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  • 1.
    Browall, Maria
    et al.
    Sahlgrenska University Hospital, Department of Oncology, Clinical Trial Unit, Gothenburg, Sweden.
    Melin-Johansson, Christina
    Mid Sweden University, Department of Health Sciences, Östersund, Sweden.
    Strang, Susann
    The Sahlgrenska Academy, University of Gothenburg, Department of Clinical Neuroscience and Rehabilitation and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Danielson, Ella
    Mid Sweden University, Department of Health Sciences, Östersund, Sweden / The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden.
    Henoch, Ingela
    Bräcke Diakoni Foundation, Research Unit, Gothenburg, Sweden / Karolinska Institutet, Institution of Learning, Informatics, Management and Ethics, Medical Management Centre, Stockholm, Sweden.
    Health care staff's opinions about existential issues among patients with cancer2010In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 8, no 1, p. 59-68Article in journal (Refereed)
    Abstract [en]

    Objective: The objective of this study was to explore health care staff's opinions about what existential issues are important to patients with cancer and staff's responsibility when existential issues are raised by patients. Method: Four focus group interviews were conducted with health care staff (N = 23) at an in-patient hospice, on an oncology ward, on a surgical ward, and with a palliative home health care team. The focus group interviews focused on two questions, first, about health care staff's opinions about patients' important existential questions and, second, about health care staff's responsibility when existential issues are raised by the patient. The interviews were taperecorded, transcribed verbatim, and analyzed by qualitative content analysis into subcategories and categories. Results: Four categories and 11 subcategories emerged from the first question. The first category, "life and death," was based on joy of living and thoughts of dying. The second category "meaning," consisted of acceptance, reevaluation, hope, and faith. The third category, "freedom of choice," consisted of responsibility and integrity, and the fourth and last category, "relationships and solitude," consisted of alleviation, dependency, and loss. One category emerged from the second question about the health care staff's responsibility, "to achieve an encounter," which was based on the subcategories time and space, attitudes, and invitation and confirmation. Significance of results: One strength of this study was that the findings were fairly congruent in different settings and in different geographical areas. Health care staff were aware of the importance of existential issues to patients. The existential issues, mentioned by health care staff, are similar to findings from studies conducted among patients, which is another strength of the present study. Health care staff are also confident about how to act when these issues are raised by the patients. The challenge for the future is to implement the findings from this study among health care staff in different settings.

  • 2.
    Ek, Kristina
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Andershed, Birgitta
    Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden / Department of Nursing, Gjøvik University College, Gjøvik, Norway.
    Sahlberg-Blom, Eva
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ternestedt, Britt-Marie
    Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden / Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    "The unpredictable death" - The last year of life for patients with advanced COPD: Relatives' stories2015In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 13, no 5, p. 1213-1222Article in journal (Refereed)
    Abstract [en]

    Objective: The end stage of chronic obstructive pulmonary disease (COPD) is described as prolonged and the symptom burden for patients with COPD is often high. It progresses slowly over several years and can be punctuated by abrupt exacerbations that sometimes end in sudden death or recovery of longer or shorter duration. This makes it difficult to identify the critical junctures in order to prognisticate the progress and time for death. patients with COPD often express a fear that the dying process is going to be difficult. There is a fear that the dyspnea will worsen and lead to death by suffocation. The present article aimed to retrospectively describe the final year of life for patients with advanced COPD with focus on death and dying from the perspective of relatives. Method:Interviews were conducted with relatives of deceased family members who had advanced COPD. In total, 13 interviews were conducted and analyzed by menas of content analysis. Result: All relatives described the patients as having had a peacful death that did not correspond with the worry expressed earlier by both the patients and themselves. during the final week of life, two different patterns in the progress of the illness trajectory emerged: a temporary improvement where death was unexpected and a continued deterioration where death was inevitable. Sigificance and Results: The patients and their realtives lived with uncertainty up until the time of death. Little support for psychosocial and existential needs was avaiable. It is essential for the nurse to create relationship with patients and relatives that enable them to talk about dying and death on their own terms.

  • 3.
    Henoch, Ingela
    et al.
    University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden / Ersta Sköndal University College and Ersta Hospital, Palliative Research Centre, Stockholm, Sweden.
    Strang, Susann
    University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden / Angered Local Hospital, Gothenburg, Sweden.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Karolinska Institute, Department of Neurobiology, Care Science and Society, Division of Nursing, Solna, Sweden.
    Danielson, Ella
    University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden / Mid Sweden University, Department of Health Sciences, Östersund, Sweden.
    Melin-Johansson, Christina
    University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden / Mid Sweden University, Department of Health Sciences, Östersund, Sweden.
    Development of an existential support training program for healthcare professionals2015In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 13, no 6, p. 1701-1709Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Our aim was to describe the developmental process of a training program for nurses to communicate existential issues with severely ill patients.

    METHOD: The Medical Research Council (MRC) framework for the development and evaluation of complex interventions was used to develop a training program for nurses to communicate about existential issues with their patients. The steps in the framework were employed to describe the development of the training intervention, and the development, feasibility and piloting, evaluation, and implementation phases. The development and feasibility phases are described in the Methods section. The evaluation and implementation phases are described in the Results section.

    RESULTS: In the evaluation phase, the effectiveness of the intervention was shown as nurses' confidence in communication increased after training. The understanding of the change process was considered to be that the nurses could describe their way of communicating in terms of prerequisites, process, and content. Some efforts have been made to implement the training intervention, but these require further elaboration.

    SIGNIFICANCE OF RESULTS: Existential and spiritual issues are very important to severely ill patients, and healthcare professionals need to be attentive to such questions. It is important that professionals be properly prepared when patients need this communication. An evidence-based training intervention could provide such preparation. Healthcare staff were able to identify situations where existential issues were apparent, and they reported that their confidence in communication about existential issues increased after attending a short-term training program that included reflection. In order to design a program that should be permanently implemented, more knowledge is needed of patients' perceptions of the quality of the healthcare staff's existential support.

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