results: The study revealed four themes and eight sub-themes. The results showed that the nurse perceived the importance of good collaboration with colleagues, patients and relatives as crucial for good palliative care. Experience has also proven to be important both in the current care and for future care of palliative patients. Many emotions arose in the care and were both positive and negative.Conclusion: Caring for patients in a palliative care stage requires knowledge and experience and many factors influenced how the care was performed

Despite hospice and palliative care services being available for patients at the end-of-life, it remains an easily accessible health care service which has been mostly underutilized and/or misunderstood. For this project, the practice problem was underutilization of hospice and palliative care services. A systematic review of the literature which focused on under usage of end-of-life care was conducted. MEDLINE, CINAHL, and ProQuest Nursing and Allied Source databases were searched (2005 to 2017). Studies that evaluated interventions for increasing hospice and palliative care services were selected. Conceptual variables included studies that addressed the under usage of end-of-life care. Kolcoba's comfort theory, Parse's theory of human becoming and Chochinov's dignity model was included to identify the issue, gather the data, and help transfer researched data into practice. The tools applied for analysis and synthesis were the appraisal of guidelines research and evaluation and the grading of recommendations, assessment, development and evaluation. The under usage of hospice and palliative care according to this systematic review, has resulted in (a)suffering negative effects on patients at the end of life, who do not receive adequate palliative or comfort care, (b) additional distress for families dealing with grief and denial, and (c) may result in unneeded acute care, adding significantly to the cost of care. This doctoral project formed a cogent set of recommendations consisting of, communication guidance and community education for a local hospice agency and the community. The contribution of positive social change in this community was through education and knowledge to bridge the gap into practice and improve end-of-life care in the community.