Bakgrund: Palliativ vård kännetecknas av att förbättra livskvaliteten i livets slutskede utifrån en helhetssyn. Det palliativa förhållningssättet omfattar alla patienter i livets slutskede, oavsett diagnos, och distriktssköterskan i hemsjukvården är både ett praktiskt och känslomässigt stöd. Ett personcentrerat förhållningssätt i samband med palliativ vård ger förbättrad livskvalitet och symtomlindring. Den personcentrerade modellen De 6 S:n främjar patientens syn på sig själv och sina önskemål i omvårdnaden. Syfte: Att beskriva distriktssköterskors erfarenheter av palliativ vård i livets slutskede inom hemsjukvården, utifrån ett personcentrerat perspektiv. Metod: Kvalitativ med deduktiv ansats. Två fokusgruppsintervjuer, 12 distriktssköterskor. Kvalitativ innehållsanalys utifrån De 6 S:n. Resultat: Självbild: Distriktssköterskan utgår från den enskilde patienten samt samordnar insatser för en välfungerande hemsituation. Självbestämmande främjas av hemmiljön och innebär visad respekt och lyhördhet. Sociala relationer bevaras genom anpassning och stödjande insatser. Symtomlindring omfattar främst farmakologiska insatser. Sammanhang omfattar samtal och främjas av hemmiljön, relationen till patienten och att distriktssköterskan ger tid och närvaro. Patientens strategier respekteras genom anpassning och stödjande insatser. Patientens önskemål möjliggörs med hjälp av närstående och omvårdnadspersonal.   Slutsats: Distriktssköterskorna utgår från och anpassar sig till patientens behov och resurser. Relationen, kommunikationen och hemmiljön främjar personcentrerat förhållningssätt. De 6 S:n utgör stöd för personcentrerad vård utifrån en helhetssyn. / Background: Palliative care is characterized by improving the quality of life in the final stages of life based on a holistic view. The palliative approach covers all patients in the final stages of life, regardless of diagnosis, and the district nurse in home health care gives both practical and emotional support. A person-centered approach in connection with palliative care provides improved quality of life and symptom relief. The person-centered model The 6 S:n promotes the patient's view of himself and his wishes in the nursing. Aim: To describe district nurses' experiences of palliative care in the final stage of life in home care, from a person-centered perspective. Method: Qualitative with deductive approach. Data collection through two focus group interviews, 12 district nurses. Qualitative content analysis based on The 6 S:n. Result: Self-image: The district nurse starts from the individual patient and coordinates efforts for a well-functioning home situation. Self-determination is promoted by the home environment and means shown respect and sensitivity. Social relations are preserved through adaptation and supportive efforts. Symptom relief mainly involves pharmacological interventions. Summary includes conversations which is promoted by the home environment, the relationship with the patient and that the district nurse gives time and attendance. The patient's strategies are respected through adaptation and supportive efforts. The patient's wishes are made possible with the help of relatives and assistant nurses. Conclusion: The district nurses focus on and adapt to the patient's needs and resources. The relationship, communication and the home environment promote person-centered approach. The 6 S:n provides support for person-centered care based on a holistic approach.

No description available.

