Palliativ vård i Sverige bedrivs både på sjukhus, Hospice, kommunala boendeformer och i patientens hem. Oavsett var vården bedrivs spelar de närstående en central roll och har rätt till individuellt anpassade stödåtgärder. För att kunna ge närstående detta behövs kunskap om deras erfarenheter och vilka domäner i livet de behöver stöd i. Syftet med studien var att beskriva och tolka erfarenheter av att vara anhörig till en person som i livets slutskede vårdas inom avancerad palliativ hemsjukvård, och dör på Hospice. Elva kvalitativa intervjuer genomfördes med närmast anhörig till patienter som vårdats vid en enhet för avancerad palliativ vård i södra Sverige. Datamaterialet analyserades med en fenomenologisk-hermeneutisk metod, inspirerad av Ricoeur. Fenomenet att vara anhörig till en person i livets slutskede innebar att delta i ett drama med okänt manus. Tre huvudteman framträdde – förändring, utsatthet och stöd. Fenomenet tolkades i ljuset av Eriksson teori om lidande, där lidandet beskrivs som ett drama. Då vårdpersonalen var medaktörer till den anhörige och bekräftade hennes lidande, lindrades lidandet. Stöd innebar att underlätta för den anhörige och den sjuke att vara regissörer i sitt eget lidandes drama, även då den sjuke fanns på Hospice. Detta stöd kan utvecklas med hjälp av familjefokuserade kommunikationsmodeller. / Palliative care in Sweden takes place both in hospital, hospice, municipal nursing homes, and in the patient's home. Regardless of where, family caregivers play a central role and are entitled to individualized support measures. In order to provide this, we need knowledge about their experiences and in which domains of life they need support. The purpose of this study was to describe and interpret the experiences of being next-of-kin to a person who, at the end of life, was cared for in advanced palliative home care, and died in Hospice. Eleven qualitative interviews were conducted with next-of-kin to patients in an advanced palliative care setting in southern Sweden. The data were analyzed using a phenomenological-hermeneutic method inspired by Ricoeur. The phenomenon of being next-of-kin to a person at the end of life meant participating in a drama with an unknown script. Three main themes emerged - change, vulnerability and support. The phenomenon was interpreted in the light of Eriksson's theory of suffering, where suffering is described as a drama. When caregivers were co-actors to the next-of-kin and confirmed her/his suffering, suffering was alleviated. Support meant helping next-of-kin and the ill person to be directors of their own drama, even when the ill person was in Hospice. This support can be developed by using family focused communication models.

The purpose of this study was to determine the effect of a single-session group music therapy songwriting session on grief processing in hospice clinicians. The study design was quasi-experimental. Participants were cluster randomized into a control group and a treatment group. The researcher led a 50-minute songwriting session focused on sharing and processing experiences of grief-related stress and burnout in hospice work. Grief processing was measured using a self-report survey for n=25. Overall differences between control and treatment groups were not found to be statistically significant. Significant differences were also not found in treatment score differences for type of hospice clinician or years of experience. For future research with hospice clinicians, a new measurement tool should be developed that is more specific to measuring an actual difference before and after a treatment. The current measurement tool is best used as an inventory for stress and grief levels that result from caregiving. Any new measurement tool should be kept under twenty questions. A single-session, though convenient for busy hospice clinicians, may not provide a complete treatment for grief and stress. Further research with hospice clinicians may require several treatment sessions to achieve a more complete grief processing experience.

Denna uppsats har som syfte att undersöka om musik används i palliativ vård i Sverige och hur det i så fall beskrivs, motiveras och dokumenteras. Det är en kvalitativ intervjustudie med hermeneutisk förståelseansats. Intervjuer har genomförts med fem personer med olika yrkesprofession inom palliativ vård (sjuksköterska, sjukgymnast, arbetsterapeut, kurator och överläkare). Kontakt med de intervjuade har upprättats genom ett upprop i ett nyhetsbrev som ges ut av Svenskt Palliativt Nätverk, SPN. I uppsatsen ges en teoretisk bakgrund om palliativ vård, kris, etik, död, existentiella frågor, musik, musikterapi samt musikterapi i palliativ vård. Resultatet visar att de intervjuade använder musik i sitt vårdarbete men ingen är professionell musiker eller utbildad musikterapeut. Musikanvändningen beskrivs av informanterna genom konkreta exempel från vårdsituationer och den motiveras dels utifrån personliga erfarenheter av musikupplevelse dels med allmänna reflektioner över musikens olika möjligheter till påverkan fysiskt, psykiskt och socialt i livets slutskede. / This thesis aims to examine whether music is used in palliative care in Sweden and how it is described and justified. It is a qualitative study with hermeneutic approach. The survey consists of interviews with five different professionals working in palliative care (nurse, physiotherapist, occupational therapist, counselor, physician). Contact with the interviewees is established by a proclamation of a newsletter published by Swedish Palliative Network, SPN. The thesis provides a theoretical background of palliative care, crisis, death, ethics, music, music therapy and music therapy in palliative care. The result demonstrates that music is used in care situations and is justified by concrete experiences of how music can affect people physically, mentally and socially in the final stages of life.

