Background Nurses work to promote health, prevent disease, restore health and relieve suffering. However, when the patient transitions into end of life care, the goal is no longer to cure, but to relieve. End-of-life care is about seeing the patient and helping them move on by doing what favors the patients’ well-being. Aim The aim of this study was to describe how nurses can preserve the patients’ dignity in end of life care. Method This study is based on a method to contribute to evidence-based nursing with foundation in analysis of qualitative research. 7 qualitative and 2 articles with mixed methods were analyzed using a five step model described by Friberg. Results Through the analysis three main themes and five sub-themes were developed. The main themes were: Involving the patient, Preserving the patient’s quality of life, Seeing the patient. Conclusion Through the actions performed by the nurse, dignity can be preserved. By protecting the patients’ integrity and autonomy through a person-centered care, the best conditions for giving a worthy death are created.

Orientador: Antonio José Maria Cataneo / Resumo: Introdução: O implemento de cuidados paliativos (CP) está associado a melhor qualidade de vida do paciente em estado terminal (PET), buscando reduzir o sofrimento de todos os envolvidos no processo de morte. Justificativa: Acredita-se que PET não deveria estar internado e nem morrer em UTI. Objetivos: Determinar se a instalação de equipes de CP podem diminuir o tempo de internação e a mortalidade na UTI de PET. Métodos: Revisão sistemática de artigos que compararam PET internados em UTI que receberam cuidados de fim de vida após a instituição de uma equipe de CP (intervenção) com aqueles que receberam os cuidados quando ainda não havia sido instituída a equipe de CP (controle). Os desfechos analisados foram o tempo de internação em UTI apresentado pela diferença de média com o correspondente IC a 95%, mortalidade em UTI apresentado como razão de risco com o correspondente IC a 95%, e qualidade de vida. Foram pesquisadas as bases de dados: PUBMED, LILACS, SCOPUS, EMBASE e Cochrane CENTRAL. Resultados: Após leitura de títulos e resumos de 399 artigos, foram selecionados 27 estudos para a análise de texto completo, e finalmente excluídos 19, restando 8 artigos para inclusão, envolvendo 7846 participantes. Sete estudos foram realizados nos Estados Unidos e um na Austrália. Foi realizada metanálise para o tempo de internação em UTI, utilizando quatro estudos, que resultou em redução de aproximadamente 2,5 dias no tempo de internação com a aplicação da intervenção: media -2,44 dia... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: The palliative care (PC) procedure is associated with better quality of life for terminally ill patients (TIP), in order to reduce the suffering of everyone involved in the death process. Rationale: it is believed that TIP should not be admitted nor die in the ICU. Objectives: To determine if the installation of CP teams can reduce the length of stay and mortality in ICU TIP. Methods: A Systematic review of articles comparing TIP in ICU beds who received end of life care following the imposition of a team of PC (intervention) to those who received care when they had not yet been introduced the PC team (control). The outcome measures were the time of ICU admission presented by average difference with the corresponding 95% CI, mortality in ICU presented as risk ratios with corresponding 95% CI and quality of life. Databases were searched: PUBMED, LILACS, Scopus, EMBASE and Cochrane CENTRAL. Results: After reading titles and abstracts of 399 articles, 27 studies were selected for full text analysis, and finally 19 were excluded, leaving 8 articles for inclusion, involving 7846 participants. Seven studies were performed in the United States and one in Australia. Meta-analysis was performed to the ICU length of stay, using four studies, which resulted in a reduction of approximately 2.5 days in the length of stay with the application of intervention: Media -2.44 days (CI -4.41 to -0 48) p = 0.01, I2 = 86%. It was also performed a meta-analysis of mortality in ICU... (Complete abstract click electronic access below) / Mestre

Flertalet sjuksköterskor upplever svårigheter i att vårda döende patienter. Olika känslor uppkommer och varierar beroende på tidigare erfarenhet inom området. För att patienten ska dö med värdighet krävs det att livskvaliteten upprätthålls ända fram till dödstillfället. Problem i omvårdnaden synliggörs när sjuksköterskan upplever att egen erfarenhet, kunskap och förståelse inte är tillräcklig. Det kan resultera i kommunikationssvårigheter, osäkerhet och en otillräcklig helhetssyn av patienten. Syftet med studien är att undersöka hur sjuksköterskor utan erfarenhet inom palliativ vård upplever vårdandet av patienter i livets slutskede. Metoden som användes var allmän litteraturbaserad metod. Nio vårdvetenskapliga studier ingår i resultatet och tre teman kunde urskiljas: Erfarenhet av döden i vårdande kontext, kommunikation och sjuksköterskans upplevelse av döden. Ur dessa teman framkom sju subteman: att bli känslomässigt påverkad, erfarenhet av vårdande i livets slut, att kommunicera med patient och anhöriga, att kommunicera med kollegor, när kommunikationen är en utmaning, den goda döden, den dåliga döden. Resultatet påvisar vikten av kommunikation, erfarenhet, ärlighet och öppenhet i vårdandet av patienten i livets slutskede. Utifrån resultatet diskuteras utvalda upplevelser som vårdandet i livets slutskede medför. Detta gäller sjuksköterskans känslor, erfarenhet, förmåga att kommunicera samt sjuksköterskestudenter och handledares perspektiv. Genom reflektion kan ökad förståelse och därmed ökad kunskap uppnås. Sammantaget är det många faktorer som behövs för att vårdandet i livets slutskede ska vara av god kvalitet.

Bakgrund: Palliativ vård bygger på ett förhållningssätt med syfte att lindra lidande och öka livskvaliteten under den sista tiden i livet. Sjuksköterskans uppgift i den palliativa vården är att utifrån en personcentrerad vård skapa förutsättningar för en god död. Trots att det finns möjlighet för vård i hemmet eller på palliativ vårdenhet händer det att patienter i ett sent palliativt skede ändå söker sig till akutmottagningen. Syfte: Att beskriva sjuksköterskors erfarenheter av att vårda patienter i ett sent palliativt skede, på akutmottagning. Metod: En litteraturöversikt har gjorts för att besvara syftet. Elva vetenskapliga orginalartiklar har inkluderats och dessa har granskats, analyserats tematiserats för att urskilja likheter och skillnader. Resultat: Två huvudteman och sex underteman identifierades. Det första huvudtemat var Sjuksköterskans erfarenheter av faktorer som utgör hinder för god palliativ vård, med tillhörande underteman vårdmiljön som ett hinder, avsaknad av nödvändiga resurser, kurativ mentalitet och anhöriga som ett hinder för god palliativ vård. Det andra huvudtemat var sjuksköterskans erfarenheter av faktorer som främjar en god palliativ vård, med tillhörande underteman en underlättande vårdmiljö och resursers betydelse för god palliativ vård. Diskussion: Diskussionen framhäver vårdkulturens betydelse för den palliativa vården på en akutmottagning. Författarna diskuterar tre fenomen, resurser, kurativ mentalitet och akutmottagningens utformning i relation till Katie Erikssons caritativa vårdteori.

Caregivers while, the biggest providers of palliative care for terminally sick patients, are often neglected in the process of providing care, which inadvertently affects their overall health and well-being. This study aims to explore the experiences of the unmet needs of the caregivers in palliative care. The literature review is based on seven quantitative, four qualitative and one mixed methodology approach studies. Results show a shortage of information given to caregivers regarding disease progression, symptomatology, support services and financial services. Furthermore the themes of unmet needs that emerged are physical, psychological, emotional, social and spiritual needs. Caregivers also reported the shortage of standard services provided by healthcare sector.  A healthy relationship scenario, where caregivers are supported to look after themselves as well as their loved ones, would boost the support they render to the patients.  The provision of needed services to caregivers, nurses, and healthcare personnel is required to fulfill a healthy relationship and further develop it by learning from the caregivers’ experiences. In conclusion, effective communication between caregivers and care providers is found to be a prerequisite for building trust and could contribute to satisfy the informational, medical, social and spiritual needs while helping to decrease health strains of caregivers.

