The purpose of this thesis is to describe what it is like to suffer from malignant lymphoma and to highlight the care given to these patients. A reflective lifeworld approach, founded in phenomenological philosophy, has been used. Data have been collected using interviews and have been analyzed using essence-seeking analysis. The results are founded upon three empirical studies and a philosophical excursus. The results are presented in four sections. The thesis describes how patients with malignant lymphoma live in limbo characterized by existential uncertainties, partly caused by the mortal threat of the disease and by failings in the actions of the healthcare staff. Patients fear dying when suffering from malignant lymphoma, regardless of whether the disease is a genuine medical threat to their life. Thus, there is a substantial need for existential support for these patients. However, the results show that deficiencies in existential support can lead to patients feeling objectified, which in turn increases their existential uncertainties. Care that is solely directed towards the physiological body and excludes the human as a subject can be experienced as a disparagement. Care that includes the patients’ lifeworld provides alleviated suffering and a possibility for the patients themselves to take an active part in the health process. Despite the healthcare staff’s genuine ambition to alleviate the suffering, patients’ existential questions are met with a degree of conflict; on the one hand they are a natural part of healthcare, and on the other the questions are of such character that they are not part of professional healthcare. A healthcare culture that does not fully acknowledge the importance of existential questions appears to be one of the greatest obstacles to a holistic healthcare approach. Furthermore, there appears to be a lack of shared strategies among the healthcare staff when meeting the patients’ existential questions. A conflict arises in an unnecessary battle between biology and existence, which in turn increases the patients’ existential insecurities. Medical knowledge is insufficient in caring for patients with malignant lymphoma. An understanding of caring science is needed in order for the care to become caring and able to meet the needs as described by patients with malignant lymphoma. Healthcare staff most be provided with sufficient support to meet the patients’ existential questions. The organization of healthcare is characterised by being a culture in which existential questions are not given sufficient attention. It seems that healthcare staff give priority to medical/technical tasks rather than conversations of existential character.

The focus of this dissertation is a group of individuals applying for psychotherapy. They have attended an office that offers psychodynamic psychotherapy, based on a Christian outlook on mankind. My research questions dealt with why they did apply for psychotherapy and what their goals were. I had planned the study and selected my data collection methods considering three domains of hypothetical reasons for their decisions to apply for psychotherapy. These grounds were their object relations, existential/religious orientations, and psychological problems and goals for the treatment. The first part of the dissertation is a survey of concepts, theories and former studies in the mentioned domains. Concerning the object-relations I make use of psychoanalytical thinking on the importance of early experiences in relation to parents and other persons but also its application to a “religious relation”, namely to the relation of the individual to her/his socalled God-representation. Concerning the existential/religious orientations I make use of existential-analytical thinking on satisfaction and meaning of life and death as an existential problem. I also make use of research from the psychology of religion on different dimensions of religiosity and its correlations to mental health. In the second part of the dissertation there is an account of my development of methods to be used in data collection. In this part of the book one can also find data from a reference group of people not applying for psychotherapy. The main part of the dissertation is the third part, describing the data of eight persons applying for psychotherapy. The information, from interviews, projective methods and scales, from each of the study subjects is put together, analysed and interpreted as intensive case studies. Questions in the interview covered religious and existential matters, relations to important persons during childhood and later, the persons’ descriptions of themselves, and the reasons for applying for psychotherapy and their goals for the treatment. Their answers were analysed using a hermeneutic method. The projective methods covered a picture and unfinished sentences. The psychological scales covered religious beliefs and satisfaction and meaning of life and a semantic differential the symbolic meaning of the words Mother, Father and GOD. According to the results the influence of the object-relations on the decision to apply for psychotherapy was sometimes direct. But on the whole the most obvious reason was the persons’ experiences and descriptions of themselves as filled with conflicting feelings and lack of or difficulties in controlling them. The influence of existential themes was not so obvious and the effects of the religious orientations were sometimes direct and sometimes only indirect. Peoples’ mental problems and goals of the psychotherapy influenced directly their decisions to apply. Most individuals had been in therapy before. There was some difference in the description of goals between those individuals who finished recently and those applying for the first time or long time after an earlier therapy. The latter having more well-defined goals. Theoretically it is possible to classify goals into treatment and life goals, but in real life they often stick together. One important conclusion was that, when the persons experience themselves as filled with contradictory feelings or conflicting strivings and having lack of feelings or difficulties in controlling them, they also experience themselves as responsible to this and as a consequence they also apply for psychotherapy.

