Background: End-of-life palliative care is provided to individuals who have a progressive and incurable disease or injury. The meaning of palliative care is to promote quality of life and to alleviate the relief of patients but also those close to them. Previous research shows that patients in palliative care have a limited everyday life and that they become more dependent on nurses, which in turn leads to reduced autonomy. There was also a lack of communication among nurses and relatives. Method: Systematic literature study with a descriptive summary, 13 care science articles were analysed, all of which have a qualitative approach. Aim: The aim of the thesis is to describe nurses' experiences of caring for patients at the end of life. Results: The analysis revealed two themes; experiences of challenges in care and experiences of being present in care. The first theme included three subthemes; to understand the importance of communication, to experience a lack of knowledge and experience and to be affected emotionally, which was about the communication difficulty and challenges those nurses encountered. The second theme in turn included two subthemes; to experience the care as rewarding and meaningful and to promote good relationships in the care, which were about how nurses were personally affected in the care of patients at the end of life and in the treatment of relatives. Conclusion: The nurse experienced gratitude in caring for the patient at the end of life. The nurse experienced the care as rewarding and satisfying when they promoted good relationships with the patient and relatives. However, the nurse experienced challenges in care due to lack of knowledge and experience. This led to the nurse experiencing an obstacle to meeting the patient's needs.

Sammanfattning Bakgrund: Vård i livets slutskede är krävande för såväl familj som sjuksköterskor, men många sjuksköterskor erfar trots det att de får någonting tillbaka av att vårda de döende. Cancersjukdomar är vanligt och både överlevnaden och prognosen skiftar mycket beroende på vilken typ av cancer en person blir diagnostiserad med. Det är därmed viktigt att sjuksköterskor har kunskap och förståelse om grundläggande palliativ vård samt vård i livets slutskede för att kunna erbjuda den bästa vården för såväl patient som dennes anhöriga. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter i vårdandet av patienter med cancer i livets slutskede på sjukhus. Metod: Examenarbetet utgick enligt en systematisk litteraturstudie med beskrivande syntes. Resultat: Utifrån 11 artiklar analys framkom två tema: Etiska utmaningar i vårdandet och sjuksköterskans utveckling. Dessa innefattar fem subteman som beskriver sjuksköterskors erfarenheter att vårda i livets slutskede. Slutsatser: Det framkom att sjuksköterskor blir utmanade av känslomässig involvering med patienter, tidsbrist, mängden information sjuksköterskor bör ge sina patienter samt att kunna vara i ett existentiellt samtal. Sjuksköterskorna erfor att de har utvecklats mycket av att vårda patienter i livets slutskede, både personligt och professionellt. Däremot erfor sjuksköterskorna också att de saknade kunskap i att ge vård i livets slutskede. / Background: To give care in the end of life is a demanding process for both family members and nurses, but the nurses experiences that in spite this, they gain a lot in return to care for the dying. Cancer is common and the survival and prognosis differs depending on what type of cancer a person is diagnosed with. It is therefore important for the nurse to have knowledge and understanding in basic palliative care and end-of-life care to be able to offer the very best care for both the patient and their family. Aim: This study describes the experiences that nurses have in the care of patients with cancer in end-of-life care in a hospital. Methods: A systematic literature study with descriptive synthesis was used. Results: After 11 articles were analyzed two themes emerged: Ethical challenges in caring and nurses’ development. These include five subthemes that describes the nurses experience in end-of-life care. Conclusions: Results showed that nurses were challenged by the emotional involvements with their patients, the lack of time, how much information to give their patients and how to be in existential conversations with their patients. The nurses experienced that they developed a lot by caring for patients in the end of life. However, the nurses experienced that they lacked knowledge in providing end-of-life care

Bakgrund: Sjuksköterskans grundläggande ansvarsområde är omvårdnad. Vård i livets slutskede handlar om att bevara bästa möjliga livskvalitén under tiden som är kvar av livet. Patienters upplevelse av vård i livets slutskede är varierande från individ till individ. Många patienter upplever rädsla och oro inför slutet. Patientens familj kan känna sig hjälplösa vid vård i livets slutskede när de behöver ta viktiga beslut. Syfte: Syftet med denna litteraturstudie är att beskriva sjuksköterskors upplevelse av att vårda patienter i livets slutskede. Metod: En beskrivande litteraturstudie. Huvudresultat: Studiens resultat visade att vård i livets slutskede var en utmaning för sjuksköterskorna, men det upplevdes även som en meningsfull process. Flera sjuksköterskor nämnde att de har fått en ny syn på livet och döden efter att de har vårdat döende patienter. Att bygga en relation med sin patient gav sjuksköterskorna styrka och meningsfullhet. I studien så framkom det även att brist på kunskap kunde påverka omvårdnaden negativt. Slutsats: Den föreliggande litteraturstudie visar att sjuksköterskor upplever vård i livets slutskede som en känslosam utmaning. Att vara professionell i mötet med döende patienter är svårt för sjuksköterskorna. För att öka de positiva upplevelserna och minska de negativa upplevelserna vid vård i livets slutskede anser författarna att det krävs fortsatt forskning inom området.

