Bakgrund Den palliativa vården bygger på fyra grundprinciper: kommunikation, lindra lidande, stödja närstående och teamarbete. Sjuksköterskans roll inom palliativ vård är att lindra lidande och stödja patienten i livets slutskede samtidigt som man stödjer och involverar närstående. Syfte Syftet är att beskriva sjuksköterskans upplevelse av att arbeta inom palliativ vård. Metod En litteraturöversikt med analys från Fribergs beskrivning, vilket inkluderade 10 kvalitativa vetenskapliga artiklar från Pubmed och Cinahl. Resultat Resultatet innehåller 4 teman som påverkar sjuksköterskan inom palliativ vård, brist på emotionellt stöd till sjuksköterskan inom palliativ vård, sjuksköterskans brist på erfarenhet och kunskap inom palliativ vård, upplevelser av att hantera dödsfall som sjuksköterska och vikten av närstående inom palliativ vård. Slutsats Sjuksköterskor upplever utmaningar i den palliativa vården. För att förbättra vården behöver de bygga goda vårdrelationer, lära sig av erfarna kollegor och förbättra sin kunskap inom palliativ vård. / Background Palliative care is based on four basic principles: Communication, alleviating suffering, supporting relatives and teamwork. The nurse’s role in palliative care is to alleviate suffering and support the patient in the final stages of life while also supporting and involving the relatives. Aim The aim is to describe the nurses experience of palliative care. Method A literature review with analysis following Fribergs description which included 10 qualitative scientific articles from the databases Pubmed and Cinahl. Results The result contains four themes that affect the nurse in palliative care, lack of emotional support for the nurse in palliative care, the nurses lack of experience and knowledge in palliative care, experiences of dealing with death as a nurse and the importance of relatives in palliative care. Conclusions Nurses experience challenges in palliative care. To improve the care they need to build better relationships with the patients and their families, learn from experienced colleagues and improve their skills in palliative care.

Syfte. Intensivvårdssjuksköterskors erfarenheter av att vårda patienter i livets slutskede. Bakgrund. På intensivvårdsavdelningar i Sverige avlider 3-4000 patienter per år vilket föranleder att palliativ vård har börjat uppmärksammas inom intensivvården. Målet med vård i livets slutskede är att skapa bästa möjliga livskvalité för patient och anhöriga där sjuksköterskan med sin helhetssyn har en central roll. Design. Kvalitativ innehållsanalys. Metod. Semistrukturerade intervjuer genomfördes under hösten 2015 med elva intensivvårdssjuksköterskor på fem olika intensivvårdsavdelningar i tre olika landsting i Norrland. Intervjuerna spelades in, transkriberades och lästes igenom noggrant. Därefter analyserades materialet med hjälp av en kvalitativ innehållsanalys. Resultat. Sjuksköterskornas erfarenheter av att vårda patienter i livets slutskede illustrerades genom deras möjligheter att påverka beslut för god vård, vilket beskrevs som att känna delaktighet i besluten om vårdnivå. De såg sig som en resurs för anhöriga i svåra situationer då de inbringade trygghet, såg deras behov av information samt hjälpte dem att hitta fokus. För att sjuksköterskorna skulle samla kraft framkom vikten av ett ärligt och öppet arbetsklimat, samt möjligheter till debriefing. Genom att ge god omvårdnad i livets slutskede kunde sjuksköterskorna hjälpa patienterna få en god och värdig död. Slutsats. Sjuksköterskorna använde sig av olika kommunikativa färdigheter för att bygga upp en relation med patient och anhöriga. Sjuksköterskorna upplevde att många etiska problem uppstod i samband med besluttagande om vårdnivå, speciellt där oenighet fanns inom vårdteamet. De saknade specifik fortbildning och tydliga riktlinjer och det visade sig att sjuksköterskorna lärde sig ge vård i livets slutskede genom egna erfarenheter och av erfarna kollegor. / Purpose. Intensive care nurses experiences of providing end-of-life care. Background. At intensive care units in Sweden 3-4000 patients die every year, which causes palliative care to emerge in intensive care. The goal of the end-of-life care is to provide the best possible quality of life for the patient and it’s family, where the nurse with a holistic approach play a central part. Design. Qualitative content analysis. Method. Semi-structured interviews were conducted in the autumn of 2015 with eleven critical care nurses in five ICUs in three counties in northern Sweden. The interviews were recorded, transcribed and read carefully. The material was analysed using a content analysis. Results. Nurses' experiences of providing end-of-life care was illustrated by their ability to influence decisions for good care, which was descibed as a feeling of beeing involved in decisions about care level. They looked at themselves as a resource for families in difficult situations and conveyed a feeling of confort which could help the families to find focus and see the need for information. The nurses gathered strength by having an honest and open work environment, and opportunities for debriefing. By providing good care at the end-of-life the nurses were able to help patients recive a good and dignified death. Conclusion. The nurses used different communication skills to build a relationship with the patients and their families. The nurses felt that many ethical problems arose from decisions about the level of care, especially where disagreement existed within the care team. They lacked specific training and clear guidelines and it turned out that the nurses learned palliative care through their own experiences and by experienced colleagues.

