Background: Living with an incurable disease means facing existential challenges that the person must relate to. Being in a palliative phase also means that the person undergoes a lot of changes which often causes suffering. Suffering in palliative care is seen as multidimensional, something that affects the whole person, which is why a holistic view is a central part of palliative care. Aim: The aim of this literature study was to describe patient's experiences of existential suffering in the palliative phase. Method: A literature study based on ten qualitative articles. Results: Four main themes were found; experiences of a changed life-situation, experiences of loneliness, experiences of meaningless and experiences of loss. Conclusion: The study shows, from an existential point of view that coping and handling with an imminent death is complex and difficult in several ways. Patients in palliative care are a vulnerable patient group whose existential suffering may be enhanced by the way health professionals provide care. The study also shows a need for further research in this area aiming to support health care professionals to alleviate existential suffering.

Diabetes type 2 is a fast growing illness and a global health problem, often a result from less appropriate standard of living. Lifestyle changes related to diet and physical activity are important lifestyle changes regarding to get control of the self-management and to avoid vascular complications. Aim The aim of this study was to describe patient's experiences of lifestyle changes in diabetes type 2. Method A literature study was carried through based on 12 qualitative scientific articles. Results The analysis result into two main themes and eight subthemes. Main themes where barriers and motivators for lifestyle changes and the subthemes where struggle, denial, lack of knowledge, alienation, support, motivation, acceptance and knowledge. Conclusion This study shows that lifestyle changes are experienced different by patient with diabetes and nurses should therefore be aware of the unique and specific demands these patients require. This is important for providing a good diabetic healthcare and to help patients with their self-management

Bakgrund: I den somatiska vården finns det patienter med psykiska sjukdomar. De vanligaste psykiska sjukdomarna är schizofreni, psykoser, depression, ångestsyndrom och bipolära sjukdomar. Behovet av somatisk vård är större för patienter med psykiska sjukdomar än de utan, på grund av ökad risk för somatiska sjukdomar. Patienter upplevde att vardagslivet påverkas av de psykiska sjukdomarna. Vårdpersonal upplevde en osäkerhet och rädsla inför denna patientgrupp. Syfte: Att beskriva hur patienter med psykisk sjukdom upplever att bli vårdad i den somatiska vården. Metod: Litteraturöversikten baserades på 13 vetenskapliga artiklar. Dessa artiklar hämtades från CINAHL Complete och Pubmed. De huvudsakliga sökorden bestod av: mental illness, mental health, healthcare experience, patients’ experience, physical illness, primary care, communication och physical care. Resultat: Fyra teman utformades i resultatet. Ett tema var upplevelser av att bli stämplad av sjukvården på grund av den psykiska sjukdomen och det gjorde att patienterna kände sig bortprioriterade. När de kände sig stämplade upplevde de känslor av skam och maktlöshet. Ett tema var upplevelser att inte bli trodd som handlade om att fysiska symtom inte blir tagna på allvar. Det tredje temat var hur upplevelser om bristande kunskap hos vårdpersonal om psykiska sjukdomar påverkade vården. Detta upplevde patienter ledde till brist på information och delaktighet. Positiva erfarenheter och önskemål var det sista temat som visades i form av upplevelser av en personcentrerad vård, då vårdpersonal visade empati. Diskussion: Valda delar i resultatet diskuterades utifrån Katie Erikssons teori om att lindra lidande. Centrala begrepp inom teorin som användes var vårdlidande och konsensusbegreppet människan. / Background: In the somatic care, there are patients with mental illnesses. The most common mental illnesses are schizophrenia, psychoses, depression, anxiety disorders and bipolar disorders. The need for somatic care is bigger for patients with mental illnesses than those without, because of an increased risk of getting a somatic disease. Patients were experiencing that their daily life was affected by the mental illness. Healthcare professionals experienced uncertainty and fear of treating these patients. Aim: To describe how patients with mental illness are experiencing to be cared in the somatic care. Method: The literature review consisted of 13 scientific articles. These articles were found in the databases CINAHL Complete and PubMed. Main search words consisted of: mental illness, mental health, healthcare experience, patients experience, physical illness, primary care, communication and physical care. Results: Four themes were formed in the result. One theme was the experience of being labeled because of the metal illnesses and that made the patients feel not prioritized. When they felt labeled, they experienced feelings of shame and powerlessness. One theme was the experiences of not being believed and included patients experience that symptoms were not taken seriously. The third theme was how the experience of a lack of knowledge among health professionals about mental illnesses affected the care. Patiens experienced that it led to lack of information and participation. Positive experiences and desires were the last theme that appeared in form of experiences of a person centred care, when health professionals showed empathy. Discussion: Based on Katie Eriksson´s theory about relieving suffering, chosen parts from the results were discussed. The key concepts in the theory that were used were care suffering and the consensus concept human.

