Genom föreliggande litteraturstudie har författarnas kunskap i palliativ vård i största allmänhet, och den existentiella dimensionen i synnerhet, fördjupats. Innan litteraturstudien gjordes, hade författarna en bild av att sjuksköterskor inom palliativ vård ofta samtalade om död och döende och att detta gav många svåra känslor. Utförandet av litteraturstudien har dock nyanserat denna bild, då många sjuksköterskors erfarenheter visade att deras liv blev mer meningsfulla och genuina. En större förståelse för att en sjuksköterska inte alltid kan lindra och bota, utan att närvaro, aktivt lyssnande och empati kan vara nog för att stödja patienter med existentiella frågor, har inhämtats. En större förståelse för den holistiska omvårdnaden har givits, där de fyra dimensionerna, fysiska, mentala, sociala och existentiella inte bara adderas, utan även interagerar.
Författarna kände en osäkerhet för att möta patienter i livets slutskede och de samtal som skulle kunna uppkomma. Med kunskapen från litteraturstudien har osäkerheten minskat och det var betryggande att inse att palliativa patienter kunde finna frid och lugn trots att det inte fanns något hopp om överlevnad. Trots att osäkerheten minskat, finns ytterligare kunskapsbehov. Författarna upplever att den teoretiska kunskapen kring hanterandet av existentiella frågor i palliativ vård har ökat, men att det finns ett behov för författarna att implementera den i
praktiken, i möten och samtal med patienter.
Föreliggande litteraturstudie sammanställer en del av den befintliga forskningen på sjuksköterskors erfarenheter av existentiella frågor inom palliativ vård.
Resultatet tyder på att det finns en brist i sjuksköterskors utbildning i palliativ vård avseende hela människan. Dessutom tycks sjuksköterskor sakna tid för reflektion och debriefing. Ytterligare undersökande av den existentiella dimensionen och dess påverkan på sjuksköterskan skulle kunna bidra till förbättringar i sjuksköterskeutbildningen avseende den holistiska omvårdnaden vid palliativ vård. Vidare skulle studerande av existentiella frågor hos patienter kunna bidra till större förståelse för patienters upplevelser, och därigenom en mer personcentrerad och holistisk omvårdnad.
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BILAGA 1
SÖKSCHEMA
DATABAS: Cinahl
SYFTE: att sammanställa sjuksköterskors erfarenheter av existentiella frågor inom palliativ vård
POR: BLOCK SÖKORD ANTAL TRÄFFAR
P
1. Sök medOR mellan varje ord
SÖKORD (Mh) Nurses+ (S1) 234 967
SÖKORD (fritext) nurs* (S2) 934 992
RESULTAT block 1 (S1 OR S2 = S3) 939 210
O
2. Sök medOR mellan varje ord
SÖKORD (Mh) Palliative care (S4) 38 922
SÖKORD (Mh) Terminal care+ (S5)
68 905
SÖKORD (Mh) Hospice and palliative nursing (S6)
5372
SÖKORD (fritext) palliative care (S7)
47 945
SÖKORD (fritext) terminal care (S8) 25 438
SÖKORD (fritext) end of life care (S9) 48 159
RESULTAT block 2 (S4 OR S5 OR S6 OR S7 OR S8 OR S9 = S10) 80 980
R
3. Sök medOR mellan varje ord
SÖKORD (fritext) existential* (S11) 208
RESULTAT block 3 (S11) 208
25 SÖKSCHEMA
DATABAS: PsycInfo
SYFTE: att sammanställa sjuksköterskors erfarenheter av existentiella frågor inom palliativ vård
POR: BLOCK SÖKORD ANTAL TRÄFFAR
P
1. Sök medOR mellan varje ord
SÖKORD (Mh) nurses (S1) 34 444
SÖKORD (fritext) nurs* (S2) 187 315
RESULTAT block 1 (S1 OR S2 = S3) 187 315
O
2. Sök medOR mellan varje ord
SÖKORD (Mh) Hospice+ (S4) 3463
SÖKORD (Mh) Palliative care (S5)
15 278
SÖKORD (fritext) palliative care (S6)
21 236
SÖKORD (fritext) terminal care (S7)
7516
SÖKORD (fritext) end of life care (S8) 13 988
RESULTAT block 2 (S4 OR S5 OR S6 OR S7 OR S8 = S9) 29 729
R
3. Sök medOR mellan varje ord
SÖKORD (Mh) existential* (S10) 15 046
RESULTAT block 3 (S10) 15 046
5. Sökningar Antal träffar
Relevanta titlar
Lästa abstract
Lästa studier i fulltext
Valda studier till kvalitets- granskning
Valda studier till resultatet
Datum
1 AND 2 9023
(1 AND 2) AND 3
211
(1 AND 2 AND 3) + peer review
193 24 24 2 1 1
2021-11-15
26 SÖKSCHEMA
DATABAS: PubMed
SYFTE: att sammanställa sjuksköterskors erfarenheter av existentiella frågor inom palliativ vård
POR: BLOCK SÖKORD ANTAL TRÄFFAR
P
1. Sök medOR mellan varje ord
SÖKORD (Mh) Nurses (S1) 93 629
SÖKORD (fritext) nurs* (S2) 1 039 339
RESULTAT block 1 (S1 OR S2 = S3) 1 039 339
O
2. Sök medOR mellan varje ord
SÖKORD (Mh) Palliative care (S4) 58 622
SÖKORD (Mh) Terminal care (S5)
54 315
SÖKORD (Mh) Hospice care (S6)
7 192
SÖKORD (Mh) Hospice and palliative care nursing (S7)
1534
SÖKORD (fritext) palliative care (S8) 89 779
SÖKORD (fritext) terminal care (S9) 64 598
SÖKORD (fritext) end of life care (S10) 94 037
RESULTAT block 2 (S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 = S11) 155 752
R
3. Sök medOR mellan varje ord
SÖKORD (fritext) existential* (S12) 5961
RESULTAT block 3 (S12) 5961
5. Sökningar Antal träffar
Relevanta titlar
Lästa abstract
Lästa studier i fulltext
Valda studier till kvalitets- granskning
Valda studier till resultatet
Datum
1 AND 2 1578
(1 AND 2) AND 3
376 90 90 9 4 2
2021-11-15
27
BILAGA 2
Author, year, country
Aim Participants Method Result Quality
Browall M, situations when caring for patients in end-of-life cancer care.”