This thesis is an ethnographic analysis of a Continuing Care Retirement Community (CCRC) in the American Midwest. I examine salient aspects of American culture, and how persons in the American Midwest understand relationships and themselves in the context of eldercare, and particularly, how issues of personhood and kinship are conceptualised in a long-term care facility. Rather than focusing exclusively on just the labour of caregivers, or how the residents in the CCRC receive care, my study is grounded in the interaction and relations that obtain during specific regimes of caregiving. Because the exigencies of ageing are met with certain exigencies of care, this study touches upon three dominant themes that make sense of the tensions that emerge when principles and practices do not square up. The first theme deals with how ageing and care are constituted, and made relational to one other. Secondly, I demonstrate that in the CCRC where I conducted fieldwork, ageing is constructed as a process and institutionalised, resulting in a distinctive way in which space and time are dealt with and unravelled from their inextricability. The resulting consequences affect not just the older residents and the CCRC staff, but also impacts how caregiving takes on specific forms and meanings. Thirdly, I investigate how formal (professional) caregivers and care receivers produce a type of social relation, which cannot be understood alone by conventional studies of kinship and economic relations. Ultimately, this thesis sets the frame for future debate on the ontological commitments involved in eldercare, and how the segregation of care and of the elderly in society relate to wider social norms regarding ageing and marginality.

Background: The purpose of end-of-life care is to relieve suffering and optimize quality of life. Important tasks for healthcare professionals are symptom alleviation and facilitate well-being. It is common for patients, who are treated palliative, to die within the surgical wards. The environment can be stressful and it is not always optimal for these patients to be cared for there. Aim: The aim was to describe how end-of-life care was delivered for patients in surgical wards, according to the nurses, with specific focus on the fundamentals of care. Method: Semi-structured interviews with 12 registered nurses in two surgical wards. The interviews were analysed using a qualitative content analysis. Result: The analysis resulted in three categories: The nursing needs of patients at the end-of-life, The organization's negative impact on patient care and Adapted care based on the patient and relative’s needs. The results showed that organizational factors such as lack of time and resources, but also lack of knowledge among the healthcare professionals, could lead to difficulties to fulfill both the physical and psychosocial needs of the patient. When a person-centered care was used the needs of the patients were easier to fulfill and the nursing care functioned in a better way. Conclusion: Person-centered care is an important part of end-of-life care. The healthcare professionals at surgical wards care for this patient-group in a dedicated way, and nursing around them usually operate well, except when there is a lack of time and more acute situations must be prioritized. There is a need to increase the knowledge of palliative care among the healthcare professionals. / Bakgrund: Palliativ vård i livets slutskede ska lindra lidande och främja livskvaliteten. Viktiga uppgifter för sjukvårdspersonalen som vårdar patienter i livets slutskede är att ge symtomlindring och underlätta välbefinnandet. Det är vanligt att patienter som vårdas palliativt i livets slutskede avlider inom slutenvården och på kirurgiska vårdavdelningar. På dessa avdelningar kan miljön vara stressig och det är inte alltid optimalt att denna patientgrupp vårdas där.  Syfte: Att beskriva hur sjuksköterskor ansåg att omvårdnaden genomfördes för patienten som vårdats i livets slutskede på en akutkirurgisk vårdavdelning, med specifikt fokus på de fundamentala delarna av vården. Metod: Semistrukturerade intervjuer med 12 sjuksköterskor från två kirurgiska vårdavdelningar. Data analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i tre kategorier: Omvårdnadsbehoven hos patienten i livets slutskede, Organisationens negativa inverkan på patientens omvårdnad och Anpassad vård utifrån patienten och dennes anhöriga. Resultatet visade att organisatoriska faktorer som tids- och resursbrist, men även kunskapsbrist hos sjukvårdspersonalen, gjorde att patienternas fysiska och psykosociala omvårdnadsbehov inte alltid blev tillgodosedda. När vården var personcentrerad och patienterna delaktiga ansåg sjuksköterskorna att omvårdnaden genomfördes på ett bättre sätt. Slutsats: En personcentrerad vård är viktigt för både patienter, som befinner sig i livets slutskede, och deras anhöriga. Sjukvårdspersonalen på akutkirurgiska vårdavdelningar är engagerade i denna patientgrupp och omvårdnaden kring dem fungerar oftast bra. Det händer dock att tiden inte räcker till för patientgruppens komplexa omvårdnadsbehov och andra akuta situationer prioriteras ibland före. Det finns ett behov av att öka kunskapen om palliativ vård hos personalen som vårdar dessa patienter.

