Syftet var att belysa hur hopp upplevs av patienter i palliativ vård. Bakgrunden uppmärksammar att ca 90 000 patienter i palliativ vård dör i Sverige varje år. Dessa patienter upplever flera dimensioner av smärta, både fysiska och psykiska. Hopp beskrivs som något som kan leda patienter mot mer positiva mål och handlingar och är därför av stor betydelse för deras välmående. Metoden för studien är en allmän litteraturstudie baserad på kvalitativ forskning. Analysen är utförd med en induktiv ansats. Utefter likheter som identifierades fastställdes 17 subkategorier, sex kategorier och två övergripande teman. Resultatet belyser hur hopp uttrycks hos patienter i palliativ vård. Oförändrat hopp, omvandlande hopp, strategiskt hopp, övervinnande hopp ochvardagsnära hopp var kategorier som framkom som hoppingivande. I kontrast till hoppet fanns där också en hopplöshet. Hopplösheten identifieras som ett hinder för hopp vilket ökade passiviteten och känslan av hjälplöshet. Konklusion av studien är att upplevelsen av hopp uttrycks på olika sätt genom vårdförloppet. Det finns flera kategorier som är återkommande i tidigare forskning. De flesta fynden identifieras som hoppingivande och visade sig ge ökad livskvalitet för patienter. Emellertid, så saknas det forskning kring hur patienter ville bli bemötta i sitt hopp. / The aim of this study was to highlight how hope is experienced by patients in a palliative care context. The background notes that about 90 000 palliative patients die in Sweden each year. The patients in palliative care experience several dimensions of pain, both physical and psychological. Hope is described as something that can lead patients towards more positive goals and actions and is therefore of great importance for their wellbeing. The method of this study is a general literature study based on qualitative research. The analysis is performed with an inductive approach. Following similarities identified 17 subcategories, six categories and two overall themes that where established. The result illustrates how hope is expressed in palliative care patients. Unchanged hope, transformational hope, strategic hope, overcoming hope and everyday hope were categories that emerged as hopeful. In contrast to the hope there were also a hopelessness. The hopelessness was identified as an obstacle to hope which increased passivity and the feeling of helplessness. The conclusion of this study is that the experience of hope is expressed in different ways through the care process. There are several categories that are recurring in earlier research. Most discoveries are identified as hopeful and proved to increase the quality of life for patients in the palliative care context. However, there is no research about how patients would like to be treated regarding their hope.

The goal of my thesis I have chosen is to identify the way hospice care is perceived in the Telč region by family members of terminally ill patients. I based my thesis on available specialised literature, current legislation and internet sources dealing with home hospice care. In the first theoretical part, I deal with the definition of hospice care trying to explain the term of general and specialised care that have a common objective, namely dignified and tranquil dying. The second section deals with family in the context of palliative care that plays the key role in the patient care. If the family decides to care for the incurable patient at home, it is vital to support it. Moreover, in this section I define needs of family members summarised in three core topics. Including the care for the patient family that I included to the hospice care as not only the patient suffers from the illness but all his/her family does. That means that each family member needs palliative care. The end of this section deals with mourning of the survivors. The core point is not leaving them alone in their mourning, to have them accompanied by someone in their grief. The third chapter focuses on the role and position of the patient. It changes when a seriously ill human becomes dependent on third party´s help losing his/her capacity to fulfil his/her professional and family role. This enormously affects his/her physical and emotional condition. Moreover, I describe needs on terminally ill people that change when the patient approaches his/her death depending on his/her family and social situation. It changes also during his/her adaptation to adverse diagnoses and forecast and emergence of difficulties and complications. I describe four groups of needs: biological, psychological, social and spiritual. The fourth chapter characterises home hospice care that is described as specialised palliative care provided in the home environment amidst patient´s family and friends. I describe the history of Czech hospice care stating that before the WWII it was quite normal to care for terminally ill patients at home till the end. This trend emerges again in the 90s. I define objectives of the home hospice care and related activities. The fourth chapter includes the description of a multi-disciplinary team and funding of home hospice care. In the fifth chapter, I characterise the home care organisation that try to expand the range of services by including the home palliative care and also deal with the home care history, objectives, delimitation of the scope of activities, agency human resources management and home funding methods. In the sixth chapter, I represent the organisation Sdílení, o.p.s. Telč, services provided by it and basic duties according to the Act No.108/2006 Coll. as well as the mission and objectives of this organisation concentrating on help and support of seriously ill people and their family members/friends in such difficult life situation. The key objective of Sdílení is to preserve maximum possible self-sufficiency and dignity of seriously ill people and support of families that are able to find the courage and force to accompany a terminally ill family member to the end of his/her life. In the practical part of my thesis, I analyse data collected by means of qualitative research based on an inquiry in the form of semi-standardised and open-code processing. Who was included to the basic file were family members of terminally ill patients who were divided to two parts. The first group consists of 3 respondents who were entrusted to the care of the home hospice Sdílení. The second group are 3 respondents entrusted to the Home Care hospice. In the practical part, I describe the process of collection of data, record results of the interview process by the open-code method.

