Background: Around 100 000 people die in Sweden every day and most of them need palliative care. Palliative care means relieving relief and promoting good quality of life for dying persons. Palliative care is included in the education programme for nurses, although it varies during the education. The aim:To describe nurses experience of care in palliative care with focus on the end of life care. Method:A literature study based on eleven scientific articles. Main Result:Showed that care for dying patients are sensitive and emotional for nurses and this can affect palliative care. The experiences showed that nurses felt unprepared to meet dying patients, this was linked to deficiencies such as knowledge, time, experience and support. The result showed that communication and close relationships are basis for good palliative care and also the promotion of good quality of life for dying patients at the end of their lives. Conclusion: Palliative care is complex. In order for nurses to be able to offer good palliative care for the dying patients, better educations and strategies are needed to deal with difficult situations and build a stronger relationship with the patients and their relatives. Furthermore, lack of time and knowledge affects the care and nursing profession. Developing the experiences as well as constant reflection on nurse's work role can help to understand the care of dying patients better. / Bakgrund: Varje år avlider cirka 100 000 människor i Sverige. De flesta behöver palliativ vård. Palliativ vård innebär att lindra lidandet och främja god livskvalitet för döende personer. Palliativ vård ingår i utbildningen för sjuksköterskor, men innehållet varierar under utbildningens gång. Syfte: Att beskriva sjuksköterskors upplevelse av vårdandet inom palliativ vård med fokus på livets slutskede. Metod: En litteraturstudie baserad på elva vetenskapliga artiklar. Huvudresultat: Visade att vårda döende patienter är känslomässigt för sjuksköterskor och detta kan påverka den palliativa vården. Upplevelserna visade att sjuksköterskor kände sig oförberedda att möta döende patienter, detta förknippades till brister såsom kunskap, tid, erfarenheter samt stöd. Resultatet visade att kommunikation och nära relation är förutsättningar för en god palliativ vård och främjar god livskvalitet för döende patienter i livets slutskede. Slutsats: Palliativ vård är komplex. För att sjuksköterskor ska kunna erbjuda en god palliativ vård till döende patienter behöver de mer utbildning och strategier för att hantera svåra situationer samt skapa en bättre relation med patienterna och anhöriga. Brist på tid och kunskap påverkar vård och sjuksköterskors profession. Utveckling av upplevelserna samt ständig reflektion över sjuksköterskornas arbetsroll kan vara till hjälp för en bättre förståelse av att vårda döende patienter.

Heart failure (HF) is one of the top causes of mortality in the United States and globally. In order to combat the high mortality rates of this disease, medical technology, including internal cardioverter defibrillators (ICD) and left ventricular assist devices (LVAD), have become one of the most common treatments. Over the past 10 years the utilization of these cardiac devices has increased exponentially, which has created a new phenomenon of how we discuss death with patients who have one of these devices. The purpose of this dissertation is to increase understanding of the end-of-life decision making processes and current experiences that patients with a cardiac device are having. This dissertation includes four original manuscripts that focus on patients with a cardiac device and their experiences with decision-making at the end-of-life. The first paper is a data-based paper that examines experiences of patients with an ICD and what factors are associated with having a conversation with their providers about end-of-life. The second paper is an integrative review of the literature regarding what is currently known about end-of-life with an LVAD. The third paper is a psychometric evaluation of the Control Attitudes Scale-Revised (CAS-R) for patients with an LVAD. The fourth paper is a data-based manuscript that looks at patients with an LVAD and their attitudes and experiences with end-of-life conversations with providers and next-of-kin and the impact of cognition on these attitudes and experiences. The findings of this dissertation will hopefully inform providers of patients with cardiac devices about their patients end-of-life decision making processes. It will also demonstrate the gaps that are currently in practice, and ideally be able expand on how to assist patients and providers on improving communication about end-of-life decision making.

Majority of the products get discarded at end-of-life (EoL), causing environmental pollution, and resulting in a complete loss of all materials and embodied energy. Adopting a closed-loop material flow approach can aid preventing such losses and enable EoL value recovery from these products. Design and engineering decisions made and how products are used impact the capability to implement EOL strategies such as disassembly and remanufacturing. Some underlying factors affecting the capability to implement these EOL strategies have been discussed in previous studies. However, relevant metrics and attributes are not well defined and comprehensive methods to quantitatively evaluate them are lacking. This study will first identify key lifecycle oriented metrics affecting disassemblability and remanufacturability. Then a methodology is proposed for the quantitative evaluation of these strategies considering the quality of returns, product-design characteristics and process technology requirements. Finally, an industrial case-study is presented to demonstrate the application of the proposed method.