Being affected by a serious or life-threatening illness implies an existentially changed situation that is accompanied by a number of questions about the illness itself, consequences of the illness in an everyday context and implications for the future. The purpose of this dissertation is to examine people’s meaning-making when they are affected by a serious illness and to determine how the illness acquires meaning in the context of their lives. The dissertation thus deals with what can be referred to as existential meaning-making. A hermeneutical approach was adopted, drawing more specifically on Paul Ricoeur’s narrative theory that emphasises the importance of different dimensions of time and memory in the understanding of narratives. An empirical study was carried out of illness narratives collected in research interviews with six women who had been diagnosed with serious illnesses, such as cancer, stroke and heart attack. The analysis reveals that the discovery of the illness and the period following was characterized by chaos and a lack of time perspective, feelings of lack of freedom and thoughts about death, but also feelings of responsibility towards the family. Experiences of the health services were also important in accounts of this early period, particularly wishes for more empathic encounters with the professionals. In the women’s accounts of the long term living with the illness, death continues to emerge as a back drop to their everyday experiences of the illness, but gradually more as confronting the problem of death rather than giving up life. Over time, relationships to significant others and the importance of everyday life also constitute increasingly important themes. In their expectations for the future, the women account for some experiences that have been important in creating a sense of hope and heightened vitality, and thus a new ‘wholeness’, such as being close to nature as well as their religious or spiritual experiences. These results are discussed in terms of how memories of significant events or places play an important role in existential meaning-making, and also how reflections on these memories can be seen as a process of existential ‘learning’.

Syfte: Studiens syfte var att ta del av teamets samlade erfarenheter av deras uppfattningar om vilka känslor, existentiella tankar och reaktioner döende patienter kan ge uttryck för, hur team-medlemmarna bemöter dessa samt deras uppfattning om teamets betydelse. Urval: Tio deltagare ur vårdteamet på hospice, nio kvinnor och en man, deltog i studien. Metod: Data samlades in genom semistrukturerade kvalitativa intervjuer. Analysresultat: Analysarbetet resulterade i tre teman. Dessa teman var Döende patienters existentiella tankar och reaktioner, Personalens bemötande samt Teamets betydelse. Resultat: Döende människors tankar och reaktioner kan yttra sig på flera olika sätt. Detta beroende på exempelvis individens personlighet, var i sjukdoms- respektive anpassningsprocessen patienten befinner sig samt möjligheten till stöd från närstående. Informanterna beskrev ett gott bemötande som; att vara närvarande, ge fysisk beröring, prioritera, se individen, vara lyhörd, respektera individen, bekräfta, inge hopp, skapa trygghet samt skapa förtroende. De nämnde även teamets betydelse för patienten, de närstående samt team-medlemmarna själva. Slutsats: Grundläggande för ett gott bemötande är att patienten känner förtroende för personalen. Detta förtroende kan skapas genom att bland annat stanna upp och lyssna på patienten, se och bekräfta denne, ge fysisk beröring samt vara ärlig och uppriktig. Ett gott bemötande kräver också att personalen flyttar fokus från sig själv till patienten och möter individen där denne är. / Aim: The aim of this study was to investigate the team members collected perception of the feelings, existential thoughts and reactions expressed by terminal patients, how the different team members respond to such feelings and their perception of the importance of the team. Sample: Ten members of the healthcare team at the hospice, consisting of nine women and one man, participated in the study. Method: Data was collected during the spring of 2009 through semi-structured qualitative interviews. Analysis Results: The analytical process resulted in three themes. These themes were: Terminal patients’ thoughts and reactions to existential questions, Interaction with the personnel and The importance of the healthcare team. Results: Terminal patients express their thoughts and reactions in different ways. Many factors contribute to the patient’s individual response: his/her personality, how long the patient has been ill, as well as support received from family and friends. The informants described a good response like; to be present, giving physical touch, prioritize, see the individual, listening, respecting individual, acknowledge, inspire hope, creating a haven and creating confidence. They also mentioned the team's importance to the patient, family and friends and the team members themselves. Conclusion: It is fundamental that the patient has confidence in the personnel. According to some of the participants, this confidence is earned by: listening to the patient, respecting and affirming the patient, answering his/her questions, physical contact, and by being honest and frank. Good care requires that the caregiver does not focus on himself but on the patient, meeting each patient as an individual.