n=83 Nurses
Part of a larger study with 102 participants. In this part of the big study, 83 nurses chose to participate.
All participants were female, and the ages were between 24 and 64, with a mean age of 45.6 and a median of 48.
Critical Incident Technique.
Examples of critical incidents written by nurses were analysed using qualitative content analysis: meaning units were identified, condensed, and labelled with a code. Inductive design.
The data analysis resulted in two main themes: Encounters with existential pain experiences and Encountering experiences of hope.
High with ethical and existential issues through co-creation at the end of life in palliative home care.”
n=12 Nurses
Eleven female and one male nurse.
The age of the participants were between 23 and 64 years.
The study was conducted using hermeneutical approach. Written interviews were analysed using thematic analysis method.
One main theme: “Deep co-creative relationships are needed to manage ethical and existential issues at the end of life”. Four sub themes were identified.
“To describe the meanings of generalist registered nurses’ experiences of caring for palliative care patients on general wards in hospitals.”
n=8 Nurses
All participants were female. Age of the participants was not stated in the study
Interviews with an open ended question and a narrative approach.
Interviews were transcribed verbatim, analysed and divided into meaning units and themes.
Analysis resulted in seven themes such as “Being grateful to be able to share in the end of another’s life”,
“Being touched by physical and existential meaning”, “To exist in time and place” and four more.
High
28
Author, year, country
Aim Participants Method Result Quality
Karlsson M, Kasén A, Wärnå-Furu C 2015
Sweden
“To describe and gain a deeper understanding of nurses’ existential questions when caring for dying patients.”
Data were analysed using hermeneutic approach. It was read through, coded and interpreted in three levels.
The result of the analysis were divided into seven themes of which three were interpreted on an existential level: “Balancing between responsibility and guilt in relation to patients”, “Balancing between fear and courage in relation to being professional caregivers and human beings” and “Balancing between hope and despair…”
“To explore (from a variety of settings) Australian palliative care nurses’ perceptions of the
facilitators, barriers and strategies to provision of spiritual/ existential care to their patients.”
n=20
Nurses. 19 were female and one male.
The ages of the
The analysis resulted in themes such as “Nurse-patient relationship”, “Communication skills”, “Examples of questions palliative care nurses use to facilitate conversation” and also barriers and strategies.
High
“To describe the nurses’ reflections on existential issues in their communication with patients close to death.” were between 24 and 64 years old.
Five group reflection sessions á 90 min. These were recorded, transcribed and analysed using qualitative content analysis.
Data analysis resulted in three domains: the content, the process and the meaning of existential
conversations.
High
29
Author, year, country
Aim Participants Method Result Quality
Tornøe K A,
“To describe the meaning of hospice nurses’ lived experience with alleviating dying patients’ spiritual and existential suffering.”
n=8 Nurses
First eight to show interest were included as participants. These were in the ages of 41 to 61 years. Genders of the participants are unknown.
Method used was qualitative phenomenological hermeneutical. Participants were interviewed individually with one open ended question. Data were interpreted in three steps: naïve reading, structural analysis and critical comprehension.
The analysis resulted in two themes: “Consolation” and and existential care for dying patients in a general hospital.”
n=6 Nurses
First six to register for the study were selected. They were between the ages of 37 and 61 years old. No declaration of number of female and male participants.
Group interviews with open ended questions.
These were audio recorded, transcribed, and later analysed using phenomenological hermeneutical method: data was divided into meaning units, then themes and subthemes.
The analysis resulted in three themes: “The elusive entanglement of suffering”,
“spiritual and existential care”
and “conveying consolation”.
Medium high
30
Author, year, country
Aim Participants Method Result Quality
Vachon
“To better understand how palliative care nurses handle death proximity;
describe their subjective spiritual-existential experience; and explore the potential links between death
confrontation and spiritual-existential experience in nurses.”
n=11 Nurses
Ten nurses were female and one male.
The age span was from 39 to 55 years, with a mean age of 46,20.
Semi-structured interviews. Data analysed using an interpretative phenomenological method.
The result of the analysis was divided into sections: “Descriptive results:
Essential themes”, “Spiritual-existential experience” and “Caring attitudes”.
Medium
“To explore the existential process of becoming for nurses working closely with end-of-life and suffering patients.
The research questions are: How does working close to death affect nurses existentially? How do nurses experience opportunities for dealing with existential processes?”
Qualitative and explorative her- meneutic design based on four focus-group inter- views with experienced nurses (n22). Our aim was to develop insight into the nurses’ “existential life- changing experiences” through group discussions.
The focus-group interview provided access to nurses’ existential life-changing experiences. Through the interpretation process, four themes emerged: powerless witness to suffering, creating bonds of love, awakening existential questions, and seeking refuge and appreciation.
High