Bakgrund: Palliativ vård ges i livets slutskede och syftar till att lindra lidande och öka livskvaliteten hos patienten. Det ställer krav på vårdpersonalen att arbeta teambaserat med god kommunikation, personcentrerat samt stödjande för både patient och närstående. Behovet av palliativ vård vid livets slutskede är stort och patienterna vårdas många gånger inom den allmänna palliativa vården på sjukhus. Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av att vårda döende patienter på sjukhus. Metod: En litteraturstudie genomfördes baserad på nio kvalitativa originalartiklar som återfanns i databaserna CINAHL och PubMed. Artiklarna kvalitetsgranskades och analyserades med hjälp av Fribergs femstegsmodell. Resultat: Analysen resulterade i tre teman och nio subteman. Temana var; Strävan att göra gott, Personlig och professionell utveckling samt Otillräckligheter i organisationen. Konklusion: Det finns brister inom den palliativa vården på sjukhus, främst inom organisationen samt bristande kommunikation och samsyn i teamet. Sjukhusmiljön behöver anpassas för att möta döende patienters och närståendes behov samt de krav som ställs på den palliativa vården idag. Att vårda döende patienter är krävande och sjuksköterskor behöver erbjudas stöd och utbildning inom palliativ vård. / Background: End-of-life care aims to alleviate suffering and increase quality of life. The staff needs to work team-based, person-centered and supportive for both patients and relatives. There is a great need for end-of-life care and patients are often cared for in general palliative care in hospitals. Aim: The aim of the study was to describe nurses' experiences of caring for dying patients in hospitals. Methods: A literature review was conducted based on nine qualitative original articles found in the databases CINAHL and PubMed. The articles were reviewed according to quality and analyzed using Friberg's five-step model. Results: The analysis resulted in three themes and nine subthemes. The themes were; Striving to do good, Personal and professional development and Inadequacies in the organization. Conclusion: There are shortcomings in end-of-life care in hospitals, mainly within the organization, and a lack of communication and consensus in the team. The hospital environment needs to adapt to meet the needs of dying patients and relatives and the demands placed on palliative care today. Caring for dying patients is demanding and nurses needs support and training in palliative care.

Bakgrund: Palliativ vård innebär en helhetsvård som ska lindra lidande och främja hälsa trots sjukdom. Sjuksköterskan ska arbeta personcentrerat och utgå utifrån “de fyra hörnstenarna” som innehåller: symtomlindring, samarbete, kommunikation och stöd till anhöriga. Metod: Den valda metoden var en litteraturöversikt av elva kvalitativa vetenskapliga artiklar som svarade på syftet. Syfte: Syftet var att belysa sjuksköterskors upplevelse av palliativ vård i hemsjukvård och i särskilt boende. Resultat: I studien framkom fyra teman och åtta underteman. Resultatet visade att sjuksköterskan upplevde vikten av ett gott samarbete med kollegor, patient och anhöriga som avgörande för en god palliativ vård. Erfarenhet har också visat sig vara viktig både i den nuvarande vården och för framtida vård av palliativa patienter. Många känslor uppkom i vårdandet och var både positiva och negativa. Konklusion: Att vårda patienter i ett palliativt skede kräver kunskap och erfarenhet och många faktorer påverkade hur vården utfördes / Background: Palliative care means comprehensive care that is intended to alleviate suffering and promote health despite illness. The nurse must work person-centered and start from the "four cornerstones" that contain: symptom relief, cooperation, communication and support for relatives. Method: The chosen method was a literature review of eleven qualitative scientific articles that answered the purpose. Aim: The aim was to shed light on nurses’ experince of palliative care in home care and in special housing. Results: The study revealed four themes and eight sub-themes. The results showed that the nurse perceived the importance of good collaboration with colleagues, patients and relatives as crucial for good palliative care. Experience has also proven to be important both in the current care and for future care of palliative patients. Many emotions arose in the care and were both positive and negative.Conclusion: Caring for patients in a palliative care stage requires knowledge and experience and many factors influenced how the care was performed