Bakgrund: Att vårdas vid livets slut kan vara en stor omställning för både patient och närstående. Enligt tidigare forskning saknas kunskap om de närståendes upplevelser kring vården och blev därmed ett relevant område att forska vidare på. Sjuksköterskan har som ansvar att se till de närståendes behov samt kunna erbjuda information, stöd och delaktighet i en situation som beskrivs som påfrestande. Syfte: Syftet var att beskriva närståendes upplevelser av vård vid livets slutskede på vårdavdelningar. Metod: Litteraturöversikt. Åtta kvalitativa artiklar en kvantitativ artikel och en artikel med mixad metod samlades in från databaserna CINAHL Complete och PUBMED. Sökningarna begränsades till full text, peer reviewed, English samt avgränsning mellan 2006 och 2016. Resultat: Fyra teman framkom under analysen; kommunikationens betydelse för vård vid livets slut, relationens betydelse och behov av närhet, upplevelse av stöd, tröst och bemötande samt närståendes delaktighet vid livets slut. Kommunikationens betydelse var stor då många närstående upplevde informationen kring vården vid livets slutskede som bristfällig och således kände sig oförmögna att fatta rätt beslut. Även en del positiva och negativa aspekter vad gäller de närståendes upplevelse av stöd samt relationens betydelse för vårdandet framkom, vilket i sin tur ledde till deras chans till delaktighet. Diskussion: I resultatet framkom stora likheter vad gäller information och kunskap, alltså kommunikationen mellan sjuksköterska och närstående. En fungerande kommunikation ansågs enligt de närstående som en väsentlig faktor för hur upplevelsen av omvårdnaden utföll. Detta diskuteras utifrån Andersheds teori samt andra infallsvinklar och på vilket sätt de närståendes delaktighet påverkas. / Background: Receiving end-of-life care can turn into a big adjustment for both the patient and the next of kin. According to previous research the knowledge is inadequate regarding this type of care-giving, which turned out to be a relevant area for further research. The nurse carries a great responsibility when it comes to the wishes and requirements of the next of kin, and is also providing information, support and involvement in this trying situation. Aim: The aim was to describe how someone who is a next of kin might experience the end-of-life care in hospital wards. Method: Literature review. Eight qualitative articles, one quantitative article and one article with mixed method were collected from the databases CINAHL Complete and PUBMED. The searches were limited to full text, peer reviewed, in English and the years of publishing from 2006 to 2016. Results: Four themes emerged during the analysis; The importance of communication for end-of-life care, the relationship’s importance and the need of closeness, experience of support, comfort and attitude and next of kin’s involvement in end-of-life care. The importance of communication was vital. This emerged from the experiences the next of kin described as inadequate, and thus feeling unable to make the right decisions. Also, some positive and negative aspects regarding the next of kin’s experiences of support emerged. This included the meaning of the relationships for the caring, which leads to an improved chance for them to get involved. Discussion: The results showed great similarities in terms of information and knowledge, which leads to improved communication between the nurse and next of kin. Direct communication was considered, according to the next of kin, as an essential factor in the development of the perception of nursing care. This is discussed on the basis of Andershed’s theory, as well as other perspectives, of the nurses and the patients, and the way in which the next of kin’s involvement is affected.