Background: The aim of palliative care is to keep the quality of life by integrating a person-centered care at the end of life. Palliative care and hospice care do not focus only on symptoms and medication. Self-esteem, dignity and support were major components for the patient at the end of life. Aim: The aim of this study was to describe how palliative care is given at a hospice in a developing country. Method: The used method was a qualitative participant observation study. The participants were health care staff at a hospice, they were chosen before the study began. The observation took place three times per week for six weeks. The researcher intertwined volunteering and observing at the same time. The data was analyzed with a qualitative content analysis. Result: The study resulted in six categories: environment, nursing records, nursing care, infection control and meals. Conclusion: The conclusion was that nature and safety had a big impact on the environment. The health care staff worked as a team to fulfill their goals. / Bakgrund: Syftet med palliativ vård är att hålla välbefinnandet genom att integrera en personcentrerad vård i livets slutskede. Palliativ vård och hospicevård fokuserar inte bara på symptom och medicinering. Självkänsla, värdighet och stöd är viktiga komponenter för patienten i livets slutskede. Syfte: Syftet med denna studie var att beskriva hur palliativ vård ges på ett hospice i ett utvecklingsland. Metod: Den använda metoden var en kvalitativ deltagande observationsstudie. Deltagarna var vårdpersonal på ett hospice, de valdes innan studien började. Observationen ägde rum tre gånger per vecka i sex veckor. Forskarna sammanflätade volontärarbetet och observationen samtidigt. Uppgifterna analyserades med en kvalitativ innehållsanalys. Resultat: Studien resulterade i sex kategorier: miljö, omvårdnads register, omvårdnad, infektionskontroll och måltider. Slutsats: Slutsatsen var att natur och säkerhet hade stor inverkan på miljön. Vårdpersonalen arbetade som ett team för att uppfylla sina mål.

De la Révolution française à la veille de la Première Guerre mondiale, un dispositif d'assistance à la vieillesse se développe, proposant aux vieux Parisiens de vivre en institution. Le choix du terrain parisien et de sa cinquantaine d'établissements permet, en amont des grandes lois républicaines structurant les schémas assistanciels et assurantiels, de revenir sur les premières générations d'assistés au nom de l'âge et du manque de ressources. Cette thèse interroge la construction d'une catégorie d'administration, la formation d'une population majoritairement âgée de plus de 60 ans et issue des classes populaires, et la genèse d'une catégorie d'expérience de la vieillesse. La formalisation d'une réponse spécifique aux misères liées à l'âge et la progressive distance revendiquée avec les institutions d'enfermement permet d'envisager le dispositif parisien d'assistance à la vieillesse comme une forme de reconnaissance et comme une tentative d'intégration économique, sociale et politique des plus fragiles. L'intégration des vieillards aux dispositifs d'assistance se fait toutefois par le bas, en privant les assistés d'un certain nombre de droits, et en reproduisant les hiérarchies sociales à l'œuvre dans le reste de la société. Aux origines de la mise en pratique d'une sécurité sociale pour les personnes âgées, le développement des hospices et des maisons de retraite au XIXe siècle participe à l'institutionnalisation de cet âge de la vie et à la construction d'un nouveau lien entre la société française et ses vieux, un lien ambivalent nourri de bienveillance et de rejet, de prévenance et de dévalorisation, de protection et de surveillance. / From the French Revolution to World War I, an assistance program developed that offered elderly Parisians the possibility of living in an institutional home. The Parisian territory and its fifty old age institutions allows us, in as much as the great republican laws shaped both the assistance and insurance systems, to study the first generation of recipients assisted in the name of old age and a lack of resources. This thesis examines the construction of an administrative category, the formation of a population mostly over the age of 60 and of popular class origins, and the birth of a category of old age experiences. The formalization of a specific response to age-related miseries and the progressive movement away from detention institutions allow us to consider the Parisian disposition toward old age assistance as a form of recognition and as an attempt at economically, socially and politically integrate the most vulnerable members of the society. Yet, this integration of the elderly works from below, depriving the assistance recipients of a number of rights, and reproducing social hierarchies at work in the rest of the society. At the origins of implementing this social security for the elderly, the development of hospices and retirement homes in the nineteenth century takes part in the institutionalization of this life stage and in the construction of a new relationship between the French society and its elderly people, an ambivalent relationship based on benevolence and rejection, considerateness and deprecation, protection and surveillance.

