Sjuksköterskans upplevelse av omvårdnad för patienter med existentiell smärta vid vård i livets slutskede : En litteraturöversikt

Background: Palliative care aims to alleviate the suffering and bring quality of life to patients who have an incurable disease diagnosis. Patients who are in need of palliative care can usually experience different dimensions of pain. Suffering in the form of existential pain can lead to strong emotions such as death anxiety and hopelessness. Several studies have shown that existential pain is not as noticed as other dimensions of pain and thus increased knowledge is needed about this form of pain. Aim: The aim of the study was to describe the nurse's experience of nursing for patients with existential pain in end-of-life care. Method: A literature review conducted with a qualitative approach. Ten articles were identified and analyzed using a thematic analysis. Result: Two themes and four subthemes were identified. Existential care with subthemes communication between nurse and patient and person-centered care. The second theme was emotional challenge with subthemes conveying hope and approach towards patients. Conclusion: The delivering of existential care in the case of existential pain can be considered challenging for the nurse where many aspects and dimensions must be taken into consideration, such as the nurses’ feelings of exhaustion and powerlessness.Bakgrund: Palliativ vård har i syfte att lindra lidandet och förbättra livskvalitén hos patienter som har en obotlig sjukdomsdiagnos. Patienter som är i behov av palliativ vård kan oftast uppleva olika dimensioner av smärta. Lidande i form av existentiell smärta kan leda till starka känslor som dödsångest och hopplöshet. Flera studier har påvisat att den existentiella smärtan inte är lika uppmärksammad som övriga dimensioner av smärta och därmed behövs utökad kunskap kring denna form av smärta. Syfte: Syftet med studien var att beskriva sjuksköterskans upplevelse av omvårdnad för patienter med existentiell smärta vid vård i livets slutskede. Metod: En litteraturöversikt genomförd med kvalitativ ansats. Tio artiklar identifierades och analyserades med en tematisk analys. Resultat: Två teman och fyra subteman identifierades. Existentiell omvårdnad med subteman kommunikation mellan sjuksköterska och patient samt personcentrerad vård. Det andra temat var emotionell utmaning med subteman förmedla hopp och bemötande gentemot patienter. Slutsats: Förmedling av existentiell omvårdnad vid existentiell smärta kan anses vara utmanande för sjuksköterskan där fler aspekter och dimensioner bör beaktas, som exempelvis känslor av utmattning och maktlöshet hos sjuksköterskan.

Modification of Microstructure and Tensile Property of Sintered Fe-Cr-Mo-C Steel by Nickel Addition

Nickel is one of the alloying elements promoting the formation of acicular ferrite at the expense of proeutectoid ferrite. The Ni addition reduces the steady-state nucleation rates of grain boundary ferrite allotriomorph in Fe-C-Ni alloys. Due to such reasons, Ni was added to modify the microstructure of the sintered steel, investigated in this study, with the aim of improved mechanical properties. The sintered steel, produced from pre-alloyed Fe-Cr-Mo powder mixed with 0.3 wt.% C, was modified by Ni addition and cooling rate. The alloy compositional change was performed additions of varied Ni contents of 1.0, 1.5, 2.0, 2.5 and 3.0 wt.%. The material processing variables were investigated by using two different cooling rates of 0.1 and 5.4 °Cs-1. Under the cooling rate of 0.1 °Cs-1, the sintered Fe-Cr-Mo-3C steel without Ni addition showed dual-phase microstructure consisting of ferrite (soft phase) and bainite (hard structure). With Ni additions, the dual-phase microstructure was replaced by bainitic structure. Microstructural heterogeneity was observed due to the presence of Ni-rich areas, which increased with increasing added Ni contents. Under the cooling rate of 5.4 °Cs-1, the sintered Fe-Cr-Mo-3C steels with and without Ni additions showed bainitic structure. Microstructural heterogeneity was similar to that of slowly cooled steel. Ni additions not only modified the sintered steel microstructure but increased tensile strength and elongation. In general, Ni pushes the C-curve of pearlite transformation to the right hand side and lowers the martensite start temperature. The absence of ferrite from the sintered steel with only 1 wt.% Ni addition and slowly cooled at 0.1 °Cs-1 suggests that Ni strongly suppresses the austenite → ferrite transformation. In another word, Ni promotes bainite formation in the sintered Fe-Cr-Mo-Ni-C steels.</jats:p