I vårt arbete med palliativa patienter har vi sett en kunskapsbrist i hur patienters existentiella behov bemöts. Det saknas tid för att lyssna på patienterna och tillgodose de existentiella behoven. Det finns en risk att medikalisera de existentiella behoven istället för att bemöta dem. Uppsatsens syfte var att, baserat på självbiografier, belysa patienters existentiella behov i livets slut. En självbiografistudie genomfördes för att få belyst vilka de existentiella behoven var. En narrativ analysmetod användes. Fyra huvudkategorier framträdde; Behov av att känna tillit, behov av att ha en tro på något, behov av att få leva ett vardagsliv och behov av livet som går vidare. Familjen, de nära vännerna och att ges möjlighet att leva vardagsliv var det mest framträdande. Även tillit till personalen var viktigt. Patienter som hade en tro behöll denna till slutet, trots att inga under skedde. Vardagslivet tillsammans med familj och vänner var det som uppskattades mest och som gav störst tillfredsställelse vid livets slut. / In our work with patients in end of life we have seen a lack of knowledge in how we respond to the existential needs. Also there is a lack of time in listening to the patients when they want to express their existential needs. It is so much easier to give sedatives to comfort the patients instead of taking the time and effort to listen to the extential needs. The aim of this study was, based on autobiographies, to examine patients existential needs in end-of-life. In order to find out what needs they had we read autobiographies. The analysis was performed with a narrative method. Four main-categories were found; Need of confidence, need to have a faith in something, need to live a everyday-life and need of life that goes on. The family, close friends and the everyday-life was very important. Also the confidence for the caregivers was of significance. Patients who had a faith kept their faith to the end of life, inspite that there was no miracle. Everyday-life with family and friends at home was the most appreciated in end-of-life.

No description available.

The aim of this s tudy is to investigate the three great existential questions—anxiety, love and death—in the works of Stig Dagerman. Emphasis is placed on the novels Ormen [The Snake] (1945), De dömdas ö [The Island of the Doomed ] (1946), Bränt barn [A Burnt Child] (1948), and Bröllopsbesvär [Wedding Worries] (1949), as well as the play Den dödsdömde [The Condemned] (1948). To this end, interpretation is used in the sense given to it by Paul Ricoeur—interpretation that leads to an understanding of a double meaning. In the present case, this means that the texts' symbolic level is revealed and accorded as great an importance as the story at the surface, manifest level . The theme of anxiety is most apparent in the first novel, while the question of eroticism is central to De dömdas ö and Bränt barn. Each novel expresses a pessimistic view of erotic love as a realizable possibility. Death, which has concrete, motivational and abstract aspects , occurs in every text. Murder and suicide interact with inner, spiritual deadness. This state means acquiring a lowered or threatened inner vitality in which the psyche becomes "icebound". Inner deadness is a form of anxiety. Analysis reveals that anxiety, the complications of love and the problem of death are related to a mother figure. The mother figures in the texts are alternately the objects of destructive hatred and excessive love. Behind these mother figures is concealed the experience of a mother who has betrayed, and who is there fore the object of both aggression and longing. This longing, according to Freudian-Lacanic theory, is expressed in a desire for the mother's body, i.e. a longing fo r the lost unity with the mother in original symbiosis. Thus, the mother figure in the texts also has mythical dimensions—Mother and death are in a sense equivalent. To die is to return to the mother, but death, or the proximity of death thus also provides the opportunity for a symbolic rebirth. Both the proximity of concrete death—as in thwarted suicide attempts—and a symbolic death — as in the form of extreme self-degradation—give rise to an increased feeling of life, if only for a moment. The psychologist Robert Jay Lifton has shown that murder can be a conscious step in a process of self- destruction. Murder is in this case a phase in a search for revitaliza-tion, which is thus the ultimate aim of suicide. This phenomenon appears on the symbolic level in Dagermans works, especially in the play Den dödsdömde. The interpretation reveals that the existential question that dominates Dagerman's texts is the struggle against the threat of inner deadness. The fixation with death in the texts is, in the final analysis , an expression of a desire to live. / digitalisering@umu

We explore the possibility of automating <i>NP</i>-hardness reductions. We motivate the problem from an artificial intelligence perspective, then propose the use of second-order existential (<i>SO</i>&#8707;) logic as representation language for decision problems. Building upon the theoretical framework of J. Antonio Medina, we explore the possibility of implementing seven syntactic operators. Each operator transforms <i>SO</i>&#8707; sentences in a way that preserves <i>NP</i>-completeness. We subsequently propose a program which implements these operators. We discuss a number of theoretical and practical barriers to this task. We prove that determining whether two <i>SO</i>&#8707; sentences are equivalent is as hard as GRAPH ISOMORPHISM, and prove that determining whether an arbitrary <i>SO</i>&#8707; sentence represents an <i>NP</i>-complete problem is undecidable.