Bakgrund: Att vårda patienter i palliativ vård beskrivs som utmanande då sjuksköterskor blir känslomässigt berörda av döende patienter. Detta medför att sjuksköterskor kan finna sig i motstridiga roller och beskrivs vara i behov av att balansera känslor gentemot patienter, anhöriga och arbetskollegor. Tidigare forskning beskriver att vårda patienter med barn i palliativ vård som betydelsefullt. Dock saknas forskning kring sjuksköterskors upplevelser av detta fenomen. Syfte: Att beskriva sjuksköterskors upplevelser av att vårda patienter med barn under 18 år i palliativ vård. Metod: Metoden bestod av en empirisk studie med en kvalitativ ansats. Datainsamlingen utfördes genom fyra semistrukturerade intervjuer och dataanalysen utfördes med en induktiv innehållsanalys. Resultat: Sjuksköterskorna upplevde sig bli berörda av patienter med barn under 18 år i palliativ vård, detta resulterade i tre kategorier; att bli berörd av patienten; att orka vårda och att inkludera hela familjen. Ur dessa kategorier kunde sju underkategorier urskiljas. Slutsats: Genom medlidande upplevde sjuksköterskorna sig bli känslomässigt berörda av patienterna. Sjuksköterskorna fann igenkännande aspekter hos patienterna, likt att vara mitt i livet samt att ha egna barn, som medförde en spegling hos dem själva. Det var essentiellt, såväl för patienterna och barnen, att få barnen delaktiga i vårdförloppet. / Background: Caring for patients in palliative care is described as challenging for nurses as they can be emotionally affected by dying patients in varying degrees. This entails that nurses can find themselves in conflicting roles and have a need of balancing different emotions towards patients, next of kin and colleagues. Previous research describes that caring for patients with children in palliative care includes a unique value. However, research on nurses' experiences of this phenomenon is lacking. Aim: To describe registered nurses experiences of caring for patients with children under the age of 18 in palliative care. Method: The method consists of an empirical study with a qualitative approach. The data was collected by four semi-structed interviews and analyzed by using inductive content analysis. Result: The nurses experienced to be affected by patients with children under the age of 18 in palliative care, this resulted in three themes; to be affected by the patient; to be able to care and to include the whole family. To these themes seven sub-themes could be distinguished. Conclusion: Trough compassion the nurses experienced to become emotionally affected by the patients. The nurses found recognizing aspects of the patients, such as being in the middle of life and having children of their own, which led to a reflection of themselves. It was essential, both for the patients and the children, to get the children involved in the careprocess.

Ethnically diverse older adults are the fastest growing population in the U.S. This population may experience transitional processes associated with immigration, acculturation, aging, and end of life (EOL). Advances in technology lead to increases in care options, which can cause uncertainty to make decisions for EOL. Unmade decisions about care prior to becoming unable to communicate are associated with burdens of last-minute decisions at EOL, unwanted intensive EOL treatments for people who may die naturally of old age, financial and emotional costs, and decreased quality of life. In the U.S., a multicultural country with a variety of care options, advance directive (AD) completion and advance care planning (ACP) may improve culturally competent and person-centered care at EOL. However, the rate of AD completion and ACP is low among Americans, especially immigrant communities. These communities, including Iranian-American older adults, have been frequently understudied, and there is a gap in studies of EOL desires, attitudes, and actions/behaviors. This inquiry focused on planning ahead for EOL care across transitional processes that older immigrants may face. The aim was to enhance culturally competent care for older adults through distinguishing significant factors, which may influence planning for EOL care. Specific purposes were: To identify relationships between attitudes toward planning for EOL care and social supports, spirituality, healthcare system distrust, and acculturation; to identify a relationship between attitudes and proactive actions toward planning ahead in Iranian-American older adults. Conceptual frameworks for this descriptive, cross-sectional study included Culture Care Diversity and Universality and Transitions theories. Findings from 135 participants revealed that they were new immigrants to the U.S. (mean year of 23 in the U.S., 97% born in Iran) and highly educated and insured with high health statuses. About 55% preferred non-intensive treatments and/or homecare at EOL, and 52.6% had not communicated their EOL wishes. Attitudes toward planning ahead for EOL were positively associated with acculturation and healthcare system distrust, and negatively associated with spirituality. No significant association was found between attitudes and social support. Furthermore, favorable attitudes predicted higher proactive actions to communicate wishes. Implications for practice, policy, education, and recommendations for further studies were discussed. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