Despite hospice and palliative care services being available for patients at the end-of-life, it remains an easily accessible health care service which has been mostly underutilized and/or misunderstood. For this project, the practice problem was underutilization of hospice and palliative care services. A systematic review of the literature which focused on under usage of end-of-life care was conducted. MEDLINE, CINAHL, and ProQuest Nursing and Allied Source databases were searched (2005 to 2017). Studies that evaluated interventions for increasing hospice and palliative care services were selected. Conceptual variables included studies that addressed the under usage of end-of-life care. Kolcoba's comfort theory, Parse's theory of human becoming and Chochinov's dignity model was included to identify the issue, gather the data, and help transfer researched data into practice. The tools applied for analysis and synthesis were the appraisal of guidelines research and evaluation and the grading of recommendations, assessment, development and evaluation. The under usage of hospice and palliative care according to this systematic review, has resulted in (a)suffering negative effects on patients at the end of life, who do not receive adequate palliative or comfort care, (b) additional distress for families dealing with grief and denial, and (c) may result in unneeded acute care, adding significantly to the cost of care. This doctoral project formed a cogent set of recommendations consisting of, communication guidance and community education for a local hospice agency and the community. The contribution of positive social change in this community was through education and knowledge to bridge the gap into practice and improve end-of-life care in the community.

Most nurses receive limited formal education regarding end-of-life (EOL) care, which affects their ability to meet dying patients' needs. Guided by Bandura's social learning theory, this explanatory correlational study examined the relationships between critical care nurses' personal and professional characteristics and their perceived knowledge and self-efficacy when providing EOL care at an academic medical center. Convenience sampling was used to recruit participants from the eligible adult, pediatric, and neonatal critical care nurses for this study. The 67 participants completed the End-of-Life Professional Caregiver Survey (EPCS) to assess EOL care knowledge and self-confidence. Total EPCS scores revealed only moderate levels of EOL knowledge and self-confidence. The Fisher's exact test indicated that higher EPCS scores were significantly associated with nurses' age and completion of advance directive. A 3-day workshop was designed to address deficits related to EPCS scores and advance directive completion, while educating younger nurses to gain confidence in their EOL discussions. Additional research is recommended to distinguish between nurses' actual knowledge and perceived knowledge about EOL care, the long-term effects of EOL care education on the quality of patient care, nurses' levels of moral distress and burnout, and nurses' communication skills with patients and other health care providers. The result of this research promotes positive social change through EOL education to improve the confidence of nurses working with dying patients and their families, as well as to understand the challenges of communicating difficult decisions regarding EOL care.

Avoidable hospitalizations of hospice patients cost Medicare $3 billion a year. When hospice nurses are able to identify early signs and symptoms of acute illness and provide appropriate interventions to prevent such admissions, 20-60% of the hospitalizations are preventable. The practice problem addressed in this quality improvement doctor of nursing project was the 30% hospital admission rate of hospice patients as evidenced by chart review, admission data, and revocation data. The first purpose of the project was to identify evidence-based nursing care paths in the literature for the top 5 medical diagnoses related to avoidable hospital admissions. The second purpose was to develop an educational curriculum to educate the staff on the care paths with a pretest/posttest to assess knowledge gained from the education. Rosswurm and Larrabee's conceptual model was used to frame the project. Three content experts evaluated the curriculum plan using a 4 item dichotomous rating of 1 (not met) and 2 (met). An average score of 2 revealed that the curriculum content met the course objectives. Content experts validated each of the 16 pretest/posttest items using a Likert scale ranging from 1 (not relevant) to 4 (highly relevant). The content validation index score was .94, indicating that the pretest/posttest reflected the course objectives and content. Recommendations were made for structuring the pretest/posttest. The project promotes social change by assessing, intervening, and treating patients in the outpatient hospice setting to prevent avoidable hospitalizations, thus promoting patient well-being and fiscal responsibility of healthcare dollars.

Background: Advance directives allow patients to put in writing the type of health care they want if they are unable to make decisions due to their medical condition. Purpose: The purpose of this study was to determine if there were differences in senior nursing students’ knowledge, attitudes, and confidence based on when the information is positioned in the curriculum. Theoretical: Social cognitive learning theory and Zimmerman’s self-regulation model provided the theoretical framework. Methods: This study reflected a non-experimental, exploratory design, with a convenience sample of senior nursing students from 2 different nursing programs in central Illinois. One program offers advance directive education in the first year and the other program offers the information in the second year. A total of 131 students participated in the study that used subscales of the Knowledge, Attitudinal, Experiential Survey on Advance Directives. Results: The group that received the information the second year rated themselves as having more confidence with advance directives. However, both groups scored low in the area of knowledge of advance directives, the Patient Self-Determination Act, and Illinois law. Students who reported higher knowledge levels had higher attitudes about end-of-life care. There was no difference in attitudes between the two groups. Conclusion: The results of this study highlight the need to review nursing curricula specifically relating to end-of-life care content and its placement in the curriculum.

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第23385号 / 人健博第92号 / 新制||人健||6(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 田村 恵子, 教授 稲富 宏之, 教授 溝脇 尚志 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM