När svåra beslut måste fattas kring vård i livets slutskede - En systematisk litteraturöversikt över upplevelser av det interprofessionella samarbetet inom intensivvården

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Sammanfattning: Background: End-of-life care is a common part of the work within the intensive care unit. The transitioning process from an active treatment to end-of-life care demands a decision made by the responsible physician. This decision changes the path of the care from life supportive treatment to palliative care. The process of making this decision begins when the active treatment is no longer assessed as appropriate for the patient. The entire team surrounding the patient, including intensive care nurses and physicians, should be a part of making this decision by contributing with the expertise within their fields. Aim: The aim of this study was to examine the experiences of intensive care nurses and physicians involved in end-of-life decision-making in the intensive care unit. Method: A systematic review based on qualitative research studies was conducted. Result: End-of-life decisions are described as a complex process. The result in this study claims that there are different opinions between intensive care nurses and physicians regarding shared decision-making, and the participation of nurses. Several of the intensive care nurses and physicians in the articles describe this process as time consuming because of the involvement of the entire team. It is also said that documentation of the treatment plan was not clear enough. Intensive care nurses and physicians raised important factors facilitating the collaboration during the process of end-of-life decisions. Open communication, clear documentation and a working climate that enables communication was perceived as contributing factors. Conclusion: Intensive care nurses and physicians experience difficulties when decisions are made regarding end-of-life care. The decision is complex, and the timing of the decision is complicated. The involvement of the entire team during end-of-life discussion is perceived as different between physicians and intensive care nurses. Positive interprofessional communication with a positive working climate is an important part of collaboration during end-of-life care decisions.

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