This dissertation addresses the need for domestic hospice care in Písek region. The aim of this study was to determine whether there is an interest in the provision of such comprehensive care that seeks to satisfy a physical, mental, social and spiritual need of a person. Investigated was not only view on the need for specialist palliative care, but also reasons why families would chose care in a domestic environment. The theoretical part focuses on the problems linked with hospice care. The study mentions history, presence, legislation and financing of hospice care in Czech Republic. The next chapter deals in detail with one of the forms of palliative care, which is a domestic hospice care. Another part of this study is also dedicated to the needs of 'a dying person' and his or her family which is vitally important in care for people terminally ill. The practical part is processed by a form of qualitative research and for this purpose a methodology of questioning and interview techniques by instructions were used. In total 18 communication partners participated in this research. The data obtained from these interviews were evaluated by a method of an open coding. The research result shows that both professional community members and caring families of are interested in a provision of specialised palliative care. The professional community welcomes an offer of domestic hospice care and considers it important and necessary in offering various types of care for people who are terminally ill. Families of terminally ill people are also interested in domestic hospice care as one of the options being offered. The reasons why families would opt for a care in a domestic environment are healthy and strong relations to their terminally ill relative a 'dying person'. The conclusions from this research may contribute to a closer view on this issue or may become a source of information for families facing difficult decisions regarding care for terminally ill relative in a domestic environment.

Caring for the chronically ill is a growing phenomenon that deserves careful attention and research, since the quality of life of the palliative caregiver is threatened by the continuous exposure to psychological, physiological, as well as relational burdens. A hermeneutic phenomenological study was used to explore palliative caregivers‟ experiences of compassion fatigue when caring for chronically ill patients in a hospice setting. Semi-structured interviews were conducted with Bophelong Community Care Centre‟s palliative caregivers between the ages of 20 and 60 years who were employed in a hospice for a minimum of at least two years, thus well-placed to describe their experiences of compassion fatigue when caring for chronically ill patients in a hospice setting. Data was collected through individual interviews, recorded and transcribed. Using thematic analysis, meaningful patterns and themes of data were discovered to better understand compassion fatigue as a phenomenon of interest. The findings pointed to four categories, i.e. the effects of compassion fatigue on palliative caregivers‟ emotional wellbeing, personal and work relationships, physical discomfort, and spiritual awareness, that describe the experiences of palliative caregivers of compassion fatigue in a hospice setting, thus providing a holistic understanding of the complexity of compassion fatigue in a palliative care hospice setting. / Psychology / M. A. (Psychology)

The diploma thesis addresses in detail the issue of a terminally ill individual and things closely associated with this topic including spiritual direction of the bereaved after the death of a close relative. Based on information from the literature it tries to reflect the basic conditions of approach to an oncology patient and his relatives (including the necessity of truthful communication and abidance by basic ethic rules). In order to provide a comprehensive view of the topic, the work includes research among the patient?s relatives realized in 4 out of the 14 hospice centers in the Czech Republic. On the basis of this research some positive aspects have been revealed on one hand, which are worthy acknowledgement and appreciation. On the other hand, there are areas and restraints motivating and challenging both types of healthcare centres to take steps that would lead to a better quality of care provided in the future.

The thesis deals with palliative and hospice care. The thesis is divided into two parts - theoretical and practical. In the theoretical part there are provided with basic information about palliative care, it describes aspects of palliative care in terms of spiritual, social, psychological and physical. There are also recorded information on facilities that provide palliative care, their characteristic, mission and goals. The thesis is also reported on problems of dying, suffering and death. The work also records a pastoral and social care about dying seniors, a description of a multidisciplinary team of hospice care. The practikal part of the thesis is reported on a detection rate of awareness of palliative and hospice care at the clients of caritas Týn nad Vltavou. Next the research found out the respondents opinion of dignified dying in a domestic care

Title of the diploma thesis: Use of promotive therapy and stimulation in hospice care Aim of the thesis: Possible use of promotive therapy and stimulation in therapy of patients in hospice care is discussed in this diploma thesis. The aim of thesis is to compare use these therapies in hospice facilities that provide accommodation for clients or in home hospice care in the Czech Republic and the Slovak Republic and to analyze way of its use in praxis. For purpose of this thesis following promotive therapies and stimulation were selected: music therapy, art therapy, bibliotherapy, basal stimulation and concept Snoezelen. Methods of work: Quantitative and qualitative investigation was used for research. Quantitative investigation in form of questionnaires provided to hospice facilities with accommodation for clients was utilized as a method for data acquisition. Observation of practical promotive therapies processes in hospice facilities with accommodation for clients was included in methodology of qualitative investigation. Results: Research deals with death and dying which is still quite often taboo theme in our conditions. This fact is perceptible in results of research investigation. It was revealed that offer of promotive therapies, which are provided professionally and defined in advance, is not...