Bakgrund: Den äldre populationen ökar och många av de äldre lider av flera olika sjukdomar. Därmed ökar behovet av professionell och god omvårdnad. Den äldre människan som ofta lider av flera sjukdomar bor vanligtvis sista tiden av sitt liv på vård- och omsorgsboende. Äldre människor vårdas inte utifrån ett palliativt perspektiv trots att behov föreligger. Palliativ vård kopplas ofta ihop med människor som är under 65 år och har en obotlig sjukdom exempelvis cancer. Syfte: Att belysa hur den äldre människan vårdas i livets slut på vård- och omsorgsboende, ur de äldres, de närståendes och vårdpersonalens perspektiv. Metod: En litteraturstudie inspirerad av Friberg (2006). Tio kvalitativa artiklar och en kvantitativ artikel har analyserats och strukturerats utifrån den teoretiska referensramen. Teoretisk referensram: Den palliativa vårdens fyra hörnstenar; Symtomkontroll, teamarbete, kommunikation/delaktighet och närståendestöd. Resultat: Samtliga områden visade på stora brister i omvårdnaden om den äldre personen. Sjuksköterskan var ofta ensam i beslutet angående symtomlindring. De äldre kände sig i vägen och till besvär. Vårdpersonalen önskade mer handledning av sjuksköterskan. Närstående saknade information och delaktighet i beslut som rörde livsuppehållande åtgärder. Diskussion: Kunskap, information och kommunikationsbrist har visat sig leda till bristande omvårdnad kring den äldre personen på vård- och omsorgsboenden. Tydligare riktlinjer, samtal och en sammanhållen arbetsgrupp behövs för att kunna möta den äldre personens individuella behov. / Background: The population of elderly people is increasing and many of those suffer from multiple illnesses, thereby the need for professional and high quality care increases. The elderly suffering from multiple illnesses usually live their final years in nursing homes, and are not cared for throw a palliative approach, despite the need for it. Palliative care is often associated with people younger than 65 years and with an incurable disease, such as cancer.  Aim: To illustrate how elderly people are cared for during end- of- life in nursing homes, from the elderly, next of kin and nursing staff perspective. Method: A literature review inspired by Friberg (2006). Ten qualitative articles and one quantitative article have been analyzed and structured using the theoretical framework. Theoretical framework: The corner stones of palliative care; symptom control, teamwork, communication / involvement and support to next of kin. Result: All areas were lacking in the care of the elderly. The nurse was often alone in the decision making process regarding symptom relief for the elderly. The elderly felt that they were in nuisance and in the way for the staff. The caring staff wanted more guidance from the registered nurse. Next of kin were missing information and participation in decision making process concerning life prolonging measures. Discussion: Lack of knowledge, information and communication are shown and was leading to inadequate caring for the elderly in nursing homes. Clearer guidelines, dialogue, and a good teamwork are needed to meet the older person's individual needs.

Syfte: Att utifrån litteratur beskriva upplevelser av palliativ vård hos patienter med obotlig cancer och som vårdas på hospice eller inom den slutna vården, samt att utifrån litteraturen belysa vad dessa patienter anser att en god palliativ vård innefattar. Metod: Beskrivande litteraturstudie baserad på 14 artiklar sökta i databaserna Cinahl, PubMed, PsycInfo och via manuell sökning. Resultatet av analysen sammanställdes i 5 huvudkategorier innehållande 23 underkategorier. Huvudresultat: Patienterna upplevde att en adekvat smärtlindring utan förbehåll och dröjsmål var det viktigaste i den palliativa vården. En god kommunikation och interaktion mellan sjuksköterskan och patienten låg till grund för att en god vård skulle kunna utvecklas. Tillit till sjukvårdspersonalens kompetens och förmågor hade avgörande betydelse för patienternas upplevelse av trygghet. Autonomi hade en central roll för patienterna då delaktighet i vården skapade känsla av kontroll och mening. Miljön på hospice bidrog till att patienterna förlorade sin identitet. Att finna mening med sitt lidande bidrog till att patienterna succesivt accepterade sin situation och kunde finna frid i sin vetskap om det oundvikliga.   Slutsats: Den mellanmänskliga kommunikationen och sjuksköterskans kompetens har nyckelroller för patienternas upplevelse av god palliativ vård. Mer forskning krävs för att möta det växande behovet av kvalificerad palliativ vård. / Purpose: The purpose of this study was to describe the experiences of terminal cancer patients’ receiving palliative care in hospice or in an in-patient care unit, and illuminate what these patients believe that good palliative care involves. Method:  The Literature study had a descriptive design and was based on 14 scientific articles that were retrieved from the databases Cinahl, PubMed, PsycInfo and by manual search. The results of the analysis were compiled into 5 categories containing 23 subcategories. Main Result: Patients experienced that the issue of most importance in palliative care was to obtain adequate pain relief without reservation or delay. Good communication and interaction between the nurse and the patient was the basis for good health care to be developed. Trust in health professionals' skills and abilities were essential to patients' perceptions of security. Autonomy was central for the patients’ participation in their health care, and it created a sense of control and meaning. The environment at the hospice had a negative impact on the patients’ self-image and made them lose their identity. Finding meaning in their suffering helped the patients gradually to accept their situation in order to find peace in their knowing of the inevitable. Conclusion: The interpersonal communication and nursing skills is of crucial importance for patients' perceptions of good health care. More research is needed to meet the growing request of qualified professional palliative care.

