Background: Living with an incurable disease means facing existential challenges that the person must relate to. Being in a palliative phase also means that the person undergoes a lot of changes which often causes suffering. Suffering in palliative care is seen as multidimensional, something that affects the whole person, which is why a holistic view is a central part of palliative care. Aim: The aim of this literature study was to describe patient's experiences of existential suffering in the palliative phase. Method: A literature study based on ten qualitative articles. Results: Four main themes were found; experiences of a changed life-situation, experiences of loneliness, experiences of meaningless and experiences of loss. Conclusion: The study shows, from an existential point of view that coping and handling with an imminent death is complex and difficult in several ways. Patients in palliative care are a vulnerable patient group whose existential suffering may be enhanced by the way health professionals provide care. The study also shows a need for further research in this area aiming to support health care professionals to alleviate existential suffering.

Background: When a patient suffer from a disease and is in need of palliative care, it is normal to have existential questions and thoughts. For some patients these questions can be painful and the nurse need to have knowledge about dealing with these kind of questions and thoughts to be able to relieve and/or prevent this kind of suffering. Aim: The aim was to describe how the nurse can prevent the existential suffering among patients with palliative care. Method: A literature-based study was based on eight qualitative studies. Results: The results showed that nurses meet patients in the palliative care environment which may suffer from existential problems when their questions and thoughts don´t get answered. It showed that the most important a nurse can do is to give time to these calls and build up a safe relation to the patient. This allows the nurse to read the patients existential questions and observing possibly suffering. The result is organized in two categories "To see and confirm" and " To listen and give support" and see subcategories " Use body language", " Create reliable relationship", respond to the existential questions", "Give the patient time", " take help from others in hard situations" and "to focus on other things" Conclusion: It is easy to only focus on the physical illness while caring for a patient and believe that it is creating suffering. Extensive human suffering is not shown at first sight although it is just as important to relieve.

Bakgrund: Andliga och existentiella frågor hamnar i allt större utsträckning hos sjukvårdspersonal. Det palliativa förhållningssättet betonar vikten av att ge en god omvårdnad vad gäller andliga och existentiella frågor. Sjuksköterskans roll är att genom goda relationer skapa en anpassad och balanserad omvårdnad för att öka välbefinnandet för patienten den sista tiden i livet. Syfte: Syftet med litteraturöversikten var att sammanställa hur andliga och existentiella frågor beskrivs i forskning utifrån sjuksköterskors erfarenheter av palliativ vård. Metod: En litteraturöversikt som sammanställer aktuell forskning inom det valda omvårdnadsområdet. Resultat: I resultatet framträdde att tid är det vanligaste hindret och utbildning är det som främjar givandet av andlig och existentiell omvårdnad. Att skapa relationer och kommunicera är viktiga aspekter inom vårdandets konst. Egenskaper som sjuksköterskan bör inneha för att underlätta givandet av andlig och existentiell omvårdnad är; en god självkännedom, empati, intuition och observationsförmåga. Slutsats: För att kunna ge en bättre andlig och existentiell omvårdnad behöver de yttre förutsättningarna ge tid för mötet mellan sjuksköterska och patient, vårdmiljön organiseras så detta möjliggörs, teamarbete tillämpas och utbildning ges. / Background: Spiritual and existential issues increasingly end up at healthcare personnel. The palliative approach emphasizes the importance of providing good care regarding existential and spiritual issues. The nurse's role is through good relationships create a customized and balanced care to improve the wellbeing of the patient, at the end of life. Aim: The aim of the literature review was to compile the spiritual and existential issues described in the research based on nurses' experiences of palliative care. Methods: A literature review that compiles current research in the chosen nursing field. Results: In the result time appeared as the most common obstacle and education promotes giving of spiritual and existential care. To establish a relationship and communicate is important aspects in the art of nursing. Characteristics that the nurse should possess in order to facilitate the giving of spiritual and existential care is; good self-knowledge, empathy, intuition and observation ability. Conclusion: To be able to ameliorate spiritual and existential care time is needed for the external conditions to enable the meeting between nurse and patient. The care environment should be organized so this is made possible, teamwork applied and education provided.