Background: Every year 250,000 children worldwide receive the unimaginable diagnosis of cancer. A cancer diagnosis inflicts a major impact on the family situation. They must deal with an entirely, both emotionally and socially new situation they are not prepared for. It is of great importance that the nurse has adequate knowledge to be able to provide the best possible care to the entire family. Aim: The aim of this study was to describe the family members' experiences of losing a child in cancer. Method: A method to contribute to evidence-based nursing with ground in analysis of qualitative research was performed to get a better understanding of families' experiences. An analysis of thirteen qualitative articles was carried out. The analysis resulted in five main themes and sixteen subthemes. Results: The results of the study showed that families losing a child in cancer are having a heart-breaking time. They described combative feelings between hope and despair. The mothers often took care of the sick child at home and the fathers kept their minds busy while working. The families put all their own needs and sorrows aside. The siblings felt lonely since the parents took care of the sick child. After the passing, the family kept a bond to the deceased child through memories and dreams. Conclusion: The families experienced a greater need of support from the nurses and the hospital staff, during the time when the child was sick and after the death.

Background: Caring for an elderly person at the end of life means a complex care situation for healthcare professionals. There are several factors to consider in this regard; the patient's, relatives and healthcare staff as described in this work from the nurse. Aim: The purpose of the study was to describe municipality nurses' experiences of caring for older people in the final stages of life. Method: The study had a descriptive design with a qualitative approach. Data were collected through eight interviews and analyzed using a qualitative manifest content analysis, whereas five categories and ten sub-categories emerged. Results: The result is that the nurse practitioners saw this work as meaningful but also emotional stress. Feelings like insufficiency, participation, adequacy and existential issues were raised at the nurse's nurse. The palliative care complexity was visualized as the patient's self-determination, relatives, and nursing staff's needs were made visible and met. Conclusion: Palliative care is a person-centered care based on patient needs, which proved to be complex. Corresponding to these expectations and implementing the required care creates experiences, good and less good, with nurses who consciously or not, affect them regardless of patient or care opportunity and give a chance of reflection, further experience and opportunity to grow as a person and in profession. Keywords: C aring, end-of-life care, elderly care, nurses’ experience, palliative care

Withdrawal of life support therapy involves controlled removal of life support modalities including artificial respiration and circulation with intent to provide a comfortable death. Withdrawal of life support therapy is necessary prior to procedures such as organ donation after cardio-circulatory death, but remains poorly explored in current literature. To enhance the current evidence, we conducted a thorough structured review, an observational study, and a qualitative comparison of components comprising withdrawal of life support therapy in both donor and non-donor patient groups. At all stages, we considered how results impacted donation after cardio-circulatory death. Withdrawal of life support therapy processes vary between countries, hospitals, practitioners, and patients. Variability in practice impacts care and outcomes for both donor and non-donor patients. Improved definitions and consensus about the process of withdrawal of life support therapy may improve patient care, success of organ donation after cardio-circulatory death, and uptake of donation protocols.

Bakgrund: Palliativ vård går ut på att främja patientens autonomi, förbättra livskvaliteten och lindra lidandet för patienten och hens anhöriga ända fram till livets slutskede. Den palliativa vården bygger på de fyra hörnstenarna: symtomlindring, närståendestöd, teamarbete och kommunikation. Sjuksköterskans omvårdnad utgår från dessa hörnstenar där patienten och dess anhöriga ska ses som en helhet utifrån fysiska, psykiska, sociala och existentiella behov.  Syfte: Syftet är att beskriva sjuksköterskans upplevelse av att vårda patienter i livets slutskede. Metod:Litteraturöversikten är baserad på åtta vetenskapliga kvalitativa artiklar tagna från databasen CINAHL Complete och som analyserats utifrån Fribergs analysmetod. I denna litteraturöversikt användes Benners teori som teoretisk utgångspunkt.   Resultat:Sjuksköterskans upplevelser och erfarenheter inom palliativ vård presenterades i denna litteraturöversikt i fyra huvudteman: Mötet med döden och döende patienter, Sjuksköterskans upplevelser av eget lidande att vårda döende patienter, Sjuksköterskans behov av stöd och relationsskapande. Diskussion: I litteraturöversiktens diskussion har resultatet diskuterats i tre huvudteman: erfarenhetens betydelse, kollegialt stöd och närhet och distans. Detta utifrån Benners teori, som talar om sjuksköterskans utveckling från novis till expert. / Background: The essence of palliative care is to promote patients autonomy, improve the life quality, and relieve suffering of the patient and their family until life’s finiteness. Palliative care consists of four cornerstones: symptom relief, relative support, teamwork, and communication. These cornerstones set the foundation for nursing care where patients and their families are seen as an entirety in terms of the physical, physiological, social, and existential needs. Aim: The aim of this literature review is to describe nurse´s experience of caring for patients in the end of life. Method: The literature review is based on eight qualitative studies taken from the CINAHL Complete database and was analyzed using Friberg’s analysis method. In this literature review Banner’s theory was used as the theoretical starting point. Results: Nurse´s experience within palliative care was described in four main themes: facing death and dying patients, nurse´s experience of own suffering from caring for dying patients, nurse´s need for support, and creating a relationship. Discussion: During the discussion of the results in this literature review three main themes emerged: importance of experience, collegiate support, and closeness and distance. Benners theory was used that describes nurse´s progress from novice to expert.