Bakgrund: Liverpool Care Pathway (LCP) är en vägledning för att vårda patienter i livets slutskede. Den är framtagen i syfte att överföra den palliativa modellen av vård till annan vårdkontext. LCP ger vägledning i kommunikation inom det multiprofessionella teamet, med anhöriga och med patienten som är döende. LCP utgör en guide för läkare om att förskriva läkemedel mot de vanligaste symtomen som kan uppträda i livets slut, för att förbättra symtomhanteringen.  LCP används idag i Sverige på flera håll inom olika ramar av vårdinrättningar. Syfte: Syftet var med denna litteraturöversikt att ur ett sjuksköterskeperspektiv beskriva vård i livets slutskede med tillämpning av Liverpool Care Pathway på akutvårdsavdelningar. Metod: Litteraturöversikt är ett examensarbete som grundar sig på nio vetenskapliga artiklar. De är utformade utefter en kvalitativ design och söktes från databaserna: PubMed, Cinhal, Medline och ProQuest Nursing & Allied Health Source. Datamaterialet har sedan analyserats och strukturerats upp samt sammanställts till ett resultat. Artiklarna är baserade på studier utförda i England, Nya Zealand och Italien. Resultat: Utifrån de valda vetenskapliga artiklarna identifierades sex olika huvudteman. Dessa var: kommunikation, dokumentation, medicinska riktlinjer och vård, ökat självförtroende, förbättrad vård och ökad kontinuitet av vård i livets slut. Diskussion:Artiklarnas relevans har diskuterats i relation till Sverige eftersom ingen av dem var gjord i Sverige. De huvudteman som identifierats diskuterades i förhållande till tidigare forskning och mot Erikssons definitioner av lidande och vårdande. / Background: The Liverpool Care Pathway is a guidance of care for the dying patient. It was created to transfer the hospice model of care into other hospital settings. LCP provides a pathway in communication within the multidisciplinary team, with relatives and the dying patient. LCP gives guidance for doctors to prescribe medication for the most common symptoms that can appear in the dying phase to improve symptom management. LCP is today used in several places in Sweden within different frameworks of medical facilities. Aim: The aim was to illustrate the use of Liverpool Care Pathway in an acute hospital setting from a nurse perspective. Methods: This essay is a systematic literature review and the data was based on nine articles of published research. The published articles were found in four different databases. These were: Pubmed, Chinhal, Medline and ProQuest Nursing & Allied Health Source. The data was then analyzed and structured into different main themes, and was then compiled into a result. The articles were based on studies made in England, New Zealand and Italy. Results: When analyzing the articles six different main themes emerged. These were: communication, documentation, increased self-confidents, medical guidelines and care, improved end-of-life care and improved continuity in the care of the dying. Discussion: The studies relevance to Sweden was discussed because none of them had been made in Sweden. The main themes were related to previous research and to Katie Eriksson's concept of suffering and care.

No description available.

