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American Journal of Critical Care. 2008;17: 113-121
Copyright © 2008 by the American Association of Critical-Care Nurses.
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CE Article

Preparing Families of Intensive Care Patients for Withdrawal of Life Support: A Pilot Study

By Karin T. Kirchhoff, RN, PhD, Jenna Palzkill, RN, BS, Jennifer Kowalkowski, RN, BS, Anne Mork, RN, BS and Elfa Gretarsdottir, RN, MS. Karin T. Kirchhoff is a professor and Rodefer Chair in the School of Nursing at the University of Wisconsin, Madison. Jenna Palzkill is a staff nurse at St. Mary’s Hospital in Madison, Wisconsin. Jennifer Kowalkowski is a master’s student in the School of Nursing, University of Wisconsin, Madison. Anne Mork is the patient care coordinator in the trauma life support unit at University of Wisconsin Hospital in Madison. Elfa Gretarsdottir is now in Boston, Massachusetts, and was a master’s student in the School of Nursing, University of Wisconsin, Madison, during the study.

Corresponding author: KarinT. Kirchhoff, RN, PHD, FAAN,Box 2455 K6/358 CSC, School of Nursing, University of Wisconsin, Madison, WI 53792-2455 (e-mail: ktkirchhoff @wisc.edu).

Background Most deaths in intensive care occur after withdrawal of life support. Although preparation of patients’ families is recommended, the specific information required has not been theoretically developed or tested.

Objective To assess the feasibility of testing 4 tailored messages to prepare families of patients having a planned withdrawal of life support, to assess barriers to conducting such a study, and to obtain preliminary data on measurable effects that could be used to compare such preparation with usual care. Self-regulation theory was used to structure the messages.

Methods Families were randomly assigned to usual care (n=10) or to an intervention group (n=10) that received 1 of 4 tailored messages to prepare them for withdrawal of life support. They were contacted 2 to 4 weeks later to complete the Profile of Mood States and to give their evaluation of the experience, inclusive of the information received.

Results Compared with the usual-care group, the intervention group was significantly more satisfied with the information they received and understood better what was to happen. The intervention group had lower negative mood scores and higher positive mood scores than did the usual-care group, although the difference was not significant. Unsolicited comments by the usual-care participants were requests for the specific information that had been received by the intervention group.

Conclusions The information provided was considered helpful. A larger sample might yield more significant differences. Further work is needed on other aspects of preparation such as healthcare support, spiritual issues, and preparation for funeral arrangements.

Notice to CE enrollees:
A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe components of end-of-life preparedness.
  2. Recognize the clinical findings and variables related to time until death following withdrawal of life support.
  3. Understand Johnson’s self-regulatory theory as it relates to withdrawal of care in the ICU setting.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.


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Home page
 Am J Crit CareHome page
L. Bell
Preparing ICU Families for Withdrawal of Life Support
Am. J. Crit. Care., March 1, 2008; 17(2): 123 - 123.
[Full Text] [PDF]


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Copyright © 2008 by the American Association of Critical-Care Nurses.