Bakgrund och problemformulering: Vård i livets slutskede innebär att vården övergår från att vara livsförlängande till att vara lindrande. Vården kan pågå från dagar till månader och det är viktigt att sjuksköterskan anpassar vården utifrån patientens hälso- och livssituation. Sjuksköterskan ska erbjuda patienten en säker och evidensbaserad vård som utgår från patientens aktuella behov och önskemål. Syfte: Syftet är att belysa sjuksköterskans erfarenheter av vård i livets slutskede i hemmet. Metod: En litteraturöversikt enligt Friberg gransknings- och analysmetod. Resultat: Resultatet presenteras i två teman och fem subteman. Teman som identifierades var att skapa en vårdande relation vid vård i livets slutskede och sjuksköterskas roll vid vård i livets slutskede i hemmet. Slutsats: Det krävs att sjuksköterskan har kompetens, kunskap och engagemang för att kunna erbjuda patienten en god vård i livets slutskede. Trots att vård i hemmet blir allt vanligare inriktar sig den aktuella grundutbildningen för sjuksköterskor i stor utsträckning från att vårda på sjukhus. / Background and problem formulation: Care in the final stages of life means that the care transitions from being life-extending to being palliative. The care can last from days to months and it is important that the nurse adapts the care based on the patient's health and life situation. The nurse must offer the patient safe and evidence-based care based on the patient's current needs and wishes. Aim: The aim is to illustrate the nurse's experiences of end-of-life care at home. Method: A literature review according to Friberg's review and analysis method. Results: The results are presented in two themes and five sub-themes. Themes that were identified were to create a caring relationship in end-of-life care and the role of nurses in end-of-life care at home. Conclusion: It is required that the nurse has the competence, knowledge and commitment to be able to offer the patient good care in the final stages of life. Despite the fact that home care is becoming more common, the current basic education for nurses largely focuses on nursing in hospitals.

Bakgrund Palliativ vård handlar om att ge vård till patienter med obotlig sjukdom. Målet med vården är helhetssyn på patienten för att tillgodose patientens fysiska, psykiska, sociala och existentiella behov samt att ge stöd till närstående. Att ha kunskap och utbildning inom området är viktigt eftersom allt flera patienter väljer att få palliativ vård i sitt eget hem. Syfte Att beskriva sjuksköterskor upplevelser och erfarenheter av palliativ vård i hemmet. Metod Litteraturöversikten baseras på 13 vetenskapliga artiklar med kvalitativ och kvantitativ ansats. Artiklarna söktes i databaserna PubMed och CINAHL och var publicerades mellan åren 2015 och 2024. Artiklarnas dataanalys genomfördes genom att följa Friberg (2017) olika steg. Resultat Sjuksköterskornas erfarenheter genererade tre huvudkategorier med sina respektive underkategorier: Att etablera en god relation: Vårdrelation till patienter och deras närstående, Stödstrategier till patienter och närstående och Kommunikation och samarbete med andra i vårdteamet. Bristande förutsättningar för en god vård i hemmet: Behov av kompetens och Tidsbrist. Hemmet som vårdmiljö: Att skapa en trygg och säker miljö i hemmet och Att visa respekt för den privata sfären. Slutsats Sjuksköterskor har en central roll inom palliativ vård och möter olika utmaningar när de tillhandhåller palliativ vård i hemmet. Att hantera dessa utmaningar på ett effektivt sätt är avgörande för att säkerställa att patienter och deras närstående får vård av god kvalitet ihemmet. / Background Palliative care is about providing care to patients living with incurable diseases. The goal of the care is a holistic approach to the patient to address their physical, psychological, social, and existential needs and to provide support to family members. To have knowledge and education in the field is important as more and more patients are choosing to receive palliative care at home. Aim To describe nurses' perceptions and experiences of palliative care at home. Method The literature review is based on 13 qualitative and quantitative scientific articles. The articles were searched in the databases PubMed and CINAHL and were published between 2015 and 2024. The articles' data analysis was carried out by following Friberg's (2017) different steps. Results The nurses' experiences generated three main categories with their respective subcategories: Establishing a good relationship: Care relationship with patients and their relatives, Support strategies for patients and relatives and Communication and co-operation with other members of the care team. Insufficient conditions for good care in the home: Need for competence and Lack of time. The home as a care setting: Creating a safe and secure environment in the home and respecting the private sphere. Conclusions Nurses play a central role in palliative care and face various challenges when providing palliative care at home. Addressing these challenges effectively is essential to ensure that patients and their families receive good quality care at home.