Despite (national) strategies/frameworks for care at the end of life, many patients do not die at their preferred location or under the form of care desired. This cross-country comparison study analyzed system-level characteristics - such as legislation, regulation and financing - that might influence service delivery in the care for terminally ill adults and their implications for outcomes and costs. Drawing on triangulated data from Canada, England, Germany and the United States of America and taking a 'most similar – most different' perspective, it was hypothesized that system-level factors might impede the broader use of (integrated) models of hospice and palliative care/the system-wide adoption of best practices. An embedded case study examined resource utilization and costs of shared care and its role as a potential best practice avenue. While similar with regard to leading causes of death, patient needs and potential avenues to care, different service models were employed – including hospice and palliative care. Generally offered alongside standard care along the disease continuum and across settings - and featuring common elements like physical, psycho-social and spiritual care - outcomes (e.g., access, utilization) varied. Legislative (e.g., jurisdictional), regulatory (including education and training) and financial issues were identified as barriers, as were public knowledge and perception ('giving up hope') challenges. Advance care planning, dedicated and stable funding, population aging and standards of practice/guidelines to care were seen as facilitators. Successful policy implementation requires concerted action to align system-level characteristics – with each alone being essential but not sufficient. Policies need to be monitored and fine-tuned, with a caveat toward their transferability between jurisdictions. The analysis of the shared-care approach in the rural Niagara-West setting revealed effective and efficient home-based hospice and palliative care – on par with per diem funding for long-term care homes and lower than average alternate level of care and hospital costs in Ontario, and in line with the Medicare Hospice Benefits in the United States of America. The thesis results provide a base for further analyses across jurisdictions and settings and might assist decision makers in the allocation of resources to meet the complex needs of hospice and palliative care populations.

Despite (national) strategies/frameworks for care at the end of life, many patients do not die at their preferred location or under the form of care desired. This cross-country comparison study analyzed system-level characteristics - such as legislation, regulation and financing - that might influence service delivery in the care for terminally ill adults and their implications for outcomes and costs. Drawing on triangulated data from Canada, England, Germany and the United States of America and taking a 'most similar – most different' perspective, it was hypothesized that system-level factors might impede the broader use of (integrated) models of hospice and palliative care/the system-wide adoption of best practices. An embedded case study examined resource utilization and costs of shared care and its role as a potential best practice avenue. While similar with regard to leading causes of death, patient needs and potential avenues to care, different service models were employed – including hospice and palliative care. Generally offered alongside standard care along the disease continuum and across settings - and featuring common elements like physical, psycho-social and spiritual care - outcomes (e.g., access, utilization) varied. Legislative (e.g., jurisdictional), regulatory (including education and training) and financial issues were identified as barriers, as were public knowledge and perception ('giving up hope') challenges. Advance care planning, dedicated and stable funding, population aging and standards of practice/guidelines to care were seen as facilitators. Successful policy implementation requires concerted action to align system-level characteristics – with each alone being essential but not sufficient. Policies need to be monitored and fine-tuned, with a caveat toward their transferability between jurisdictions. The analysis of the shared-care approach in the rural Niagara-West setting revealed effective and efficient home-based hospice and palliative care – on par with per diem funding for long-term care homes and lower than average alternate level of care and hospital costs in Ontario, and in line with the Medicare Hospice Benefits in the United States of America. The thesis results provide a base for further analyses across jurisdictions and settings and might assist decision makers in the allocation of resources to meet the complex needs of hospice and palliative care populations.