The diploma thesis titled Euthanasia in the film an analysis of selected pieces, is divided into theoretical and practical parts. I devoted to a description of a current state of euthanasia in the theoretical part. First I focused on definitions of euthanasia, assisted suicide etc. A chapter is also devoted to a history of euthanasia. I wanted to highlight the fact, that euthanasia is not only a problem of the modern society, but beginnings of a discussion about euthanasia we could find already in the ancient world. Through the concept of euthanasia in the Middle Ages and modern times I got up to the World War II, which is in my opinion an important milestone in the history of euthanasia, because at that time euthanasia was perceived as a tool for a disposal of persons who, in the context of its time, seemed to be undesirable. Among such people there were classified for example people so called racially unsuitable, weak and sick. Because there are legally different views of euthanasia, in chapters I mention the fact how euthanasia is perceived in the world. In terms of acceptance of euthanasia and assisted suicide I particularly emphasize the Netherlands and Switzerland. One chapter I also dedicate to euthanasia in the Czech Republic. It includes a description of the discussion and arguments for and against euthanasia. One more separate chapter I devoted to questions whether to legalize or not to legalize euthanasia. I found out that a discussion on this topic is very extensive and here could be applied the rule that each man has his own opinion. It turned out that even experts in one area, doctors of philosophers, are not unanimous in the issue of euthanasia and its pros and cons are from both sides argued with plenty of arguments that are worth thinking about. A separate chapter I devoted to a man, who I consider to be the main promoter of euthanasia and assisted suicide and if you pronounce his name, people would link him with that theme. This is Dr. Jack Kevorkian, nicknamed Dr. Death. Jack Kevorkian, who understood his acts as medical services for terminally ill people, helped with the voluntary termination of life to several hundred of people. Although he had written certain "rules" about the situations when he can people "help" to solve their suffering and pain, it turned out that those people in many cases had no anatomical evidence of disease in their body. Jack Kevorkian has had and even currently has many supporters and opponents. In case of Jack Kevorkian there are arguments for and against euthanasia as in the whole debate about it. The aim of the study was to analyse how the topic of euthanasia has been reflected in the film production. At the beginning of the research I have asked this research question: Which are usual attitudes to euthanasia reflected in filmmaking? In order to find out the given objective and to answer the research question I chose a qualitative research based on the method of disinterested observation of six selected movie titles. Titles in their alphabetical order were following: Doktor smrt (You Don´t Know Jack, USA, 2010, 134 min), Hlas moře (Mar adentro, Španělsko/Francie/Itálie, 2004, 125 min), Hodinu nevíš, Česko, 2009, 94 min), Invaze barbarů (Invasion barbares, Kanada/Fancie, 2003, 99 min), Millon Dollar Baby, (USA, 2004, 132 min) a Skafandr a motýl (Le Scaphandre et le papillon, Francie/USA, 2007, 107 min).