Bakgrund: Palliativ vård bygger på ett förhållningssätt där målet är att förebygga och lindra lidande samt förbättra livskvalité hos patienter och närstående. Vården tillhandahålls utifrån ett helhetsperspektiv vilket innefattar andliga och existentiella frågor. Dessa frågor kan vara komplexa att hantera för sjuksköterskan. Arbetet kan därför kännas slitsamt och påfrestande men samtidigt vara berikande och utvecklande. Förmåga att bemästra svåra situationer underlättas av att sjuksköterskan har goda kunskaper om existentialfilosofi och livsfrågor samt får stöd i yrkesrollen. Hur sjuksköterskan själv ser på sjukdom, lidande och död påverkar i sin tur mötet med patienterna. Syfte: Att beskriva sjuksköterskors erfarenheter av att möta döende patienter med existentiella och andliga behov inom palliativ vård Metod: Litteraturbaserad studie med grund i kvalitativ forskning utifrån 12 vetenskapliga artiklar. Resultat: Tre kategorier med tillhörande underkategorier utgör resultatet: Bygga en tillitsfull relation; Främja personlig växt; Hantera känslomässigt påfrestande situationer. Slutsats: Det krävs en tillitsfull relation för att sjuksköterskor ska kunna identifiera patienters andliga och existentiella behov. Sjuksköterskor utvecklar personlig växt utifrån relationer med patienter men upplever samtidigt att de ställs inför känslomässigt påfrestande situationer, vilket kräver stöd och handledning i yrkesrollen samt en balans i tillvaron. / Background: Palliative care is based on an approach where the purpose is to prevent and palliate suffering and improve quality of life for patients and their relatives. The care is based on holism, which means that both spiritual and existential aspects are included. This can be very complex to handle for the nurse. Therefore, nurses can experience their work situation as strenuous and trying at the same time as enriching and developing. An ability to handle difficult situations is, together with professional support, facilitated by the fact that nurses have sound knowledge of existential philosophy and existential questions. Significant when meeting the patients is the nurse’s own experience concerning illness, suffering and death. This relation influences the contact with patients. Aim: To describe nurses’ experience of meeting dying patients with existential and spiritual needs in palliative care. Method: Literature-based study on qualitative research from 12 scientific articles. Result: Three main categories with subcategories emerged; Developing a trusting relationship; Promote personal development; Dealing with emotionally stressful situations. Conclusion: A relation based on trust is required if nurses shall be able to identify a patient’s spiritual and existential needs. Nurses gradually increase personal development from relations with patients but simultaneously experience that they are confronted with emotionally stressful situations which require support and professional guidance together with a balanced life.

BAKGRUND: Omvårdnad skall bedrivas holistiskt enligt International code of etics (ICN) trots detta bedrivs den till viss del naturvetenskapligt med fokus på den medicinska delen, som i sig är viktig. Tydliga riktlinjer för andlig omvårdnad saknas och forskningen är begränsad. SYFTE: Syftet med denna studie var att utifrån aktuell omvårdnadsforskning beskriva faktorer som påverkar sjuksköterskors bemötande av frågor med existentiellt innehåll. METOD: Systematiskt litteraturstudie där sju artiklar och en avhandling ingick vilka var etiskt granskade. RESULTAT: Fyra kategorier identifierades, adekvat kompetens, tillåtande vårdmiljö, holistisk människosyn och reduktionistisk människosyn. Existentiellt, andligt behov har inte en självklar plats i omvårdnad och detta kan relateras till utbildning saknas samt utbildningsansvariga och vårdorganisationens förmåga att strukturera detta. Sjuksköterskor som har längre tids erfarenhet av att bemöta patienters andliga behov utför andlig omvårdnad holistiskt och kan utföra detta utan kliniska och vetenskapliga riktlinjer. SLUTSATS: För att sjuksköterskan skall kunna utveckla sin förmåga att bemöta andligt behov krävs utbildning både före och under yrkeskarriär. En sjuksköterska behöver också stöd från och samarbete med andra yrkeskategorier som präst, psykolog och/eller socionom. / BACKGROUND: Spiritual nursing should be a natural part of nursing due to holistic guidelines in accordance with the International code of ethics (ICN) for nurses, but that isn’t the case. Nurses tend to focus on the patients biological needs, which also is important. There are no current official guidelines for spiritual nursing and there is lack of scientific studies in this subject. AIM: The objective of this study was based on current studies, to describe factors that influence nurses’ respond to questions with spiritual content from patients. METHOD: A systematic review, based on seven scientific articles and one academic dissertation. RESULTS: Four categories were identified; adequate competence, a supportive healthcare environment and holistic outlook on people and reductionistic outlook on people. Patients’ spiritual needs are not always met, because of the nurses’ lack of education in the subject and support from the healthcare organization. Nurses, who have longer time experiences in responding to patients spiritual needs, are able to support patients in a holistic way without clinical and scientific guidance. CONCLUSION: It is important that the nurses’ needs for education in spiritual care are met, both before and during their career, so they can respond to patients’ spiritual needs and be able to provide holistic care. To maintain spiritual care the nurses also need support from the healthcare organization and other professions such as priest, psychologist and social worker.