<p>According to the health care law and the national care guarantee, all individuals with mental illness have the right to good health care that is knowledge based as well as to rehabilitation where and when they need it. They also should be able to choose and have control over who is performing the care, including the design of these efforts. The purpose of this study is to investigate patients' experiences of general psychiatric emergency care and the cooperation between outpatient care, inpatient care and the municipality. This study is a descriptive cross-sectional study, conducted with a quantitative and qualitative method. The study is performed in collaboration with Akademiska Sjukhuset and is part of a larger quality improvement project. The participants in the study are patients who got in contact with the general psychiatric emergency care during a 6 weeks period. Data collection method consists of a questionnaire that was distributed to patients at discharge from different units. The questionnaire was designed by the project's principals, in collaboration with department managers, operations manager and the authors. The results show that the psychiatric care can be improved in all the areas this study has highlighted, where; encounter, information, participation and staff availability are included. The improvements, which need to be done, are not only between patients and health professionals, but also improvements between and within different professions in the mental health services.</p> / <p>Enligt hälso- och sjukvårdslagen och den nationella vårdgarantin ska alla individer med psykisk sjukdom ha rätt till en god vård som är kunskapsbaserad samt till rehabilitering där och när de behöver den. De ska även ha möjlighet att välja och ha inflytande över vem som utför vården samt utformningen av dessa insatser. Syftet med detta arbete är att undersöka patienters upplevelser av allmänpsykiatrisk vård samt av samarbetet mellan öppenvård, slutenvård och kommun. Denna studie är en deskriptiv tvärsnittsstudie, utförd med kvantitativ och kvalitativ metod. Studien utförs i samarbete med Akademiska Sjukhuset och är en del av ett större kvalitetsförbättrings-projekt. Deltagarna var de patienter som kom i kontakt med den allmänpsykiatrisk akutvården under en sex-veckorsperiod. Datainsamlingsmetoden bestod av en enkät som delades ut till patienterna vid hemgång från olika enheter. Enkäten utformades av projektets huvudansvariga i samarbete med avdelningschefer, verksamhetschef samt författarna. Resultatet visar att den psykiatriska vården kan förbättras i alla de områden som denna studie har belyst där; bemötande, information, delaktighet och personalens tillgänglighet ingår. Det inte bara förbättringar mellan patienter och vårdpersonalen som behöver göras, utan även förbättringar mellan och inom olika yrkeskategorier i den psykiatriska vården.</p>

