This thesis was concerned with the psychological adjustment of 67 end-stage cancer patients, and three psychosocial variables considered to influence that adjustment: emotional support from spouse, positive meaning, and working models of attachment. Furthermore, this thesis was also concerned with the psychological adjustment of the patients' spouses, and the influence of emotional support from patient and working models of attachment on their adjustment. It was hypothesised that each of these psychosocial variables would directly influence the psychological adjustment of patients and spouses, measured using the negative affectivity scale of the Positive and Negative Affect Scale (PANAS). Furthermore, it was hypothesised that emotional support would influence positive meaning, and working models of attachment would influence both emotional support and positive meaning. Variables were measured via paper and pencil self-report inventories, with the exception of positive meaning, where verbal responses to an open question were coded. Univariate analyses indicated an association between patients' and spouses' emotional support provided by one another and their psychological adjustment. Univariate results also showed that patients' positive meaning was related to patients' psychological adjustment, and that patients' working models of attachment involving higher levels of attachment anxiety were associated with patients' poorer psychological adjustment. All these individual associations remained statistically significant after three control variables related to the patients' physical condition were taken into account. In addition, univariate analyses indicated that attachment was associated with emotional support, and that emotional support was associated with positive meaning. Following univariate analyses, variables were integrated into one model for patients and another for spouses using path analyses. Results were generally consistent with the prior sets of analyses. However, patients' working models of attachment involving higher levels of attachment anxiety no longer had a direct effect on patients' psychological adjustment to statistically significant levels. Rather, the influence of the working models of attachment on patients' psychological adjustment was mediated by emotional support. In addition, patients' positive meaning no longer had a significant direct effect on patients' psychological adjustment. The insignificant path coefficients between attachment anxiety and psychological adjustment, and between positive meaning and psychological adjustment, were attributed to the large amount of variance in negative affect due to emotional support. In summary, this research indicates that emotional support given and received between patients and spouses is important to the psychological adjustment of each party. Furthermore, emotional support influences patients' ability to construe positive meaning in their illness, although positive meaning does not appear to be as critical to the psychological adjustment of patients as emotional support. Working models of attachment influence the psychological adjustment of patients primarily through their influence on emotional support.

While there is considerable international interest in the development of hospice and palliative care programs, as an alternative form of care for the terminally ill, there is minimal empirical research undertaken on the needs of recipients of these programs. Using a Q-sort, developed by the author, this research examined the relationship between individual patient's ranking of their needs, and the nurse's perception of the needs identified by individual patients in their care. A basic assumption of the study was that patients' needs could be categorised in four groups, namely spiritual, physical, emotional, and social. Consequently, the study also examined whether patients and nurses identified, as most important, needs from one group, more frequently than the other groups. The limited size of the sample placed severe restrictions on the analysis of results derived from this research. However, while no definite conclusions could be drawn from data obtained from the small sample, tentative analysis identified trends that may have proved significant had they continued in a larger sample.

