Delirium is a disturbance of consciousness and cognition that affects many terminally ill patients before death. It can manifest as confusion, hallucinations, and restlessness, all of which are known to be distressing to patients, families, and professional caregivers. Underlying the contemporary palliative care movement is a belief in the idea that a good death is possible; that dying can be made better for patients and families through the proper palliation of distressing symptoms and through proper attention to psychological, social, and spiritual issues that affect wellbeing at the end of life. Given that delirium is potentially disruptive to all that the good death assumes, i.e., mental awareness, patient-family communication, peace and comfort, the question was asked: What is the relationship between end-of-life delirium and the good death in hospice care? Ethnographic fieldwork was conducted at a freestanding residential hospice over a period of 15 months in a suburban community in eastern Canada. The research methods included participant observation (320 hours over 80 field visits), interviews with 28 hospice caregivers, and document analysis. The findings of this study provide an in-depth examination of the nature of caregiving relationships with patients and with families in end-of-life care. They illustrate how a commitment toward providing for the good death prevails within the cultural community of hospice, and how the conceptualization, assessment, and management of end-of-life delirium are organized within such a commitment. In this setting, experiences of conscious and cognitive change in dying are woven by hospice caregivers into a coherent system of meaning that is accommodated into prevailing scripts of what it means to die well. At the same time, delirium itself provides a facilitative context whereby processes of supporting families through the patient’s death are enabled. This study highlights the relevance of considering the contextual and cultural features of individual end-of-life care settings that wish to examine, and perhaps improve, the ways in which care of delirious patients and their families is provided.

Bakgrund: Palliativ vård är en aktiv holistisk vård som utgår från den enskilde patientens livssituation. WHO definierar palliativ vård som ett förhållningssätt som syftar till att förbättra livskvaliteten för patienter och deras närstående som drabbats av livshotande sjukdom. Sjuksköterskans roll i denna vårdkontext kan beskrivas som relationsskapande, stödjande, kommunikativ och koordinerande. Patienten i palliativ vård befinner sig i en utsatt situation och dennes behov består i att upprätthålla god livskvalitet genom smärtlindring och existentiellt stöd. Denna situation ställer krav på sjuksköterskor att ständigt skapa och upprätthålla vårdrelationer med patienter som senare dör, vilket kan vara en utmaning för sjuksköterskan. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av att vårda patienter i palliativ vård. Metod: Litteraturöversikt baserad på åtta vetenskapliga kvalitativa artiklar hämtade från databaserna CINAHL och MEDLINE. Artiklarna har analyserats enligt Fribergs analysmetod. Benner och Wrubels omsorgsteori har använts som teoretisk utgångspunkt för att diskutera resultaten. Resultat: De erfarenheter av palliativt vårdarbete som sjuksköterskorna beskrev i denna litteraturöversikt fångas i fyra centrala teman; Sjuksköterskans relation till patient och dennes familj i palliativ vård, Hur palliativ vård påverkar sjuksköterskans egen person och liv, En vårdande inställning samt Utmaningar i det palliativa vårdarbetet. Diskussion: Resultatet ger en bild av ett komplext vårdområde där ett holistiskt förhållningssätt är nödvändigt. Sjuksköterskan följer med patient och närstående på en resa i livets slutskede som kräver närhet och påverkar hen emotionellt. Utmaningarna och de negativa aspekterna i vården uppvägs av stimulans, tacksamhet och strategier att bemästra de svåra situationerna. / Background: Palliative care is an active, holistic care which is based on the individual patient's life situation. WHO defines palliative care as an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness. The role of the nurse in this context can be described as relationship-building, supporting, communicative and coordinating. The patient in a palliative care context is put in a vulnerable situation and is in need of maintaining a good quality of life through pain management and existential support. This situation puts demands on nurses to constantly create and maintain care relationships with patients whom will later die, which can be a challenge for the nurse. Aim: The aim was to describe nurses' experiences of caring for patients in palliative care. Method: Literature review based on eight scientific qualitative articles retrieved from the databases CINAHL and MEDLINE. The articles have been analysed according to Friberg's method of analysis. Benner and Wrubel's theory of caring has been used as a theoretical starting point to discuss the results. Results: The nurses' experiences of working in palliative care in this literature review were described in fourcentral themes; The nurse's relation to the patient and her family in palliative care, How palliative care affects the nurse's own person and life, A caring attitude and Challenges in the palliative nursing care. Discussions: The result shows a complex nursing field where a holistic approach is essential. The nurse follows the patient and family on a journey at the end of life which requires closeness and affects her emotionally. The challenges and the negative aspects are balanced by satisfaction, gratitude and strategies to cope with the difficult situations.

In the last fifty years, hospice palliative care has changed the modern understanding of dying. Rather than focusing on death, it promotes the facilitation of optimizing life for patients whose conditions have worsened beyong the possibility of recovery or cure. As such, this thesis is a response to the demands of architecture to support this unique stage of life. It analyzes and posits guidelines for designing spaces which must cater to the specific and vastly different needs of the palliative care specialists, family members, and the patients themselves. Also, it seeks to examine the nuanced complexities and poetics involved in a proposed architectural design for a hospice in downtown Toronto. The typology for a hospice is one that is both complex and evolving. It must combine the domestic scale of a home with the efficiency and standardization of an institution. The contemporary hospice must also accommodate rituals and beliefs surrounding the end of life that vary greatly from the many cultures that make up the contemporary city. At the very least, the building must provide inspiration and a hope for a peaceful and dignified transition, recognizing also that this is no longer a traditional place for cure. The distinctions suggest a reconsideration of what is needed and what is expected for those involved in and affected by the dying process. This thesis will explore the architectural possibilities inherent in a new social understanding of the end of life that defies the fatalistic view of an inevitable death, in favour of a hope for dying with dignity while embracing an opportunity to experience liminality during our final days.

Thèse (M.A.)--Université Laval, 2006. / Titre de l'écran-titre (visionné le 28 mars 2007). Bibliogr.

Thesis (M.A.)--Catholic Theological Union at Chicago, 1996. / Vita. Includes bibliographical references (leaves [44]-47).

Thesis--University of Oklahoma. / Bibliography: leaves 71-73.

Thesis (Ph.D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed on June 24, 2009). Includes bibliographical references.

Thesis (D. Min.)--Emmanuel School of Religion, 2007. / Vita. Includes bibliographical references (leaves 176-177).

Thesis (Ph.D.)--Georgetown University, 2008. / Includes bibliographical references.

Thesis (D. Min.)--Emmanuel School of Religion, 2007. / Includes vita. Description based on Microfiche version record. Includes bibliographical references (leaves 176-177).