Introduction: Withdrawal of life-sustaining measures occurs frequently in ICUs. Families who choose to be present at the bedside during withdrawal are placed in a unique and stressful situation. Families have identified that preparation would improve their experience since they did not know what to expect.
Purpose: The purpose of this study was to learn how ICU nurses have prepared families for withdrawal.
Design: This was a descriptive study.
Sample and settings: This study used a convenience sample of 64 intensive care nurses from four ICUs located at three hospitals (one rural and two urban) in a mid-western community.
Concept or variables studied: The Self-Regulation Theory (SRT) has been extensively used to formulate Concrete Objective Information for patients undergoing diagnostic procedures or surgery. The features of the Concrete Objective Information are: physical observations, temporal characteristics, environmental, and the causes of sensations, symptoms, and experiences (Johnson, 1999). The theory is now beginning to be used with families of patients and has been used in this study.
Method: A two-page "Preparing Families for Withdrawal" questionnaire was developed using the four features of the SRT. The physical observation feature was expanded to include body systems and definitions were provided for the other three features. The subjects were asked to complete the questionnaire.
Findings: Thirty-one out of 64 questionnaires were returned. Forty-three descriptors or common themes were identified from nurses' responses to the items in the questionnaire out of which eight descriptors were mentioned by 50% or more of the nurses. Breathing pattern, sound during breathing, and effort associated with breathing, color, temperature changes related to skin, loss of bowel control/incontinence, the variable time frame for death to occur, and varying levels of consciousness at withdrawal were descriptors mentioned by more than 50% of the nurses.
Conclusion: Nurses commonly focus on the physical sensations and symptoms while preparing families with less focus on other concrete objective features.
Implication: This study identified a need for developing comprehensive preparatory information for families in order to better prepare them for the experience of withdrawal of life support with more focus on the temporal characteristics, environmental features, and cause of sensations, symptoms and experience.
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