SAMMANFATTNING Bakgrund: Att drabbas av cancer innebär för många en dramatisk upplevelse som påverkar de fysiska, psykiska, sociala och andliga/existentiella dimensionerna hos människan. Syftet med studien var att undersöka upplevelser av medicinsk yoga som rehabiliteringsform bland personer som drabbats av cancer. Syftet var också att beskriva vilken uppfattning personerna hade angående deras psykiska och andliga/existentiella hälsa, samt den medicinska yogans eventuella betydelse för detta. Metod: Explorativ kvalitativ metod med individuella intervjuer där åtta informanter deltog. Rekryteringen utgick från en cancerrehabiliteringsverksamhet på Akademiska sjukhuset, Uppsala Läns landsting. Rehabiliteringsformen var inriktad på medicinsk yoga. Resultat: Den psykiska hälsan upplevdes förhållandevis god hos personerna men den hade varierat under tiden. Samtalsstöd var viktigt för den psykiska och andliga/existentiella hälsan. Beträffande andliga och existentiella frågor funderade många över sin sjukdom, död och meningen med livet. Den medicinska yogan gav positiva upplevelser. Samtliga informanter kände av och erhöll känsla av lugn och avslappning samt både under och efter yogapassen. Gruppträningen bidrog även till socialt umgänge som var betydelsefullt för flera av informanterna. Det framkom även andliga och existentiella upplevelser i samband med yogapassen. Slutsats: En cancersjukdom medför ofta att den psykiska och andliga/existentiella hälsan påverkas. Den medicinska yogan var betydelsefull som en del av cancerrehabiliteringen och berörde deras fysiska, psykiska, sociala och andliga/existentiella dimensioner. Med informanternas upplevelser i åtanke kan den medicinska yogan vara ett viktigt bidrag till sjukvården och bidra till en bättre hälsa hos personer som drabbas av cancer. / ABSTRACT Background: To suffer from cancer often means a dramatic experience that affects the physical, psychological, social and spiritual/existential dimensions. The purpose of this study was to examine experiences of medical yoga as a part of the rehabilitation for people who suffer from cancer. The purpose was also to describe what perception the people had concerning their psychological and spiritual/existential health, and the eventual significance of the medical yoga related to that. Method: Explorative qualitative method with individual interviews where eight informants participated. The recruitment emanated from a cancer rehabilitation center at the Academic hospital, Uppsala county council. The rehabilitation form was focused on medical yoga. Result: The psychological health was experienced as relatively good but it had varied over time. Therapeutic talks were important regarding the psychological and spiritual/existential health. Regarding the spiritual and existential issues many of the informants thought about their disease, death and the meaning of life. The medical yoga brought positive experiences. All of the informants felt and received a feeling of calmness and relaxation both during and after the yoga sessions. The group training lead to social interaction which was meaningful to several of the informants. Spiritual and existential experiences in connection with the yoga sessions arose. Conclusion: A cancer disease often affects the psychological and spiritual/existential health. The medical yoga was a meaningful part of the cancer rehabilitation and affected their physical, psychological, social and spiritual/existential dimensions. With the informants experiences in mind the medical yoga could be able as an important contribution to the health care and contribute to a better health among persons who suffers from cancer.

