Etisk support inom akutsjukvård och intensivvård

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Sammanfattning: Background: Health care personnel often face ethically difficult situations in their work with patients. The ethical difficult situations that occurs, can be questions regarding lifesustaining treatment by a critical ill patients, patients autonomi to conflics between health care personnel and surrogates. The way of facilitate clinical ethical support has developed in different directions in the health care sektor during the last 30 years over the world and many studies describes how the support works within different specialities, outcome and how the health care team and sometimes surrogatesexperiences the ethical support. There is not as much research done about ethical support in critical- and intensive care.Aim: The aim of this study was to examine theoretical and empirical studies about where and when ethical support was used, also how ethical support can contribute in critical- and intensive care.Method: An integrative literature review with thematic analysis was conducted on quantitative and qualitative data with a systematically performed search and data analysis.Result: In the analysis of 22 articles, the theme organisation of ethical support with subtheme initiation and a changed time of care emerge. Another theme was the experience of ethical support and which dilemmas the health care staff and surrogates experiencedduring ethics consultation and ethics rounds.Conclusion: The studies showed mostly positive experiences of the support and where associated with reduced hospital and ICU-days and also useful in resolving conflicts that may have prolonged nonbeneficial treatments in the intensive care. Ethics rounds and Moral Case Deliberation led to a broadened insight about ethicsand critical reflection. It also improved teamwork because of inceased understanding, tolerance and dialoge and improved care of the patients.

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