Bakgrund: Sjuksköterskan har många olika arbetsuppgifter och att vårda döende patienter, är något som en del sjuksköterskor kommer att träffa på någon gång under sin karriär. Att vårda döende patienter påverkar sjuksköterskan, särskilt de som inte har varit med om detta tidigare. Syfte: Syftet med denna studie var att sammanställa tidigare kvalitativa empiriska studier om hur sjuksköterskan upplever och hanterar mötet med döende patienter. Metod: En litteraturstudie utfördes med tio kvalitativa empiriska intervjustudier som beskriver sjuksköterskans perspektiv på att vårda döende patienter. Datan insamlades genom databaserna CINAHL och PubMed och de relevanta artiklarna granskades av en mall från statens beredning för medicinsk utvärdering (SBU). De valda artiklarna till resultatet analyserades genom datakategorisering. Resultat: Fyra teman identifierades; Att känna emotionell stress, Att använda copingstrategier, Existentiella tankar hos sjuksköterskan och En önskan att vara expert. Under temat “Att använda copingstrategier”, uppkom fyra subteman; Att ha någon att prata med, Att skydda sig själv, att kunna koppla av och Att ha en andlig tro. Konklusion: Sjuksköterskan upplever att arbetet med att vårda döende patienter är påfrestande. De känner sig stressade i mötet med dessa patienter och det kunde ibland leda till utbrändhet. Detta var mer frekvent hos oerfarna sjuksköterskor. Därför har många sjuksköterskor nyttjat olika copingstrategier, som; stöd från familj, kollegor och vänner, andlig tro, gränssättning och genom att sjuksköterskan utvecklade sina kompetenser inom vård av döende patienter. Detta minskade risken för emotionell stress. / Background: Caring for patients in the final stage of life, is something that some nurses will encounter at some time during their career. This has certain effects on nurses who have not previously been involved in this type of situation. Aim: The purpose of this study is to compile previous qualitative empirical studies on how the nurse experience and manage the meeting with dying patients. Methods: A litterature review was conducted with ten qualitative emperical interviews that described the nurse´s perspective of caring for patients in the final stages of life. The data was collected through the databases: CINAHL and PubMed. The relevant articles were reviewed by Swedish agency for health technology assessment and assessment of social services. The selected articles were analysed by data categorization. Results: Four themes were identified; To feel compassion fatigue, Taking on coping strategies, Existential thoughts of the nurse & Wishing on becoming an expert. Under the theme of “Taking on coping strategies”, four subthemes emerged; To have someone to talk to, To be able to protect yourselves, To be able to relax and To having spiritual beliefs. Conclusion: Nurses experience that caring for patients in the final stage is stressful and could sometimes lead to burnout. This was more common with inexperienced nurses. Therefore, many nurses used coping strategies, such as; support from family, colleagues and friends, spiritual beliefs, boundaries and developing nurses skills in care of the final stage of life. This reduced the risk of developing compassion fatigue.