Inledning: Psykoterapi och psykoanalys är påfallande frånvarande i studier när det gäller palliativ vård och död. Syftet med denna undersökning är att undersöka hur psykoterapeuter arbetar i terapi med döende patienter. Frågeställning: Hur arbetar psykoterapeuter med psykodynamisk inriktning med döden i terapirummet? Metod: Studien baseras på halvstrukturerade intervjuer med fem legitimerade psykoterapeuter med psykodynamisk inriktning med erfarenhet av terapi med döende patienter. Materialet analyserades med hjälp av tematisk analys. Resultat: Resultatet beskriver psykoterapeuters arbete med döende patienter. Fyra teman framträder. Det första belyser att döden är ramen i terapin. Det andra visar på den livsviktiga alliansen. Det tredje beskriver närmare den terapeutiska praktiken och innehållet i terapin. Det fjärde beskriver de särskilda utmaningar som terapeuten möter i terapi med döende patienter. Diskussion: I studien framkommer att döden återverkar på hela terapiförloppet. Döden blir ramen i terapi med döende patienter. När det gäller alliansen ser den ut att komma snabbare i terapier med döende patienter. Själva innehållet i terapin blir också något annorlunda, det blir ett annat fokus. Livsfrågor får ett stort utrymme. Många starka känslor väcks i terapin, såväl hos patient som hos terapeut. Teoribildningens betydelse betonas för att kunna förstå dessa känslor i termer av överföring/motöverföring och projektion/identifikation. Bland det mest utmanande i terapier med döende patienter är de starka känslor som väcks hos terapeuten. Studiens resultat är i linje med tidigare forskning som främst består av kliniska rapporter. / Introduction: Psychotherapy and psychoanalysis are strikingly absent in studies of palliative care and death. The purpose of this study is to explore how psychotherapists work in therapy with dying patients. Research question: How do psychotherapists with psychodynamic orientation work with death in the therapy room? Method: The study is based on semi-structured interviews with five licensed psychotherapists with psychodynamic orientation and with experience of therapy with dying patients. The material was analyzed using thematic analysis. Results: The result describes psychotherapists' work with dying patients. Four themes emerge. The first theme is that death becomes the framework of the therapy. The second theme shows the vital alliance. The third theme describes the therapeutic practice and the content of the therapy. The fourth theme describes the specific challenges that the therapist faces in therapy with dying patients. Discussion: The study reveals that death affects the entire therapy. Death becomes the framework in therapy with dying patients. Alliance seems to come faster in therapies with dying patients. The content of the therapy will have a different focus. Life issues are given a lot of space. Many strong feelings are aroused in the therapy, both in the patient and in the therapist. The importance of theory formation is emphasized in order to understand these feelings in terms of transference/countertransference and projection/identification. The strong feelings aroused by the therapist is among the most challenging issues in therapies with dying patients. The results of the study are in line with previous research, which mainly consists of clinical reports.

Individuals with advance-stage illnesses frequently face illness or treatment-related adverse effects in the mouth. These adverse effects can have serious consequences. Despite that, the importance of oral care in this population is often overlooked and there are no definitive guidelines as to what kind of oral care should be provided to these individuals. Given that, our study aims were to explore and better understand the oral health-related concerns, perceived oral care needs of palliative care patients and the berries that face in accessing dental care services. We conducted a qualitative description study by recruiting a purposive sample of 11 participants with advanced stage health conditions from the outpatient palliative care services of the University of Iowa Hospitals and Clinics. Data were collected using in-depth, semi-structured interviews using an interview guide. All interviews were fully transcribed, with the data managed with Atlas.ti software to facilitate the analysis. All participants had oral concerns although they varied widely from person to person and their illness statuses. The most significant concerns were related to dry mouth, loose dentures, and eating difficulties. Among those who stated that they would seek dental care if required, they were not planning on seeking dental care even though they had treatable oral problems, suggesting a mismatch between their oral health status and their perceived needs. The frequently observed barriers that prevented them from seeking dental care were their illness and illness related priorities, finances, feeling discriminated against by the dentist, and a dislike towards the dentist. Providing information to the palliative care clinicians about the significance of oral health and its impact, incorporating a dental care provider in palliative care team, and providing timely information to individuals with advanced health conditions may enhance the understanding of their oral health problems and help them better manage their oral health and may enhance their dental care seeking behavior.

