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  • Institutionen för Neurobiologi,

    Vårdvetenskap och Samhälle

    Sektionen för omvårdnad

    Sjuksköterskeprogrammet

    Examensarbete i omvårdnad 15 hp

    _____________________________________________________________

    Palliative cancer care in Uganda

    The Nurse experience

    Palliativ cancervård i Uganda

    Sjuksköterskors erfarenheter

    Författare: Karoline Ekblad och Sara Dorrian

    Handledare: Lena Wettergren, Institutionen för Neurologi, Vårdvetenskap

    och Samhälle

    Examinator: Kristiina Heikkilä, Institutionen för Neurologi, Vårdvetenskap

    och Samhälle

  • Sammanfattning

    Bakgrund: Cancer ökar globalt och Uganda är ett av de länder som är beräknat att drabbas

    påtagligt av ökningen. Cancervård i Uganda är underfinansierat och omkring 30 % av

    cancerpatienter i låginkomstländer som till exempel Uganda får palliativvård. Sjuksköterskan

    har en nyckelroll inom den givna cancervården.

    Syfte: Syftet med studien var att beskriva palliativ cancervård i Uganda utifrån

    sjuksköterskors erfarenheter.

    Metod: En kvalitativ metod har använts. Data har samlats in genom semistrukturerade

    intervjuer med sex sjuksköterskor anställda på Ugandas cancer institut. Ett bekvämlighets

    urval användes och informerat samtycke erhölls. Intervjuerna transkriberades och data

    analyserades med hjälp av så kallad kvalitativ innehållsanalys.

    Resultat: Följande tre kategorier utgjorde resultatet: Utmaningar, Lindra lidande och

    Betydande relationer.

    Slutsats: Att ge cancervård i Uganda innebär ett flertal utmaningar. Underfinansiering leder

    till att patienter avlider till följd av brist på nödvändiga resurser. Patienters lidande kan lindras

    genom smärtlindring och interaktion. Sjuksköterskorna kommer patienterna nära och blir

    beroende av anhöriga i omvårdnaden.

  • Abstract

    Background: Cancer is increasing globally and Uganda is estimated to be particularly

    effected. Cancer care in Uganda is underfunded and about 30 % of the cancer patients in low-

    income countries such as Uganda are being given palliative care. Nurses play a core role in

    providing the care to the patients.

    Aim: The aim of the study was to describe palliative cancer care in Uganda as shown through

    the nurse experience.

    Method: A qualitative method was used and the data was collected by semi-structured

    interviews with six nurses working at the UCI. The sample was selected using convenience

    sampling and informed consent was obtained. The interviews were transcribed and the data

    was analysed using content analysis.

    Results: The three following categories constitute the result: The challenges, Easing suffering

    and Significant relationships.

    Conclusion: Cancer care in Uganda is seen to face major challenges. The financial

    underfunding leads to lack of necessary resources, and it so happens patients die due to severe

    shortages. Patient suffering is eased by pain control and interaction. The nurses become

    attached to the cancer patients and the caregivers are needed to provide acceptable care.

  • Acknowledgements

    We would like to thank Jackson Orem and Victoria Walunsansa at the Uganda Cancer

    Institute (UCI) for generously allowing us to carry out our study and all the staff involved for

    their valuable help. To our supervisors, Lena Wettergren, Rose Nabirye and Allen Naamala,

    we would like to give a deep appreciation of the encouragement and guidance you gave us.

    Also we would like to thank Tom Ngabirano for his appreciated assistance. We wish to

    express our gratitude toward the Department of womens and childrens health at Uppsala

    University and the Swedish International Development Cooperation Agency (SIDA) who

    granted us minor field study (MFS) scholarships. Last but not least a special thanks to our

    families and friends for their love and support.

  • Table of Contents

    1. Introduction ............................................................................................................................ 1

    2. Background ............................................................................................................................ 2

    2.1 The cancer burden ........................................................................................................ 2

    2.2 Health care in Uganda .................................................................................................. 2

    2.3 Cancer care in Uganda ................................................................................................. 3

    2.4 Palliative care ............................................................................................................... 3

    2.5 Problem statement ........................................................................................................ 4

    3. Aim ......................................................................................................................................... 5

    4. Method ................................................................................................................................... 6

    4.1 Data collection .............................................................................................................. 6

    4.2 Data analysis ................................................................................................................ 6

    4.3 Ethical considerations .................................................................................................. 7

    5. Results .................................................................................................................................... 8

    5.1 The challenges .................................................................................................................. 8

    5.1.1 Poverty ...................................................................................................................... 8

    5.1.2 Lack of resources ...................................................................................................... 9

    5.1.3 Lack of staff .............................................................................................................. 9

    5.1.4 Patients lack of knowledge regarding cancer .......................................................... 10

    5.1.5 Wish for specialisation ............................................................................................ 10

    5.2 Easing suffering .............................................................................................................. 10

    5.2.1 Holistic perspective ................................................................................................. 10

    5.2.2 Pain control ............................................................................................................. 10

    5.2.3 Interaction ................................................................................................................ 11

    5.3 Significant relationships ................................................................................................. 11

    5.3.1 Attachment .............................................................................................................. 11

    5.3.2 Depending on caregivers ......................................................................................... 11

    6. Discussion ............................................................................................................................ 12

    6.1 Method discussion ...................................................................................................... 12

    6.2 Result discussion ........................................................................................................ 13

    6.3 Relevance for nursing science and society ................................................................. 14

    6.4 Conclusion .................................................................................................................. 15

    References ................................................................................................................................ 16

    Appendix 1 ............................................................................................................................... 19

    Appendix 2 ............................................................................................................................... 21

  • 1

    1. Introduction The idea to conduct our bachelor thesis abroad developed during an exchange program we

    participated in Sydney in the spring of 2012. We were both intrigued by practising health care

    outside Sweden. Our curiosity and interest lead us to contact a teacher and professor at the

    Nursing department at Karolinska Institutet who was conducting research in Uganda. This

    resulted in the UCI agr