According to the health care law and the national care guarantee, all individuals with mental illness have the right to good health care that is knowledge based as well as to rehabilitation where and when they need it. They also should be able to choose and have control over who is performing the care, including the design of these efforts. The purpose of this study is to investigate patients' experiences of general psychiatric emergency care and the cooperation between outpatient care, inpatient care and the municipality. This study is a descriptive cross-sectional study, conducted with a quantitative and qualitative method. The study is performed in collaboration with Akademiska Sjukhuset and is part of a larger quality improvement project. The participants in the study are patients who got in contact with the general psychiatric emergency care during a 6 weeks period. Data collection method consists of a questionnaire that was distributed to patients at discharge from different units. The questionnaire was designed by the project's principals, in collaboration with department managers, operations manager and the authors. The results show that the psychiatric care can be improved in all the areas this study has highlighted, where; encounter, information, participation and staff availability are included. The improvements, which need to be done, are not only between patients and health professionals, but also improvements between and within different professions in the mental health services. / Enligt hälso- och sjukvårdslagen och den nationella vårdgarantin ska alla individer med psykisk sjukdom ha rätt till en god vård som är kunskapsbaserad samt till rehabilitering där och när de behöver den. De ska även ha möjlighet att välja och ha inflytande över vem som utför vården samt utformningen av dessa insatser. Syftet med detta arbete är att undersöka patienters upplevelser av allmänpsykiatrisk vård samt av samarbetet mellan öppenvård, slutenvård och kommun. Denna studie är en deskriptiv tvärsnittsstudie, utförd med kvantitativ och kvalitativ metod. Studien utförs i samarbete med Akademiska Sjukhuset och är en del av ett större kvalitetsförbättrings-projekt. Deltagarna var de patienter som kom i kontakt med den allmänpsykiatrisk akutvården under en sex-veckorsperiod. Datainsamlingsmetoden bestod av en enkät som delades ut till patienterna vid hemgång från olika enheter. Enkäten utformades av projektets huvudansvariga i samarbete med avdelningschefer, verksamhetschef samt författarna. Resultatet visar att den psykiatriska vården kan förbättras i alla de områden som denna studie har belyst där; bemötande, information, delaktighet och personalens tillgänglighet ingår. Det inte bara förbättringar mellan patienter och vårdpersonalen som behöver göras, utan även förbättringar mellan och inom olika yrkeskategorier i den psykiatriska vården.

Bakgrund: Palliativ vård inleds när sjukdom inte är kurativ längre och fokus flyttas tillatt lindra lidande och främja patientens livskvalitet. Cancerrelaterad fatigue[CRF] är ett av de vanligaste symtomen vid cancerbehandling ochcancersjukdom och beskrivs som en oroande, ihållande, subjektiv känsla avtrötthet eller utmattning som inte står i proportion till den senaste tidensaktivitet och stör den vanliga funktionen. För att identifiera CRF beskrivskrävas en ordentlig anamnes, fysisk undersökning, uteslutning av andrabehandlingsbara faktorer och användning av mätverktyg valida förändamålet. I kompetensbeskrivningen för sjuksköterskan inom specialiseradpalliativ vård beskrivs att sjuksköterskan ska kunna uppmärksamma symtomhos patient som baseras på komplexa tillstånd och tidigt kunna identifiera,bedöma, planera och utföra evidensbaserad vård utifrån detta. Syfte: Patienters upplevelser av cancerrelaterad fatigue i ett palliativ skede. Metod: Litteraturöversikt över 13 kvalitativa och 4 kvantitativa artiklar somanalyserades med Whittemore &amp; Knalfs integrativa metod. Resultat: I resultatet framkom det tre olika huvudkategorier som beskrev olikadimensioner av patientens upplevelse av CRF. Fysiska symtom och förlustav kontroll, psykisk och emotionell påverkan och patientens strategier för atthantera CRF. Slutsats: CRF är ett komplext symtom som kräver noggrann utredning. Om symtometinte identifieras kan ett onödigt lidande skapas för patienten. Användning avvalida mätverktyg för att identifiera CRF och skapa möjlighet för patientenatt få samtala och få information gällande CRF ses vara behov patienten harfrån sjuksköterskan, specialistsjuksköterskan och sjukvården. / Background: Palliative care is initiated when illness no longer is curative and the focus isshifted to alleviating suffering and promoting the patient’s quality of life. Cancer-related fatigue [CRF] is one of the most common symptoms of cancer treatment and cancer and is described as a disturbing, persistent, subjective feeling of fatigue or exhaustion that is disproportionate to recentactivity and disrupts normal function. Identifying CRF is described as requiring a thorough medical history, physical examination, exclusion of other treatable factors, and use of measurement tools valid for the purpose. Competence description for the palliative care nurse specialist describes the importance of placing focus on symptoms associated with complex conditions to help identify, assess, plan and perform evidencebased care.  Aim: Patients' experiences of cancer related fatigue in palliative care Method: Literature review of 13 qualitative and 4 quantitative articles analyzed with Whittemore &amp; Knalfs integrative method.    Results: The results of this study revealed three main categories that describeddifferent dimensions of the patients’ experience of CRF. Physical symptoms and loss of control, mental and emotional experiences and the patient's strategies to manage their CRF.   Conclusion: CRF is a complex symptom that requires careful investigation. If the symptom is not identified, the patient can experience unnecessary suffering.The use of valid measurement tools is recommended to help identify CRF and give the patient opportunity to talk about and gain information about CRF from a nurse, specialist nurse or health care professional.