Bakgrund: Existentiella frågor som rör meningen med livet, friheten (att göra sina val i livet), existentiell isolering och döden kan bli aktuella när en människa möter en krissituation i livet nära döden. Exempel på när sådana krissituationer kan uppstå är när patienter befinner sig i livets slutskede inom palliativ vård. Sjuksköterskor kommer att möta patienter med dödliga sjukdomar och samtalsämnen som rör existentiella frågor kan då bli aktuella. Detta i sin tur ställer krav på sjuksköterskor att kunna möta patienternas behov av att samtala om dessa frågor. Hur sjuksköterskor förhåller sig i samtalssituationer till sina patienter är av betydelse för välbefinnandet eller frånvaron av den hos de döende människorna. Syfte: Att belysa sjuksköterskors erfarenheter av att samtala med patienter i palliativ vård om existentiella frågor. Metod: En litteraturöversikt baserad på tio originalartiklar inom vårdvetenskap. Systematiska databassökningar har genomförts. Den teoretiska utgångspunkten som användes var Joycee Travelbees vårdteori om mellanmänskliga relationer och kommunikation. Resultat: Fyra teman utvecklades och dessa var: Sjuksköterskors färdigheter och erfarenheter av samtal med tre underteman som sjuksköterskors uppfattning av existentiella frågor, aktivt lyssnande och timing. Det andra temat behandlade de existentiella samtalens innehåll. Temat berör samtal om liv och död men även vardagliga samtal med koppling till existentiella frågor, summeringen av livet och de livsval som gjorts. Det tredje temat beskrev sjuksköterskors sårbarhet och belyser hur sjuksköterskorna påverkas av samtalen med patienterna. Det fjärde temat handlar om faktorer som påverkar de existentiella samtalen med tre underteman tidsbrist, miljöns betydelse och betydelsen av stöd från kollegor. Diskussion: Att möta patienters behov av existentiella samtal kräver färdigheter i att lyssna och att samtala. Sjuksköterskan måste också väga in patienters vilja och önskan att samtala om dessa ämnen för det krävdes också av sjuksköterskan en förmåga att förstå och tolka behovet hos patienten vilket kunde vara ledtrådar om andligt eller existentiellt lidande. Travelbee visar på att det finns ett ömsesidigt skapande i den mellanmänskliga relationen men att sjuksköterskan har ett ansvar för att etablera och underhålla relationen dem emellan. I samtalet är det aktiva lyssnandet en viktig färdighet vilket bereder möjligheter till personcentrerad förståelse av patienters erfarenheter och ståndpunkter. Timing handlade om en förmåga att vid rätt tillfälle tillvarata de stunder som patienten ville samtala. / Background: Existential issues concerning the meaning of life, freedom (to make choices in life), existential isolation, and death can be encountered when a person faces a crisis in life close to death. An example of when such a crisis might occur is when patients are in the final stages of life in palliative care. Nurses will encounter patients with fatal diseases and topics related to existential questions can then be discussed. This in turn requires nurses to meet the patient´s needs to discuss these issues. How nurses relate to these situations as well as their attitudes are important when considering the well-being or lack or well-being when a patient is dying. Aim: To highlight nurses' experiences of talking with patients in palliative care about existential issues. Method: A systematic literature review was carried out including ten original articles in health care sciences. Joycee Travelbee´s care theory of interpersonal relationships and communication was used as the theoretical frame work. Result: Four main themes were developed these were: Nurses' knowledge and skills of conversation with the sub- themes of perception of existential questions, active listening and timing. The second theme dealt with the existential content of the conversations. The theme concern issues on life and death, but also everyday conversations related to existential issues, the summation of life and choices made in life. The third theme described the nurses' vulnerability which highlights how nurses are influenced in dialogue with the patients. The fourth theme is about factors that affect existential conversations with three sub-themes: lack of time, importance of the environment and support from the colleagues. Discussion: To meet patient needs of existential conversations requires nursing skills in listening and talking. The nurse must also take into account patients' willingness to talk about these topics, which required the nurse´s ability to understand and interpret the needs of the patient, which could be clues to spiritual or existential suffering. Travelbee show that there is a mutual establishment of the interpersonal relationship, but the nurse is responsible for establishing and maintaining the relationship between them. In the conversation active listening is an important skill which prepares opportunities for a more person-centered understanding of the patients' experiences. Timing is about the ability to capture the right moments when the patients want to talk.