Bakgrund: I Afrika är behovet av palliativ vård stort efter utbredning av HIV, samt cancer och andra sjukdomar. Den palliativa vården avser att öka livskvalitet en hos patienter och närstående, lindra lidande och behandla smärta. World Health Organization startade ett projekt för att utveckla palliativ vård i Afrika, ett projekt som önskar utveckla synen på palliativ vård, integrera den i vårdprogram och förbättra möjligheten till läkemedelstillgångar och utbildning. Sjuksköterskan är en central figur inom den palliativa vården och relationen är betydelsefull för patienten. För sjuksköterskan är mötet med den palliativa patienten både smärtsamt och stressfullt, och väcker starka känslor. Syfte: Beskriva sjuksköterskors upplevelse av palliativ vård i Tanzania. Metod: En empirisk studie och datainsamling i form av semistrukturerade intervjuer genomfördes med åtta sjuksköterskor i Tanzania. Intervjuerna transkriberade s och analyserades sedan enligt kvalitativ innehållsanalys. Resultat: Resultatet presenteras i två huvudkategorier; Sjuksköterskans uppfattning av vårdandet och Utmaningar som sjuksköterskan möter i den palliativa vården. I dessa redovisas bland annat; betydelsen av relationer i vården, patientens behov, sjuksköterskans beskrivning av brister och hur tro kan påverka vården samt krav som ställs i mötet med patienter och närstående. Diskussion: Sjuksköterskornas reflektioner på relation och kommunikation di skuteras, tillsammans med synen på god relation och god vård. Sjuksköterskans invändningar på de anhöriga i vården kontra hur deras egen tro påverkar vården, samt reflektioner kring fokuseringen på fysiska symtom i relation till övriga behov gjordes. Studiens utförande diskuterades också. / Background: In Africa, the need for palliative care is high after the prevalence of HIV, cancer and other diseases. The aim of palliative care is to improve quality of life for patients and families, to relieve suffering and to treat pain. World Health Organizati on launched a project to develop palliative care in Africa, a project that wishes to d evelop the perception ofpalliative care, to integrate in treatmentprograms and improve access to medicine and education. The nurse is playing a major part in palliative care therefor their relationship becomes important for the patient. For the nurse the meeting with the palliative patient could be both painful and stressful, and create strong emotions. Purpose: To describe nurses experiences of palliative care in Tanzania. Method: An empirical study and datacollection in the form of semi-structured interviewswere conducted with eight nurses in Tanzania. The interviews were transcribed and then analyzed according to qualitative content analysis. Resultat: The results are presented in two main categories: Nurses perception of caring and Challenges that the nurse is facing in palliative care. These are, among others; the importance of relations, patient needs, nurse description of shortcomings in palliative care and how faith can affect the care, and also demands that is expected in contact with patients a nd relatives. Discussion: In the discussion nurses reflect on relations and communication together with their vision on good care. Nurses thoughts about the relatives and how their own beliefs affect the care, and reflections about focus on physical symto ms in relations to other needs were discussed. The study design was also discussed.

Syftet: Syftet med studien var att beskriva hur omvårdnadspersonal inom kommunens särskilda boende och korttidsboende upplever att vårda personer i livets slutskede.Metod: Studien bygger på åtta kvalitativa intervjuer med undersköterskor. Datainsamlingsmetoden baserades på Critical Incident Technique och som analysmetod användes kvalitativ innehållsanalys. Resultat: I intervjuerna framkom att samarbetet till de övriga i teamet och närstående hade en stor och avgörande betydelse för hur vården utvecklades. Omvårdnadspersonalen kände ibland att sjuksköterskan saknades i vissa omvårdnadssituationer. Fördelning av personal under dygnet bidrog till kontinuitet i samverkan. De upplevde att olika faktorer i miljön kunde vara både till hjälp eller till hinder i samspelet till den döende och närstående. De intervjuade talade också om vikten av att respektera patientens vilja. Omvårdnadspersonalen gav även stöd till de närstående och de kom familjerna nära. De upplevde att närvaro utan krav och stress var av betydelse för interaktionen till den döende och dess närstående. Det var viktigt att både den döende och de närstående var tillfreds med symtomlindringen. Det var viktigt att få ge ett värdigt omhändertagande efter döden. Slutsats: Det genomgåendet temat visade att interaktion och samverkan med vårdteamet, närstående och patienten var av avgörande betydelseför hur vården i livets slut skulle bli trygg och värdig. / Aim: The aim of this study was to describe how the nursing staff within themunicipality's special housing and short term care perceived their caring forpatients receiving palliative care.Method: The study is based on eight interviews with enrolled nurses. The datacollection method was based on the Critical Incident Technique. The analysis ofinterviews was carried out with qualitative content analysis.Result: Cooperation between the care team and the relatives had a great andsignificant impact on how care was delivered. At times the nursing staff felt thatthe nurse was not present during various nursing interventions. Distribution ofstaff during the day contributed to the continuity of the interaction. The enrollednurses expressed that different environmental factors were either helpful orobstacles in the interaction between the dying person and their relatives. Theenrolled nurses illuminated the importance of respecting the patient's wishes. Thenursing staff provided the families with support which contributed to a feeling ofcloseness. Furthermore, the enrolled nurses felt that their presence withoutdemands and stress were significant in the interaction between the dying personand their family. It was important that the dying patient and their families weresatisfied with symptom control. It was significant to provide a dignified treatmentafter death.Conclusion: The overall theme was that the nursing staff perceived that interactionand collaboration between the care team, family and the patient was of significantimportance for a secure and dignified end of life care.