Andelen äldre personer ökar i Sverige och världen vilket innebär att efterfrågan av vård ökar, men all vård behöver inte ske på sjukhus. Insatser som kan förhindra undvikbar slutenvård bör vara viktiga att arbeta fram dels ur ett hållbarhetsperspektiv, men även viktigt för att minska den påfrestning, förvirring och försämrad hälsostatus en sjukhusvistelse kan innebära för den äldre sköra patienten. Mobila närsjuksvårdsteam som utgår från sjukhusen är en relativt ny vårdform i Sverige och introducerades i Västra Götalandsregionen för ungefär 10 år sedan. Mobila närsjukvårdsteam gör insatser för sköra patienter med komplexa behov i hemmet och i teamen arbetar bland annat sjuksköterskor. Inom sjuksköterskans kompetensområde ingår att självständigt kunna ansvara för omvårdnad av patienter, inneha förmågan att se hela patientens livsvärld samt arbeta för en säker vård.  Syftet med den här studien är att belysa sjuksköterskans arbete med sköra patienter i mobila närsjukvårdsteam. Denna studie har genomförts som kvalitativ metod med induktiv ansats och bygger på intervjuer som datainsamlingsmetod. Vi har intervjuat sjuksköterskor verksamma på tre olika mobila närsjukvårdsteam. Resultatet av vår studie har visat att sjuksköterskan i mobila närsjukvårdsteam har en viktig roll då de utför avancerad vård i hemmet genom samverkan i team och med andra vårdaktörer. Sjuksköterskan har ett helhetsperspektiv med patienten i fokus och på så sätt kan andelen onödiga sjukhusinläggningar minska. Vår studie visar att snabb uppföljning i hemmet av sköra patienter som skrivs ut från sjukhus skapar trygghet samt minskar återinläggningar. Dessutom är rätt vård av sköra äldre patienter en organisatorisk fråga och vården behöver bedrivas av rätt kompetens. Sjuksköterskans arbete i mobila närsjukvårdsteam innebär att arbeta med hållbar utveckling genom att konsumtion av slutenvård minskar. / The proportion of older people is increasing in Sweden and the world, which means that the demand for care is increasing, but all care need not executed in hospitals. Efforts that can prevent avoidable outpatient care should be important to work on from a sustainability perspective, but also important to reduce the stress, confusion and deteriorating health status a hospital stay can cause for the older fragile patient. Mobile local health care teams executed from the local hospital are a relatively new form of care in Sweden. Mobile local health care teams were introduced in the Västra Götaland region about 10 years ago. Mobile local health care teams makes efforts for fragile patients with complex needs in their home.  The registered nurse’s expertise includes being able to independently be responsible for the care of patients, having the ability to see the entire patient's needs and working for patient's safety. The aim of this study is to illustrate the nurse's work with fragile older patients in mobile local health care teams. This study has been conducted as a qualitative method with an inductive approach and is based on interviews as a data collection method. We have interviewed nurses working on three different mobile local health care teams. The result has shown that the registered nurse in mobile local health care teams plays an important role as they carry out advanced care in the home through collaboration in teams and with other healthcare players. The registered nurse has a holistic perspective with the patient in focus, unnecessary hospitalizations and re-admission can be reduced. This study shows that fast follow-up in the home of fragile patients who are discharged from hospitals creates security and reduces re-admissions. In addition, proper care of fragile elderly patients is an organizational issue and care needs to be conducted by the right expertise. Registered nurse's work in mobile local health care teams means working with sustainable development by reducing the consumption of inpatient care.

<p><p><p>This thesis has focused on specific aspects of the law concerning the 2nd paragraph of The Care of Young Persons Act (1990:52), LVU. The purpose of this study was to examine the provision <em>other circumstance in the home </em>from a legal perspective; how is the provision defined in the law? A second purpose was to reveal any discrepancy between the intention of the legislation of the already mentioned provision and how this provision was interpreted and applied in practice. This study was jurisprudential and based on both traditional juristic method and sociological methods with qualitative interviews with social workers and text analysis of a case from The County Administrative Court. The gathered information was analysed using a method of discourse analysis. The theoretical framework for this thesis was social constructionism based upon the work of Berger and Luckmann. The conclusion of this study was that the provision <em>other circumstance in the home </em>is connected to the role of the mother though this is not noticed through the legislation. Another conclusion was that the practice considers the legal demand to anticipate as unattainable. The interpretation and application of the provision made by the practice, compared with the intention of the legislation, was representing both an expand and restriction of the provision.</p></p></p>