Effect of Aluminum Addition on Al&lt;sub&gt;x&lt;/sub&gt;CoFeMnNiZn Multi-Component Production

Five multi-component alloy (MCA) formulations of CoFeMnNiZn (MCA01), Al0.5CoFeMnNiZn (MCA02), Al1.0CoFeMnNiZn (MCA03), Co5Fe5Mn30Ni20Zn40 (MCA04) and Al8.4Co4.6Fe4.6Mn27Ni18.4Zn37 (MCA05) were prepared by mechanical alloying and melting process (MAM). Five-component alloys of MCA01-MCA05 were designed using empirical formulae for high entropy alloys. Phase formation and microstructure were evaluated by X-ray diffraction (XRD) and scanning electron microscopy (SEM). The results showed that MCA01 was partially melted by MAM process. However, MCA02-MCA05 could be melted and cast by MAM process. The microstructures of as-cast MCA02 and MCA03 showed dendritic solidification. Nevertheless, the as-cast MCA04 showed microstructure similar to that of Ni-based superalloy, i.e., the as-cast MCA04 consisted of γ matrix and γ′ phase. Moreover, egg type core shell structure was found in the interdendritic regions of the MCA05 alloy. In addition, the Al-added MCA02 and MCA03 alloys showed crystal structures of FCC1, FCC2 and BCC. MCA04 alloy demonstrated crystal structure of FCC whereas MCA05 alloy had crystal structures of FCC and Primitive Cubic.</jats:p

Effect of non-reactive hard particles on sintered Fe material

The presence of non-reactive hard particles (Al2O3) causes some effects on P/M processing of sintered Fe materials.With constant compacting pressure and sintering conditions, particle size and quantity of Al2O3 particles caused reduction of green and sintered densities. Tensile strengths, elongation and hardness of the sintered material were maximum when 2 wt.%of Al2O3 particles with particle size between 20-32 um was added. The presence of Al2O3 particles may reduce sinterability of the Fe powder

The effect of molybdenum on the microstructure and mechanical behaviour of the sintered Fe-Mo-Mn-Si-C composite

Abstract Experimental sintered Fe-Mo-Mn-Si-C composites were prepared from 3 different pre-alloyed Fe-Mo-Mn powders, namely Fe-0.50Mo-0.15Mn, Fe-0.85Mo-0.15Mn and Fe-1.50Mo-0.15Mn, mixed with fixed 4 wt.% silicon carbide powder. Sintered Fe-SiC composite was also prepared, as a reference material, from pure Fe powder mixed with fixed 4 wt.% silicon carbide powder. All specimens were processed by using the ‘press and sinter’ method. Sintering was performed in a vacuum furnace at 1250ºC for 45 minutes and slow cooling in the furnace. The microstructures of most sintered alloys showed a common feature consisting of a black particle enveloped with ferrite and pearlite. Sintered composites produced from high-molybdenum powders showed different matrices, in which some pearlite regions were replaced by BF/M- A structures. The Tensile and hardness test showed that the sintered alloys exhibited an increase of tensile strength, yield strength, and hardness with increasing molybdenum content. The pearlite + BF/M-A fractions of sintered composites played important roles in material strengthening. In the sintered composites produced from high-molybdenum powders, the carbide-free BF/M-A structure showed a promising strengthening effect.</jats:p

The Effect of SiC p

In this study, corrosion and wear behaviors of PM 316L matrix composite materials reinforced with SiC particles in amounts of 10 vol% are evaluated. The samples are uniaxially cold pressed, and then sintered by two different methods, conventional sintering and microwave sintering. Corrosion properties are evaluated by both immersion and cyclic polarization tests. Wear properties are evaluated by dry sliding wear tests. Brinell and Vickers microhardness tests are applied, in order to support the wear test results. The results show that 10 vol% SiCp reinforced composite samples have acceptable corrosion properties and improved wear resistence in a similar manner, as they show good mechanical properties. In addition, microwave sintering results in better wear properties compared to conventional method