Bakgrund: Den palliativa vården blir allt viktigare för personer med icke-cancersjukdomarsom hjärtsvikt. Flera intresseorganisationer och internationella yrkesföreningar trycker påbehovet för tidigare information rörande prognos och integrering av palliativ vård för dessapatienter. Trots detta står denna patientgrupp ofta utan denna typ av vård och stöd även närpatienten närmar sig ett terminalt skede av livet. Syftet var att undersöka barriärer som fannsför initiering av palliativ vård hos vuxna patienter med hjärtsvikt Metoden var en ickesystematisk litteraturöversikt med ett systematiskt arbetssätt där totalt 17 artiklar valdes ut fördatagranskning. Resultatet visade på flera barriärer som kunde sammanfattas underrubrikerna Personalrelaterade barriärer, Patientrelaterade barriärer samt Organisatoriskabarriärer. Slutsatsen Resultatet identifierade flertalet komplexa barriärer som var patient,personal och organisatoriskt beroende. Dessa barriärer försvårade integrering av denpalliativa vården hos patienter med hjärtsvikt. Att möjliggöra för sjukvården att skapa godarelationer med proaktiv kommunikation är av stor vikt. Vidare behövs organisatoriskt stödmed tid för samtal, personalkontinuitet, utbildning och förbättrad kommunikationsförmåga.Detta tillsammans med tydligare riktlinjer och samarbete inom vården. / Background Palliative care is becoming increasingly important for patients with noncancerous diseases such as heart failure. Several interest groups and international professionalassociations emphasize the need for timely information regarding prognosis and integrationof palliative care for these patients. Despite this, this patient group is often without this typeof care and support even when the patient is approaching a terminal stage of life. Aim Wasto investigate barriers that existed for the initiation of palliative care in adult patients withheart failure. Method The method used was a non-systematic literature review with asystematic approach where a total of 17 articles were selected for data review. Result The results showed several barriers that could be summarized under the headings under theheadings Personnel-related barriers, Patient-related barriers and Organizational barriers. Conclusion The results identified several complex barriers that were patient, staff andorganizational dependent. These barriers made it more difficult to integrate palliative care forpatients with heart failure. Enabling the creation of good relationships with proactivecommunication in healthcare is of great importance. Furthermore, support from theorganization is needed which includes time for conversations, staff continuity, training andimproving communication skills. This together with clearer guidelines and cooperation inhealthcare.

Bakgrund: I Sverige vårdas döende patienter både på hospice och på allmänna vårdavdelningar. Vissa av dessa patienter uttrycker en önskan om att få påskynda döden. Sjuksköterskor beskriver ibland en osäkerhet i hur de ska bemöta dessa patienter och vad denna önskan består i. Det kan finnas olika bakomliggande orsaker till en förfrågan av den här typen och en del av dessa kanske går att åtgärda. Syfte: Att beskriva bakomliggande faktorer till att vissa svårt sjuka patienter önskar påskynda sitt döende. Metod: En litteraturstudie baserat på 11 vetenskapliga artiklar genomfördes. Resultat: Rädsla inför lidande i framtiden visade sig vara den mest förekommande faktorn till att vissa patienter önskade påskynda döendet. Fler bidragande orsaker var svåra symtom (särskilt smärta), förluster av bland annat identitet och värdighet, samt en känsla av att vara en börda. Kombinationen av flera faktorer orsakade ett svårt lidande för patienten, och väckte en önskan om få avsluta livet innan lidandet blev för stort. Slutsats: Svårt sjuka patienters önskan om en påskyndad död betyder inte alltid att de önskar att dö, utan kan vara en följd av svåra smärtor eller annat lidande. Om dessa faktorer kan kontrolleras finns kanske en möjlighet att patientens lidande minskar. Klinisk betydelse: Denna studie bidrar till en ökad förståelse hos sjuksköterskor om vilka faktorer som påverkar patientens välbefinnande i livets slutskede. Genom att uppmuntra till ökad medvetenhet kring de riktlinjer och åtgärder som finns, framför allt i den allmänna vården utanför hospice, kan bemötandet av dessa patienter förbättras. / Background: In Sweden dying patients are cared for both in hospices and at ordinary wards. Some of these patients wish to hasten their death. Nurses sometimes describe insecurity in how to respond to a patient‟s death wish. There can be different reasons why a patient asks for euthanasia, some may be possible to eliminate. Aim: The aim of this study was to describe why some terminally ill patients wish to hasten their death. Method: A literature review based on 11 scientific papers was made. Findings: Fear of suffering in the future turned out to be the most common contributing reason to why patients wanted to end their lives. Other reasons were severe symptoms (especially pain), loss of identity and dignity, among other things, and feelings of being a burden. A combination of different factors led to a severe suffering for the patient, and a wish of ending life before the suffering grew too severe. Conclusion: Severely ill patient‟s wishes to hasten death do not necessarily mean they want to die, but can be an expression of a difficult pain or suffering. If these factors can be controlled or eliminated, there is a possibility that the patients suffering decreases. Clinical significance: This study contributes to a better understanding among nurses about the factors that influences patient‟s wellbeing at the end of life. By encouraging to a raised awareness of the existing guidelines and interventions, especially in the primary care outside of hospices, the treatment of these patients can improve.