Background: Intimate partner violence is a public health issue that causes suffering for victims, abusers and children. Interventions have been made to prevent and treat the problem but the evaluation of them are often insufficient. The clinic for intimate partner violence in Uppsala (MVU) offers abusers treatment to stop using domestic violence. Aim: To produce a general evaluation of MVU’s treatment for aggression- and violence problematics in intimate relationships by studying participating men’s experiences of the treatment. Method: A qualitative interview study was used. By using a retrospective consecutive sample 11 men were recruited to individual semi structured interviews. Data was analyzed by thematic analysis. The ecological model was used as a theoretic perspective. Result: The study showed that the informants had positive experiences of the arrangement of the treatment and the content was educative even though somewhat demanding. The therapists were considered to be competent and had a way of working that was suitable for the purpose of the treatment. Those who had been in group therapy found help and support from the group and several men missed the group when the treatment was finished. After the treatment the informants had come to realize that they had a violence issue that they were responsible of. They had learned to control their temper in a better way and had become better at communicating. They also experienced health improvements. Conclusion: Men have a predominately positive experience of the treatment at MVU. The treatment was in some aspects considered mentally challenging but overall the men experienced better health after the treatment compared to before. / Bakgrund: Våld i nära relationer är ett folkhälsoproblem som orsakar lidande för offer, utövare och eventuella barn. Insatser har utformats för att förebygga och behandla problemet men ofta är utvärderingen av dem bristfällig. Mottagningen mot våld i nära relationer i Uppsala (MVU) erbjuder våldsutövare behandling för att sluta bruka våld i nära relationer. Syfte: Att göra en generell utvärdering av MVU:s behandling mot aggressions- och våldsproblematik i nära relationer genom att studera deltagande mäns upplevelser av behandlingen. Metod: En kvalitativ intervjustudie användes. Genom ett retrospektivt konsekutivt urval rekryterades 11 män till individuella semistrukturerade intervjuer. Data analyserades med tematisk analys. Den ekologiska modellen tillämpades som teoretiskt perspektiv. Resultat: Studien visade att informanterna upplevde behandlingens upplägg som bra och innehållet lärorikt om än något krävande. Terapeuterna upplevdes vara kompetenta och arbeta på ett sätt lämpligt för behandlingens syfte. De som hade gått i gruppbehandling fann hjälp och stöd i gruppen och flera sakande gruppen efter avslutad behandling. Efter behandlingen hade informanterna kommit till insikt om att de hade ett våldsproblem som de själva var ansvariga över. De hade lärt sig att hantera sitt humör på ett bättre sätt och blivit bättre på att kommunicera. De upplevde även hälsoförbättringar. Slutsats: Män har en övervägande positiv upplevelse av MVU:s behandling. Behandlingen upplevdes i en del avseenden som psykiskt krävande men efter behandlingen mådde männen överlag bättre än före behandlingen.

The aim of this study was to examine whether certain background variables (sex, age group, reasons for placement, amount of problems, involuntary placement/voluntary placement) affect the probability of children/youths being placed in emergency homes (jourhem) and whether these variables correlate with the occurrence of placement breakdown. The material consists of 445 requests for children/youths to be placed in emergency homes in six municipalities within the Stockholm region during a three-year-period (2016-2018). Frequency tables, cross tables and simple and multiple logistic regression were used to analyze the data and Bronfenbrenner's theory of developmental ecology was used as the theoretical framework. Results show that emergency homes differ from other types of placement in some regards: behavioral problems reduced the probability of placement occurring significantly compared to problems relating to the parent's abilities as a caregiver. Youths had a significantly higher risk for placement breakdown than children. Involuntary care reduced the likelihood of placement occurring and increased the risk for placement breakdown compared to voluntary placement. The prevalence of placement breakdowns was similar to the figures found in prior research on other forms of placements. The implications for social work and the need for further research is discussed.

This thesis has focused on specific aspects of the law concerning the 2nd paragraph of The Care of Young Persons Act (1990:52), LVU. The purpose of this study was to examine the provision other circumstance in the home from a legal perspective; how is the provision defined in the law? A second purpose was to reveal any discrepancy between the intention of the legislation of the already mentioned provision and how this provision was interpreted and applied in practice. This study was jurisprudential and based on both traditional juristic method and sociological methods with qualitative interviews with social workers and text analysis of a case from The County Administrative Court. The gathered information was analysed using a method of discourse analysis. The theoretical framework for this thesis was social constructionism based upon the work of Berger and Luckmann. The conclusion of this study was that the provision other circumstance in the home is connected to the role of the mother though this is not noticed through the legislation. Another conclusion was that the practice considers the legal demand to anticipate as unattainable. The interpretation and application of the provision made by the practice, compared with the intention of the legislation, was representing both an expand and restriction of the provision.