This thesis investigates potential materials to be used in the rotary sealing industry that provide low power loss and minimize cost. The studied rotary valve utilizes slots that act as timing valves to allow for flow axially, through the seal face, at particular times within a heat pump cycle. This investigation examines various combinations of multiple PTFE materials, plastics, and soft metals that have been proven to provide low friction coefficients. Leakage and wear requirements are stated for the future use of the rotary valve and are used to determine the effectiveness of sealing the fluid while examining the power loss. In conclusion, the study finds the combination of a modified PTFE stationary ring and Aluminum Bronze rotating face to provide the lowest power loss. Numerical analysis was completed to verify the lubrication regime to be partial lubrication and was also used to investigate geometry changes and impact on the power loss.

This qualitative and quantitative study focused on exploring hospice patient’s perceptions of family support. Family support was conceptualized as which family member they expect to receive support from, types of support provided, frequency of support, family communication about medical illness, and type of support that is perceived to be most helpful. Fifteen partcipants between the ages of 70 to 98 were interviewed using purposive sampling. Findings showed that although participants found both physical and emotional support helpful, more than half reported perceiving emotional support as the most helpful. Recommendations for social work practice and research were discussed.

Effective June 9, 2016, many terminally ill patients residing in the State of California will now have the legal option of terminating their life because of protections offered under The California End of Life Options Act. Social workers whose population of care includes terminally ill patients will likely be engaging in conversations about end of life options, including physician assisted death, with their patients. Little research exists addressing what factors may influence social workers perceived preparedness to discuss physician assisted death with patients, yet the expectation that social workers be prepared to discuss all available end of life options with patients is present. The purpose of this quantitative study is to explore the influence of demographic characteristics and experience with terminal illness on California social workers perceived preparedness to discuss physician assisted death as an end of life option with terminally ill patients. Convenience sampling was utilized which included sixty-two Master of Social Work level or higher social workers who are employed in medical social work positions and are providing direct care for chronically and terminally ill patients. Participants completed a voluntary paper survey that gathered demographic information, experience with terminal illness and perceived preparedness to discuss physician assisted death with patients through Likert Scale measures. The findings showed a positive relationship between California social workers who perceived themselves as prepared to discuss physician assisted death and the identification of their social work education as a source of their preparedness.

Calciphylaxis is a deadly disease seen primarily in patients with end stage renal disease. Literature indicated that improved patient outcomes are seen with routine screenings. Many dialysis providers lack fundamental knowledge that would enable early identification of calciphylaxis in patients with renal disease. The purpose of this project was to design a screening instrument and develop a staff education program that would transform calciphylaxis management by promoting early identification and treatment of the disease. Knowles's theory of andragogy was used as the theoretic framework for the project. Dialysis center staff (n = 26) participated in the education. The number of participants was based on the number of staff working at the partner dialysis site. There were no exclusions as all members of the interdisciplinary team play an important role in calciphylaxis management. Surveys conducted following the education were used to determine whether dialysis staff believed they had acquired the knowledge and skills necessary to identify early signs of calciphylaxis. Descriptive data collected by the surveys indicated 60% of participants were not at all comfortable identifying patients at risk for developing calciphylaxis prior to attending the education presentation. Following the presentation, 68% of participants felt very comfortable identifying at-risk patients, an increase of 82.3%. This project exemplified that calciphylaxis detection is a secondary prevention nursing intervention that has potential for promoting positive social change by improving patient outcomes, reducing mortality rates in the end stage renal disease population, and providing empirical data to inform evidence-based therapies for at-risk patients.

