<p><p>Syftet med studien var att beskriva vad sjuksköterskor anser vara god omvårdnad av äldre patienter samt att beskriva vad som är viktigt i en god omvårdnad. I en empirisk kvalitativ studie av beskrivande karaktär intervjuades sju kvinnliga sjuksköterskor med mellan 2 och 39 års erfarenhet. Vid intervjuerna ställdes två öppna frågor och följdfrågor användes för att utveckla svaren. Intervjuerna spelades in på band och svaren analyserades genom att författaren skrev ner intervjuerna ordagrant för att sedan, genom bearbetning av textmaterialet, bilda subkategorier och kategorier. Resultatet redovisades med fem kategorier: grundläggande behov, informationssökning, rehabilitering, respekt och tid samt elva subkategorier. Informanterna ansåg att tid och individanpassad vård var viktigast när det gällde omvårdnad av äldre patienter, men att det egentligen inte fanns någon indelning utifrån ett åldersperspektiv avseende god omvårdnad. Respekt, rehabilitering och att söka information om patienternas tidigare historia var andra viktiga faktorer för innebörden av god omvårdnad.</p></p> / <p><p>The purpose of this study was to describe what nurses consider to be good care of elderly patients, and to describe what is important in good care. The method used was an empirical qualitative approach with a descriptive character. Seven nurses, whose experiences varied between 2 and 39 years, were interviewed. They all work at a hospital, but at three different departments. Two open questions were used for the interviews. The interviews were recorded on tape from where it was extruded to text by the author. The responses were then analyzed by being categorized into five different categories and eleven subcategories. The respondents agreed that time and personal care was the most important parts in care of elderly patients. However, the respondents also clamed that there are no differences between younger and older people with respect to good care. Respect, rehabilitation, and search for information about the patients earlier history are also very important aspects of good care.</p></p>

Syftet med studien var att beskriva vad sjuksköterskor anser vara god omvårdnad av äldre patienter samt att beskriva vad som är viktigt i en god omvårdnad. I en empirisk kvalitativ studie av beskrivande karaktär intervjuades sju kvinnliga sjuksköterskor med mellan 2 och 39 års erfarenhet. Vid intervjuerna ställdes två öppna frågor och följdfrågor användes för att utveckla svaren. Intervjuerna spelades in på band och svaren analyserades genom att författaren skrev ner intervjuerna ordagrant för att sedan, genom bearbetning av textmaterialet, bilda subkategorier och kategorier. Resultatet redovisades med fem kategorier: grundläggande behov, informationssökning, rehabilitering, respekt och tid samt elva subkategorier. Informanterna ansåg att tid och individanpassad vård var viktigast när det gällde omvårdnad av äldre patienter, men att det egentligen inte fanns någon indelning utifrån ett åldersperspektiv avseende god omvårdnad. Respekt, rehabilitering och att söka information om patienternas tidigare historia var andra viktiga faktorer för innebörden av god omvårdnad. / The purpose of this study was to describe what nurses consider to be good care of elderly patients, and to describe what is important in good care. The method used was an empirical qualitative approach with a descriptive character. Seven nurses, whose experiences varied between 2 and 39 years, were interviewed. They all work at a hospital, but at three different departments. Two open questions were used for the interviews. The interviews were recorded on tape from where it was extruded to text by the author. The responses were then analyzed by being categorized into five different categories and eleven subcategories. The respondents agreed that time and personal care was the most important parts in care of elderly patients. However, the respondents also clamed that there are no differences between younger and older people with respect to good care. Respect, rehabilitation, and search for information about the patients earlier history are also very important aspects of good care.

Older people should have a life with a sense of value and should feel confident. These ethical values, which are expressed in normative ethics, are expected to prevail in empirical ethics. Central components of nursing are the ethical issues of autonomy, beneficence, non-maleficence and the principles of justice. The general aim of this thesis is to identify and describe the ethical values that are apparent in the caring encounter and their influence on the people involved. This is done from the perspective of the older person in study (I), next of kin in study (II) and nurses in study (III). In study (IV) the aim was to synthesize the concepts from empirical studies (I- III) and analyze, compare and interrelate them with normative ethics. Studies (I, III) were empirical observational studies including follow-up interviews. Twenty-two older people participated voluntarily in study (I), and in study (III) 20 nurses participated voluntarily. In study (II) fourteen next of kin were interviewed. In studies (I- III) constant comparative analysis, the core foundation of grounded theory, was used. Five concepts were used in the analysis in study (IV); three from the grounded theory studies (I- III) and two from the theoretical framework on normative ethics i.e. the ICN code and SFS law. Five categories; being addressed, receiving respect, desiring to participate, increasing self-determination and gaining self-confidence formed the basis for the core category ‚Approaching‛ in study (I). ‘Approaching’ indicates the ethical values that guide nurses in their caring encounters with older people. These ethical values are noted by the older people and are greatly appreciated by them, and also lead to improved quality of care. Four categories were identified in study (II): Receiving, showing respect, facilitating participation and showing professionalism. These categories formed the basis of the core category ‚Being amenable‛, a concept identified in the next of kin’s description of the ethical values that they and the older patients perceive in the caring encounter. In study (III), three categories were identified: showing consideration, connecting, and caring for. These categories formed the basis of the core category ‚Corroborating‛. Corroborating deals with support and interaction. Empirical ethics and normative ethics are intertwined, according to the findings of this study (IV). Normative ethics influence the nurse’s practical performance and could have a greater influence in supporting nurses as professionals. Criteria of good ethical care according to this thesis are: showing respect, invitation to participation, allowing self-determination, and providing safe and secure care. These criteria are elements of the concept of being professional. Professionalism of nurses is shown by: the approach nurses adapt to the performance of their duties, and their competence and knowledge, but also how they apply laws and professional codes