Bakgrund: Sjuksköterskor möter ibland obotligt sjuka patienter som uttalar en önskan om att få avsluta sitt liv i förtid och detta är både ett komplext och kontroversiellt ämne som diskuteras flitigt runt om i världen. En uttalad önskan om att få avsluta sitt liv i förtid kan ha många olika betydelser och bör förstås utifrån varje unik patients egen sjukdomssituation, livshistoria och upplevelser. Syfte: Att undersöka hur sjuksköterskor upplever och hanterar mötet med terminalt sjuka patienter som uttalar en önskan om att få avsluta sitt liv i förtid. Metod: En litteraturöversikt har gjorts och baseras på åtta vetenskapliga artiklar publicerade mellan år 2001-2010. Analysen har skett genom en kategorisering av resultaten och Erikssons teori om lidande har utgjort den teoretiska utgångspunkten för diskussionen. Resultat: När patienter, på grund av vad de upplever som ett omänskligt lidande, uttalar en önskan om att få avsluta sitt liv i förtid kan sjuksköterskor uppleva maktlöshet, moralisk stress samt en önskan om kontroll. Sjuksköterskor hanterar detta genom god kommunikation och att dra personliga gränser. De uttrycker även ett behov av stöd och av att få samtala. Diskussion och slutsats: Många sjuksköterskor upplever en rädsla över att förlora kontrollen över situationen vilket kan leda till att de upplever osäkerhet och svårigheter när de vårdar terminalt sjuka patienter som önskar avsluta sitt liv i förtid. Sjuksköterskor kommer troligtvis alltid att möta dessa patienter och det finns därmed ett behov av stöd och riktlinjer. / Background: Nurses sometimes meet terminally ill patients who express a wish to end their life untimely and this is a complex and controversial issue that is discussed all around the world. An expressed wish to end life untimely can mean many things and must be understood based on the situation of the disease, life history and experiences of every unique patient. Aim: To explore how nurses experience and handle the meeting with terminally ill patients who express a wish to end their life untimely Methods: A literature review has been made and is based on eight scientific studies published between years 2001-2012. Categorizing the text of the articles has done the analysis and Eriksson ́s theory about suffering from illness is the theoretical framework that has been used. Result: When patients, because of what they perceive an inhumane suffering, state that they would like to end their life untimely nurses can experience powerlessness, moral distress and a wish to control the situation. Nurses handle this through good communication and by drawing their own personal line. They also express a need of support and to talk about this. Discussion and conclusion: Many nurses experience a fear of losing control over the situation which leads to feelings of insecurity and difficulties when they care for terminally ill patients who wish to end their life untimely. Nurses will probably always get in contact with those patients and therefore there is a need for support and guidelines.

Abstract not available. / Until now, historians have devoted relatively little attention to the rich field of patients' struggles with chronic progressive disease. This study proposes to begin to fill this lacuna by examining in detail the meaning and implications of one central principle of nineteenth-century clinical medicine: incurability. Though the judgement of incurability is the product of a medical encounter, its significance extended well beyond the clinic. For being incurable in nineteenth-century France was a social event in the broadest sense, putting the individual at the centre of a complex web of people with different expectations and duties. Patients and their farnilies sought relief and solace within the confines of their homes and, frequently enough, in hospital. The physician was expected to prognosticate and to heal, while women, usually members of the immediate family or a religious order, carried out the duties of daily care. Either by choice or institutional diktat, many incurably ill individuals were visited by a priest or some other representative of the Church. Finally, their lives were deeply influenced by the decisions of local and, to an ever increasing degree, national politicians mandated to tackle questions of charity and social policy. Each chapter of this thesis will examine facets of the experience of incurability within the context of existing social structures: medical, religious, economic, and political.

The topic of this study, euthanasia, has become a modern-day issue that challenges some of societies traditionally held beliefs towards death and dying. This study drew upon the theoretical insights of Michel Foucault to provide a discursive analysis of the term euthanasia, and the issues surrounding the "right-to-die". It involved an analysis of primary texts from; nursing, general, and legal literature as well as the media between the years 2002-2004. Drawing upon data researched, the study analyses the main discourses regarding the practice of euthanasia for terminally ill individuals. The two competing discourses that emerged were what I have termed the sanctity-of life-discourse and the right-to-die discourse. The aim of the study was to uncover the discourses understanding of "truth" regarding the right-to-die. The analysis revealed that a small percentage of cancer sufferers (5%) die with their pain insufficiently treated and the right-to-die discourse claims that no individual should have to suffer needlessly, asserting the individuals right to autonomy. Directly opposing this is the sanctity-of life-discourse which states all life is sacred and nothing can justify euthanasia as an acceptable practice in society. My findings indicate the need for effective palliative care and pain management when caring for the terminally ill individual. The legal, ethical and moral implications of euthanasia are many and this study discusses the effects these may have on health professionals involved with the care of terminally ill patients. The study revealed an increasing deployment of the right-to-die discourse in the media and revealed concerns regarding the nursing professions lack of preparation to deal with euthanasia if it becomes a legal option in end of life care.

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 5 uppsatser.

Dissertation (Ph.D.)--University of South Florida, 2008. / Title from PDF of title page. Document formatted into pages; contains 134 pages. Includes vita. Includes bibliographical references.

Zugleich: Diss. Bielefeld, 2008. / Literaturverz.

Thesis (M.S.)--University of Michigan, 1992.

Thesis (doctoral)--Universität, Freiburg/Schweiz, 2005.