This diploma thesis focuses on the existential themes of religious seniors. In the theoretical part the notions of 'spirituality' and 'religiosity' are discussed. The following chapters are aimed at the old age in connection to spirituality, personality development and existential questions. The data obtained through semi structured interviews with the religious seniors (n = 8, 6 females and 2 males, average age 82.25 years) are analysed and interpreted by the means of interpretative phenomenological analysis in the research part. The analysis and interpretations answer research tasks specified on broader basis as follows: a) what is characteristic for the faith of the interviewed respondents and what were the changes of faith throughout their lives; b) the way the seniors have been coping with existential themes throughout their lives, some of these being especially urgent in this age period: the meaning of life, hope for the future, the meaning of pain and suffering, coping with the mortality of themselves as well as with the one of their relatives and friends, and dealing with solitude.

Bakgrund: Ett omvårdnadsvetenskapligt synsätt är att se människan som en enhet av kropp, själ och ande. Omvårdnad ska, enligt sjuksköterskans kompetensbeskrivning, utgå från en helhetssyn på människan. Trots detta försummas andlighet hos patienter på grund av bristande utbildning och förståelse av begreppet andlighet samt organisatoriska begränsningar. En vanlig uppfattning är att religion och andlighet ses som synonymer, trots att andlighet är ett vidare begrepp. Syfte: Att beskriva hur svårt sjuka patienter uttrycker sin andlighet. Metod: En litteraturöversikt av tio kvalitativa artiklar där analysen har inspirerats av innehållsanalys. Resultat: Svårt sjuka patienter uttrycker sin andlighet genom att vara i behov av relationer till sig själv, andra, Gud/Högre makt samt till naturen. Det uttrycks även genom att vara i behov av kunskap och information om sin sjukdom och behandling. Sökandet efter mening med livet uttrycks genom att patienterna finner mening genom relationer till andra och till Gud/Högre makt samt genom att hjälpa andra. Vid svår sjukdom uppstår tankar om livet och döden där en omvärdering av livet sker. Att känna hopp uttrycks genom en kamp för överlevnad eller som en kamp för att hinna uppnå mål i livet. Slutsats: Det råder oklarhet kring begreppet andlighet, vilket gör det svårt för sjuksköterskor att uppmärksamma andliga behov hos patienter. Andligheten är ett vidare begrepp än att endast innefatta religion och patienter uttrycker sin andlighet genom behov, att känna hopp och existentiella funderingar. Klinisk betydelse: Den här uppsatsen hoppas bringa viss klarhet i hur patienter uttrycker sin andlighet och då även vad patienterna applicerar på begreppet andlighet. Kunskapen om hur patienter uttrycker sin andlighet finns och behöver implementeras i utbildning och verksamhet. / Background: In Sweden, one nursing scientific approach is to view the human as a unity of body and spirit. Nursing should, according to The National Board of Health and Welfare, be based on a holistic approach, yet spirituality is neglected in the care of patients due to lack of education, difficulties in defining the concept of spirituality and organizational constraints. A common comprehension is that religion and spirituality are used interchangeably, although spirituality is a broader concept. Aim: To describe how severely ill patients express their spirituality. Method: A literature review of ten qualitative articles in which the analysis was inspired by content analysis. Findings: Severely ill patients express their spirituality through being in need of relationships with oneself, others, God / Higher Power and nature. Spirituality is also expressed by being in need of knowledge and information about their illness and treatment. The search for meaning in life is expressed by the patients to find meaning through relationships with others and with God / Higher Power, and through helping others. During severe disease thoughts about life and death occur and a reassessment of life takes place. The sense of hope is expressed by a fight for survival or as a fight to achieve goals in life. Conclusion: There is uncertainty about the concept of spirituality, making it difficult for nurses to pay attention to spiritual needs of patients. Spirituality is a broader concept than to just include religion, and patients express their spirituality through needs, to feel hope and existential issues. Implications for practice: This literature review might bring some clarity into how patients express their spirituality and how patients perceive the concept of spirituality. The knowledge about how patients express their spirituality already exists and needs to be implemented in education and in healthcare.