HIV-positive children in sub-Saharan Africa have numerous challenges to overcome. These challenges increase psychosocial stress as well as symptom burden including fatigue, weight loss, pain, and mental changes. The symptoms may persist even after initiation of antiretroviral therapy, so such children need additional care. Palliative care lays emphasis on holistic patient-centered care, including physical, psychological, social, and spiritual symptoms, alongside antiretroviral therapy. There is limited data on the impact of integrating palliative care with standard HIV care and treatment in children. The purpose of this study was to fill the gap in the literature by investigating the impact of palliative care on health status in HIV-positive children on antiretroviral therapy. The theoretical framework was based on the humanistic nursing theory. Using the Mann Whitney U and logistic regression tests, the health-related quality of life of 97 children who received palliative care in addition to standard HIV care was compared to 180 HIV-positive children who received standard HIV care only through chart reviews. According to study results, children receiving palliative care alongside antiretroviral therapy have better physical and psychosocial health compared to children receiving only antiretroviral therapy. Increasing age was a contributing factor to better psychosocial and physical health in patients receiving palliative care. Emotional, social, and school functioning are important factors that determine treatment outcomes in children on antiretroviral therapy, and addressing those factors through palliative care will create a positive social change by improving treatment outcomes, quality of life, and longevity.

The Plasma Impedance Probe (PIP) is an electronic instrument that measures the impedance of a dipole antenna immersed in a plasma environment. Measurements made by the PIP provide valuable information regarding the plasma environment. Knowledge of ionospheric plasma density and density disturbances is required to understand radio frequency communication with satellites. The impedance curve provides us with significant plasma characteristics such as the electron-neutral collision frequency and plasma electron density. The work proposed here is a transistor-level implementation of the analog front-end, the non-inverting amplifier that is used to drive the antenna. The antenna immersed in plasma is excited with a sinusoidal/pulse stimulus and the output from the non-inverting configuration is fed into the difference amplifier. In the difference amplifier the output signal from the non- inverting amplifier is subtracted from the original stimulus and then fed into a high-speed pipeline data converter. The entire analog and mixed signal components are integrated on a single chip. The obvious advantages with this design are that it eliminates several sources of analog signal processing errors, thereby improving stability. A Fast Fourier Transform (FFT) is then applied on the sampled input stimulus as well as the processed signal. The input voltage FFT is then divided by the current FFT to obtain the antenna impedance. The FFT method helps in reducing transient errors and improves noise immunity of the system. The antenna impedance span curves over the frequency range from 100 kHz to 20MHz. The approach for the tranistor-level design is implementing short-channel design tech- niques using the gm/ID method. This is the primary focus of the thesis where the emphasis has been on using a simple and intuitive method to design the front-end amplifier in the TSMC .35 um technology. The design specifications for this amplifier are derived from the system-level simulations. The transition from a Printed Circuit Board (PCB)-based design to System on Chip (SOC) implementation is explored. This makes the design components highly specific to the application. The following are the design approaches used for the analog front-end design. * A detailed study of the various factors affecting the PIP instrument measurement capabilities from the previous works. * System-level simulation of the the entire PIP system to completely characterize the analog front-end. * Exploration of the possible design topologies for the transistor-level implementation. * A novel method of analog amplifier design using the gm/ID methodology. Miniaturization of the instrument and using a pulse-based measurement scheme also offer an immediate benefit to sounding rocket missions. The reduction of power, mass, and volume will enable the instrument to be flown on many more sounding rockets than at present. The faster measurement is especially valuable since the ionospheric plasma changes in character most rapidly with altitude.

The hospice care population with cancer are often older adults who report many cancer-related symptoms experienced often in clusters. Most prevalent of these symptoms is fatigue and often it co-occurs with depressive symptoms and poor physical functioning. This dissertation examined fatigue, symptom clusters, depression, physical activity, and functional status in older adults with cancer. The aims of the literature review were to understand the relationship among physical functioning, cancer fatigue, fatigue-related symptom clusters, and their relationship with functional status In older adults. The literature related to these associations is insufficient and inconclusive. The methods section aimed to investigate the reliability and validity of the Center for Epidemiology Studies-Depression scale, Boston Short Form (CESD-10). Using Structural Equation Modeling (SEM) for confirmatory factor analysis, the factor structure of responses in a cross-sectional sample (N = 200) of adults with different types and stages of cancer was examined. Internal consistency reliability estimate Cronbach’s alpha =0.737. The CESD-10 four-factor model (positive affect, depressive affect, somatic complaints, and interpersonal challenges) fits the data well. The CESD-10 was a valid and reliable measure for assessing depressive symptoms in this study. The final section examined fatigue related symptom clusters and their relationships with functional status in older adult hospice patients with cancer (N=519). The fatigue-related symptom cluster (lack of energy, feeling drowsy and lack of appetite), significantly predicted poor functional status. Experiencing physical and psychological symptoms has a significant impact on functional dependence. Hospice healthcare professionals should be alert to older adults’ symptom cluster experience during assessment and management.