Aim: The overall aim of the thesis was to describe the experiences of awake patients during surgery under regional anesthesia. In addition, the aim was to develop a model for intraoperative care that can support and enhance patients’ well-being during the intraoperative period.   Methods: Study I was a patient interview study guided by a reflective lifeworld approach. In study II a philosophical reflection of the findings from study I was carried out. In study III a hermeneutic approach inspired by Ricoeur and Gadamer was used in order to interpret video recorded material. In study IV a hermeneutic approach inspired by Gadamer was used to synthesize the findings in studies I-III transformed into an intraoperative caring model.  Overall main findings: The analysis shows that being awake during surgery can be compared with walking a tightrope because of ambiguous feelings. The proximity and presence of the nurse anesthetist (NA) anchors the patient in the present and strengthens the patient’s feeling of trust. The temporary disruption in the relationship between the body and the world due to regional anesthesia means that the patient’s being in the world is exposed to revolutionary experiences. Gaps between the patient’s experiences and the situation can be bridged over when the NA acts as the patient’s bodily extension and links the patient as a subject to the world in the intraoperative situation. From the patient’s perspective this calls for the NA’s proximity and genuine presence in the ‘intraoperative caring space’. When the NA’s performance of his/her professional duties clashes with the patient’s existential being in the intraoperative situation the need of present presence from the NA is crucial. Conclusions: The findings contribute to knowledge development about intraoperative care and raise awareness that care for the awake patient cannot be performed on formal routines that might disregard the uniqueness of each patient’s situation. The model can be used as a tool to encounter awake patients’ existential needs in the intraoperative situation and to further enlighten NAs about the possible impact of their proximity, interaction and communication behavior in the delivery of intraoperative nursing care.

Background: Cancer in the head and neck region is an unusual form of cancer. The treatment for this cancer can cause permanent damage to vital functions. Nurses' have expressed frustration about feeling insufficient to accommodate the patients' needs. Patients' with head and neck cancer are reported to have low quality of life. Aim Describe patients' experiences of undergoing treatment of cancer in the head and/or neck region. Method: A qualitative systematic literature review with descriptive approach of qualitative articles. Result: Undergoing treatment for cancer in the head and neck region created challenges for the patients'. Many patients' have had experienced that the time between the diagnose and treatment went fast. The treatment caused side effects that led to constraints in daily life and many created a new identity because they did not recognize themselves in the same way as before the diagnose. Patients became dependent to the medical care and made them omitted to others. They had to handle a new life situation, and to manage that, the patients created strategies. Conclusion: The treatment provided side effects that affected the everyday lives of the patients. The side effects impacted on patients both physically, psychologically, socially and existentially. More knowledge is needed in order to improve the health care for patients with head and neck cancer.