Four interrelated studies on drug users in prison are presented within the framework of a proposed model for approaching the enhancement of health for persons that builds on an existential view of prisoners’ needs, as well as the risk management and “good lives” perspectives. Risk management is the major focus in current offender rehabilitation based on research on “what works,” which has shown that focusing treatment on risk factors termed “criminogenic needs,” such as impulsivity, poor family relations and drug abuse, reduces recidivism by 10-15 percentage points. The “good lives” perspective proposes that offender rehabilitation should go beyond risk management and also address non-criminogenic needs such as autonomy, relatedness and competence as foundations for building personally meaningful lives. Study I explores the assessment of drug use problems, and describes the psychometric evaluation of the Drug Use Disorders Identification Test (DUDIT), a newly developed 11-item test for quick screening of drug-related problems. Studies II-IV explore treatment for offenders in prison identified as drug users. Study II is a randomized controlled trial of two auricular acupuncture treatments for men and women in prison, inconclusive with regard to point specificity but showing that participants in both groups reported reduced symptoms of discomfort and improved night-time sleep. Study III evaluates the Reasoning & Rehabilitation program, an internationally widespread cognitive-behavioral program for groups of offenders. Results showed significant pro-social short-term changes in sense of coherence, impulsivity and attitudes towards the criminal justice system, as well as a 25% lower risk of reconviction among program completers compared to matched controls. However, the quasi-experimental nature of the study precludes any certainty regarding program effects; a selection bias whereby more motivated program participants are recruited could explain the findings. Study IV is a pilot project exploring the special needs of a subgroup of drug-using inmates with psychiatric and/or violent co-morbidity. Inmates housed in psychiatric prison units were offered long-term auricular acupuncture treatment. Half of the 22 inmates in the study received treatment twice a week for over eight weeks, and those treated over 25 times had lower psychopharmacological medication levels than untreated controls. Studies I-IV address individual facets of a proposed model for enhancing health among drug users in prison. The health enhancement model approaches offender rehabilitation from perspectives of existential psychology, good lives and risk management. Specific definitions of physical, social, psychological/personal and spiritual needs indicate a framework according to which prison treatment can help drug-using offenders find ways to secure healthy need satisfaction.

No description available.

<p>The main purpose of this thesis was to apply the WHO and NHS palliative care approach to dementia care. </p><p>Thirty-one staff-members in mid-Sweden (studies I and II) and 20 next-of- kin (study IV) were interviewed. In study III, 316 staff-members from dementia care and 121 staff-members from palliative cancer care responded to a questionnaire about family support. The interviews were tape-recorded and analysed with a qualitative phenomenographic (I and II) and a hermeneutic approach (IV). The questionnaires (III) were analysed using qualitative and quantitative content analysis.</p><p>The staff-members stated almost unanimously that daily leadership was lacking, and consequently clear goal formulations and care planning were rare (I). Proper teamwork between the doctor and the staff who worked on a daily basis with the patients was absent (I). With respect to existential issues, education and staff discussions were lacking (II). The staff were at a loss concerning how to deal with these issues. Nevertheless, these issues are central to family-members who have to deal with an existential crisis (IV). Important questions emerged about obligation and guilt, faithfulness, responsibility, and paying back what you once received. Existential isolation could be identified e.g. in the reversal of roles experienced as "being a parent to your parent" and in the burden of "visiting a living dead person". </p><p>There were no routines for bereavement visits. The type of support suggested for dementia family members is partly similar to support in palliative cancer care, but it also differs in other respects such as feelings of guilt because the early signs of the disease are misunderstood, the need for respite because of the long trajectory of dementia diseases, and the occurrence of anticipatory grief because in the late phase family members can no longer make any contact at all with the patient (III).</p><p>A palliative approach can improve the quality of life for the dementia patient and for the family. It can be used as a basis for a clear goal formulation. Some of the suggestions listed in this thesis for improving the quality of care are more a reflection of the need for a change in attitudes rather than the need for substantial budget increases.</p>