Par sa fréquence et sa gravité, le cancer colorectal pose un problème majeur de santé publique en France et touche majoritairement les sujets âgés. Peu d’études évaluant la qualité de vie au diagnostic de ces patients et son impact sur leur survie ont été menées en population générale. Ce travail s'appuie sur une étude de population réalisée par le Registre Bourguignon des cancers digestifs portant sur les patients âgés de 65 ans ou plus et diagnostiqués entre 2003 et 2005 en Saône et Loire. Parmi les 401 patients éligibles, 246 ont renvoyé un questionnaire à au moins un des temps d'étude. Les non-répondeurs étaient plus âgés et diagnostiqués avec un stade tumoral plus avancé. La qualité de vie des patients s'améliorait avec le temps. Elle n'était pas modifiée par la présence de traitements adjuvants. La qualité de vie au diagnostic était un facteur pronostique indépendant de la survie des patients quand elle était évaluée par les patients eux-mêmes. La concordance entre le niveau de qualité de vie déclaré par les patients et l'appréciation de leur qualité de vie par le médecin traitant était moyenne à faible En conclusion, cette étude montre que chez les patients âgés, l'administration d'un traitement adjuvant n’entraîne pas d'altération de la qualité de vie à court et moyen terme, confirmant la nécessité de ne pas prendre uniquement en compte l'âge chronologique lors de la décision thérapeutique. Enfin, elle souligne l'importance de l'évaluation de la qualité de vie par le patient lui-même, y compris dans un contexte d'étude épidémiologique en population réalisée auprès de patients âgés dont il est parfois difficile d'obtenir la participation à une étude. / Colorectal cancer is one of the most common malignancies in France and predominantly affects older patients. Few studies evaluating baseline quality of life of those patients, its short term evolution and its prognosis value on patients' survival have been performed in the context of a population-based study. This work is based on a prospective longitudinal cohort study performed by the Burgundy Digestive Cancer Registry. All patients aged 65 and over, diagnosed with a new colorectal cancer and registered by the Registry between 2003 and 2005 were eligible. Among the 401 eligible patients, 246 fulfilled at least one questionnaire. Non-respondents were older and diagnosed with a more advanced cancer stage.Patients' quality of life improved with time. Quality of life was affected neither by the presence of adjuvant treatment, nor by the palliative or curative intent of cares. Quality of life was an independent prognosis factor of survival, only when assessed by patients themselves. The agreement between the levels of quality of life declared by patients and the level of quality of life estimated by patients' general practitioner was low. In conclusion, this study shows that quality of life is of major importance when evaluating elderly colorectal cancer patients' care. For those patients, adjuvant treatment did not seem to impact quality of life or its evolution with time, suggesting that chronological age should not determine candidacy for treatments. Lastly, it underlines the value of elderly patients' rating of their quality of life in the context of a population based study, even if getting this assessment is challenging.

Människor lever längre och det innebär att de allra flesta som dör i Sverige är äldre. Vårdfilosofin palliativ vård definieras som en helhetsvård, där patienten och anhöriga ska göras delaktiga i omvårdnaden. Enligt svensk lag har sjuksköterskan en skyldighet att göra patienten delaktig i sin vård. Vården i livets slutskede blir allt mer avancerad och det är viktigt att patienten görs delaktig, för att främja en god död. Samband i form av delaktighet och en god död har påvisats. Sjuksköterskan kan skapa förutsättningar för patientens delaktighet genom att vara lyhörd och lyssna samt se till att patientens delaktighet finns dokumenterad. Studiens syfte var att beskriva sjuksköterskans upplevelse och möjlighet att göra den äldre patienten delaktig vid vård i livets slutskede inom kommunens hemsjukvård. En kvalitativ intervjustudie med en induktiv ansats genomfördes. Deltagarna var åtta sjuksköterskor med erfarenhet av vård i livets slutskede i kommunens hemsjukvård. Kvalitativa innehållsanalysen gav ett resultat med fyra huvudkategorier: sjuksköterskans roll, teamets betydelse, anhörigas roll samt etiska dilemman. Slutsatsen är att det behövs mer dokumentation om den äldres delaktighet i kommunens hemsjukvård. / People live longer and that means that the vast majority of people who die in Sweden are older. Care philosophy, palliative care is defined as a holistic care, where the patient and relatives must be involved in the care. According to Swedish law, the registered nurse has an obligation to involve the patient in their care. The end of life care is becoming more advanced and it is important that the patient becomes involved in their care, as it can lead to a good death. Relationships in the form of participation and a good death have been demonstrated. The registered nurse can create conditions for the patient's participation by being responsive and listening, and ensuring that the patient's participation is documented. The aim was to describe the registered nurse's experience and opportunity to involved the older patient in care at the end of life within the municipality's home health care. A qualitative study with an inductive approach was conducted. Eight registered nurses with experience in end of life care in municipality's home care. The qualitative content analysis a resulted in four main categories: the registered nurse's role, the importance of the team, the role of relatives and ethical dilemmas. The conclusion is that more documentation is needed about older patient´s participation in municipality's home health care.