Hospice services provide a holistic approach to end-of-life care to terminally ill patients though there is some evidence to suggest that African American military beneficiary populations may not access hospice care as often as expected. The purpose of this nonexperimental study was to evaluate reasons for the low use of hospice care among the terminally diagnosed members of this population, between the ages of 18 and 64. Kolcaba's comfort theory provided the theoretical framework for this study. The research explored whether a statistically significant difference exist among African Americans military beneficiaries population as compared to non-Hispanic Whites pertaining to their knowledge of hospice care, attitudes and beliefs about hospice, distrust in the health care system, and advanced care plans. This study used a simple random sample of 32 participants (18 African Americans and14 non-Hispanic White) from a military ambulatory care setting in Maryland. Johnson, Kuchibhatla, and Tulsky's End-of-Life Care survey was used to collect data from the 2 groups of participants. Data were analyzed using a one-way multivariate analysis of variance. The results indicate that there are not statistically significant differences between the groups in terms of knowledge of hospice care, attitudes and beliefs about hospice, distrust in the health care system, and advanced care plans based on race. Based on the results of this study, further research is recommended to replicate using a larger sample size to include other minority groups at more than one medical treatment facility. The implication of this study may open up an avenue to policy makers and administrators who are responsible for disseminating information about hospice benefits to focus on improving the quality of the end-of-life for terminally ill patients.

No description available.

Bakgrund Palliativ vård är en vårdform som ska lindra lidande och förbättra livskvalitén hos patienter och anhöriga när sjukdom inte längre går att bota och livet går mot sitt slut. Palliativ vård utgår från ett helhetsperspektiv (holism). Det finns en ojämlikhet i tillgänglighet till palliativ vård globalt, då endast en liten andel av de med palliativa vårdbehov får detta tillgodosett. Det blir allt vanligare med palliativ vård i hemmet. Studier visar på bristfällig forskning av patienters upplevelser av denna vårdform. Syfte Syftet med litteraturöversikten var att undersöka patienters upplevelser av palliativ vård i hemmet. Metod En litteraturöversikt med systematisk ansats genomfördes i tre databaser; PubMed, CINAHL Complete och Nursing & Allied Health Premium. Femton vetenskapliga artiklar med kvalitativ data valdes ut och analyserades med Thomas och Hardens tematisk analys. Resultat Resultatet visade att hemmet är en viktig plats för patienter med palliativa vårdbehov för att öka välbefinnande och även öka möjlighet till närhet till anhöriga. Hemmet bidrog till normalitet och oberoende trots svår sjukdom. Det framkom att vården i hemmet kunde upplevas både trygg och otrygg beroende på hur vården var organiserad. Patienterna hade en oro för att svårbehandlade symtom skulle uppstå i hemmet eller att de skulle vara en börda för anhöriga. Det var viktigt för patienterna att ha en god relation till hälso- och sjukvårdpersonalen. Det framkom att patienters emotionella behov blev otillräckligt bemötta. Slutsats Hemmet är en viktig plats för patienter med palliativa vårdbehov. När vårdpersonalen samordnar vården och har ett gott bemötande ökar patienters trygghet och välbefinnande. Alla patienter bör få tillgång till palliativ vård av god kvalitet vid livets slut. Mer forskning behövs som belyser patientperspektivet inom denna kontext. / Background Palliative care is a form of care that is supposed to ease suffering and enhance patients and relatives’ quality of life during terminal illness at the end of life. There is an inequality in access to palliative care worldwide, since only a few of those in need receive it. It´s becoming more and more common with palliative home care. Studies show that there is a lack of knowledge about patients experience of this form of care. Aim The aim of the literature review was to explore patients’ perspective of palliative home-based care. Methods A literature review with a systematic approach were performed in three databases: PubMed,CINAHL Complete and Nursing & Allied Health Premium. Fifteen scientific articles of qualitative data were selected and analysed through three steps based on Thomas and Hardens thematic synthesis. Results The result showed that the patient´s home is an important place for terminally ill patients since it enhanced their wellbeing their ability to be close to relatives. Being at home also gave a sense of normality and independence despite severe illness. Home-based palliative care could be perceived as both safe but also unsafe depending on how well the care was organized. Patient´s worried that intractable symptoms would occur in their home or that they would be perceived as a burden to their relatives. It was important for patient´s to establish a good relationship with the healthcare professionals. Sometimes the patient´s emotional needs were insufficient met. Conclusions The patients home seem to be an important place for patients with palliative needs. When the health care staff coordinates care and have a friendly reception it increases the patients’ security and well-being. All patients should have access to palliative care of good quality at the end of life. More research reflecting the patient’s perspective in this context is needed.