This qualitative study aimed to examine which discourses can be found within the Child and Adolescent Psychiatry (BUP) and women’s shelters against domestic violence, concerning children that have experienced violence within the family, from two perspectives: the child’s need of father and of protection from violence. The study also aimed to examine which discourses can be found within the organisations concerning children’s well-being, how they define their mission concerning domestic violence and how this can affect the practical work with children that have experienced violence and their parents. The questions that the study aimed to answer were which discourses can be distinguished within BUP and the women’s shelters against domestic violence and how they can affect the different agencies’ view of the child’s need and well-being. These questions have been answered with collected interviews from the two respective agencies which have then been interpreted and processed through a critical discourse analysis from different theoretical concepts such as dominant discourses and service discourses in relation to Social Work, children’s need as a social construction and discourses of the child as a victim and an active participant. What the study showed was that the active participant-discourse overall was more prominent within BUP and that the victim-discourse was more prominent within the women’s shelters against domestic violence but also that both discourses were distinguishable in different ways and to different extents in both agencies in different combinations and variations. The study also found that the discourses, in different ways and to different extents, also affected the agencies’ view of the child’s need of father and of protection from violence.

Diss. (sammanfattning) Stockholm : Univ., 2004. / Härtill 4 uppsatser.

Bakgrund: Vårdmiljöer sägs kunna bidra till att lindra såväl lidande som möjliggöra välbefinnande för patienter vid livets slut, och det privata hemmet kan möjliggöra livskvalitet och är föredragen vårdplats för döende och död i samhället. Arbetet som sjuksköterska i hemmet vid livets slut involverar att möta patienter och familjemedlemmar i deras egen miljö, vilket beskrivs som utmanande men också som positiva erfarenheter beroende på klinisk organisation och sjuksköterskans ansvarsområde. Ytterligare erfarenhetsbaserad omvårdnadsforskning om denna vårdmiljö är eftersträvansvärd. Syfte: Syftet med studien var att undersöka sjuksköterskors, som arbetar i specialiserad palliativ hemsjukvård, erfarenheter av det privata hemmet som vårdmiljö vid livets slut. Metod: Den här studien har kvalitativ design, guidad av forskningsapproachen tolkande beskrivning. Deltagarproducerade fotografier användes som utgångspunkt vid tio individuella intervjuer med sjuksköterskor inom specialiserad palliativ hemsjukvård. Resultat: Datanalysen resulterade i fyra teman; Komma till ett unikt privat hem förberedd på att anpassa interaktioner och handlingar beroende på miljön; Stödja patienter och familjemedlemmar att balansera egenvård, oberoende och säkerhet; Guida patienter och familjemedlemmar inför och igenom förändringar i hemmiljön för att stödja vård vid livets slut; Använda bilfärden mellan hemmen till reflektion, återhämtning och förberedelse. Diskussion och slutsats: Resultatet i denna svenskspråkiga uppsats diskuterades utifrån Liaschenkos teorier; som framhåller att omvårdnadsansvaret i hemmet innebär att bevara och skydda patientens möjlighet till autonomi och självbestämmande i deras naturligt subjektiva miljö, som påverkas av sjukdom och sjukvård. Resultatet genomsyras av sjuksköterskornas strävan att uppnå detta, något som beskrivs kräva specifik kompetens, men också innebär en rad utmaningar och ibland risker för det egna välbefinnandet. Då resultatet samtidigt antyder hemmet som plats med dubbla syften, dels som en privat plats vid livet slut och en arbetsplats. Omvårdnadsarbetet involverar en rad anpassningar i interaktion med vårdmiljön och personerna som bor där, och ett tillitsfullt samarbete mellan sjuksköterska, patient och/eller familjemedlem beskrivs möjliggöra en optimal och delad vårdmiljö vid livets slut. / Background: Care environments are shown to be a contributing factor for alleviate suffering and enhance wellbeing for dying patients, and private homes is found to benefit life quality and is a preferred place death and dying in society. Working in home care at end-of life involves meeting patients and family members in their own environment, entailing challenges and feasibilities depending on clinical organization and nursing role. Further experiential nursing research about this care environment at end-of-life is desirable. Aim: Exploring palliative care nurse’s experiences of the private home as an end-of-life-care environment. Method: The design of this study was qualitative, guided by the interpretive description approach. We used participant-produced photographs with follow-up interviews with ten nurses working in specialised palliative home care. Findings: Four themes were constructed; Entering the unique private home prepared to adjust interactions and actions depending on the environment, Supporting patients and family members to balance between self-care, independency and security, Guiding patients and family members towards and through environmental changes to support end of life care at home and Using the time driving between homes to reflect, recover and prepare. Discussion and conclusions: The findings in this Swedish written essay was discussed by using Liaschenkos theories; displaying that the nursing role in this care settings involves keeping and protecting the patients autonomy and self-determination in their own natural subjective home, which is affected by disease and health care. This findings clearly demonstrate the nurses strive for this, requiring specific competence, but also impair several challenges and sometimes risks for their own wellbeing. Thus, the private home is suggested being a space with dual purposes; an exclusive place for death and dying and a working environment. This involves a variety of adjustments in interactions with the environment and the persons living there, facilitated by a confident cooperation between the nurse, patient and/or family members for an optimal and shared care environment in end-of-life. / Plats och rum för vård i livets slutskede