Bakgrund: Palliativ vård kännetecknas av att förbättra livskvaliteten i livets slutskede utifrån en helhetssyn. Det palliativa förhållningssättet omfattar alla patienter i livets slutskede, oavsett diagnos, och distriktssköterskan i hemsjukvården är både ett praktiskt och känslomässigt stöd. Ett personcentrerat förhållningssätt i samband med palliativ vård ger förbättrad livskvalitet och symtomlindring. Den personcentrerade modellen De 6 S:n främjar patientens syn på sig själv och sina önskemål i omvårdnaden. Syfte: Att beskriva distriktssköterskors erfarenheter av palliativ vård i livets slutskede inom hemsjukvården, utifrån ett personcentrerat perspektiv. Metod: Kvalitativ med deduktiv ansats. Två fokusgruppsintervjuer, 12 distriktssköterskor. Kvalitativ innehållsanalys utifrån De 6 S:n. Resultat: Självbild: Distriktssköterskan utgår från den enskilde patienten samt samordnar insatser för en välfungerande hemsituation. Självbestämmande främjas av hemmiljön och innebär visad respekt och lyhördhet. Sociala relationer bevaras genom anpassning och stödjande insatser. Symtomlindring omfattar främst farmakologiska insatser. Sammanhang omfattar samtal och främjas av hemmiljön, relationen till patienten och att distriktssköterskan ger tid och närvaro. Patientens strategier respekteras genom anpassning och stödjande insatser. Patientens önskemål möjliggörs med hjälp av närstående och omvårdnadspersonal.   Slutsats: Distriktssköterskorna utgår från och anpassar sig till patientens behov och resurser. Relationen, kommunikationen och hemmiljön främjar personcentrerat förhållningssätt. De 6 S:n utgör stöd för personcentrerad vård utifrån en helhetssyn. / Background: Palliative care is characterized by improving the quality of life in the final stages of life based on a holistic view. The palliative approach covers all patients in the final stages of life, regardless of diagnosis, and the district nurse in home health care gives both practical and emotional support. A person-centered approach in connection with palliative care provides improved quality of life and symptom relief. The person-centered model The 6 S:n promotes the patient's view of himself and his wishes in the nursing. Aim: To describe district nurses' experiences of palliative care in the final stage of life in home care, from a person-centered perspective. Method: Qualitative with deductive approach. Data collection through two focus group interviews, 12 district nurses. Qualitative content analysis based on The 6 S:n. Result: Self-image: The district nurse starts from the individual patient and coordinates efforts for a well-functioning home situation. Self-determination is promoted by the home environment and means shown respect and sensitivity. Social relations are preserved through adaptation and supportive efforts. Symptom relief mainly involves pharmacological interventions. Summary includes conversations which is promoted by the home environment, the relationship with the patient and that the district nurse gives time and attendance. The patient's strategies are respected through adaptation and supportive efforts. The patient's wishes are made possible with the help of relatives and assistant nurses. Conclusion: The district nurses focus on and adapt to the patient's needs and resources. The relationship, communication and the home environment promote person-centered approach. The 6 S:n provides support for person-centered care based on a holistic approach.

As few studies focus explicitly on social support for residents by residents in retirement communities which have staff, this thesis is designed to explore the nature of informal social support among residents at planned, non-subsidized retirement care facilities: the types, the amount, the impact, the limitation and the appropriateness of such support. Our focus is to explore whether different organization of a retirement community affects social support among residents, so we compare two retirement care facilities. One provides single-level care for its residents and the other provides multiple-level care. We chose our two sites from retirement care facilities in the City of Portland, Oregon. We generated our data by interviewing residents who live independently in the two retirement communities.

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