”Nu kom munvårdbrickan fram” – En studie om sjuksköterskors erfarenheter av palliativ brytpunkt på äldreboende.

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Sammanfattning: Background: The term transition is often used in health care to describe transitions between different phases of a disease. The transition to palliative care refers to the transition from the medical care being curing to relieve suffering. In the elderly person, the dying process may be more elaborate and look different than to younger people (Socialstyrelsen, 2013). A palliative approach is applicable to all dying processes and all dying persons in Sweden are entitled to palliative care regardless of diagnosis, age or housing/care form (Socialdepartementet, 2001). Nurses at nursing homes are uncertain of their authorities and experience their role as unclear, which makes the palliative care scary (Reimer-Kirkham et al., 2016). They feel lonely and vulnerable when the elderly approach the end of life (Törnquist et al., 2012). For the staff at nursing homes it’s important that the nursing home is a place to live, not to die (Cable-Williams & Wilson, 2017) and they are afraid to talk with elderly and their relatives about death and dying. Instead, they focus on living here and now, this until just before the old person will die (Beck et al., 2011). Early introduction of palliative care results in better care at the end of life and a better dying process (Smedbäck et al., 2017). There is a need for nurses to be mandated to determine the need for palliative measures early in the process, the responsibility should not only be the doctors alone (Reimer-Kirkham et al., 2016).Aim: To describe nurses' experiences of when and how the transition to palliative care is initiated in nursing homes.Methods: Qualitative method, four focus group interviews with registered nurses conducted at nursing homes in Gothenburg in December 2017 and January 2018.Results: Overall, the result shows that nurses in nursing homes experience that transition to palliative care is initiated too late and that dying is not acknowledged as a process. The analysis was done under four themes where eleven categories were identified, themes were: characteristics; the dying person; relatives and team. Nurses’ experience that the teamwork is malfunctioning, we use different languages. Nurses believe that they take great responsibility in the transition to palliative care, including responsibilities that should belong to the doctor. Nurses possess the knowledge of when and how transition to palliative care should be initiated but not mandated to be a ruler of the process.Conclusion: Nurses experience that they have the knowledge of when and how the transition to palliative care should be initiated for the elderly patient, but they lack the mandate and tools in this process. There are obstacles in the team work, which means that the transition to palliative care is initiated too late in nursing homes.

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