ABC of intensive care: Withdrawal of treatment

In this article the results of research undertaken to explore and describe the experience of Registered Nurses regarding the withdrawal of treatment from the critically ill patient in an Intensive Care Unit (ICU), are discussed. Withdrawal of treatment from a critically ill patient in an Intensive Care Unit (ICU) is a very traumatic experience for all those involved. The Registered Nurse has the most contact with all those who are involved throughout the process. This raises questions regarding how the nurse experiences the withdrawal of treatment, and about guidelines that can be developed to accompany the nurse during the process of treatment withdrawal. The study was qualitative, descriptive, exploratory, descriptive and contextual in nature. Data was gathered by means of phenomenological interviews conducted by the researcher. Trustworthiness was ensured through the implementation of Guba’s model (in Krefting 1991: 214). The following themes were identified: 1. The relationships the nurse develops with individuals involved in the process of treatment withdrawal. 2. The inner moral conflict experienced by the nurse relating to the ethical aspects of withdrawal of treatment. The focus of this article is on the discussion of these experiences of the registered nurses. Based on the identified themes, guidelines were developed to accompany the nurse during the process of withdrawal of treatment.

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Ethical and practical considerations of withdrawal of treatment in the Intensive Care Unit

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/bf03012952 ◽

1999 ◽

Vol 46 (5) ◽

pp. 497-504 ◽

Cited By ~ 15

Author(s):

Gregg M. Eschun ◽

Eric Jacobsohn ◽

Daniel Roberts ◽

Barney Sneiderman

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Withdrawal Of Treatment

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Withdrawal of treatment in the Intensive Care Unit

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/bf03012937 ◽

1999 ◽

Vol 46 (5) ◽

pp. 405-408 ◽

Cited By ~ 2

Author(s):

Charles J. Wright

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Withdrawal Of Treatment

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The controlled death: withdrawal of treatment in the intensive care unit

Australian Critical Care ◽

10.1016/s1036-7314(96)70338-7 ◽

1996 ◽

Vol 9 (1) ◽

pp. 34

Author(s):

B. Copnell

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Withdrawal Of Treatment

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Withholding or withdrawal of treatment under French rules: a study performed in 43 intensive care units

Annals of Intensive Care ◽

10.1186/s13613-015-0056-x ◽

2015 ◽

Vol 5 (1) ◽

Cited By ~ 34

Author(s):

Olivier Lesieur ◽

◽

Maxime Leloup ◽

Frédéric Gonzalez ◽

Marie-France Mamzer

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Withdrawal Of Treatment

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Withdrawal of Treatment in a Pediatric Intensive Care Unit at a Children’s Hospital in China: A 10-year Retrospective Study

10.21203/rs.2.24029/v4 ◽

2020 ◽

Author(s):

Huaqing Liu ◽

Dongni Su ◽

Xubei Guo ◽

Yunhong Dai ◽

Xingqiang Dong ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Interquartile Range ◽

Published Data ◽

Children's Hospital ◽

Parental Decision Making ◽

Withdrawal Of Treatment ◽

Children’S Hospital

Abstract Background: Published data and practice recommendations on end-of-life care generally reflect Western practice frameworks; there are limited data on withdrawal of treatment for children in China. Methods: Withdrawal of treatment for children in the pediatric intensive care unit (PICU) of a regional children’s hospital in eastern China from 2006 to 2017 was studied retrospectively. Withdrawal of treatment was categorized as medical withdrawal or premature withdrawal. The guardian’s self-reported reasons for abandoning the child’s treatment were recorded from 2011. Results: The incidence of withdrawal of treatment for children in the PICU decreased significantly; for premature withdrawal the 3-year average of 15.1% in 2006–2008 decreased to 1.9% in 2015–2017 (87.4% reduction). The overall incidence of withdrawal of care reduced over the time period, and withdrawal of therapy by guardians was the main contributor to the overall reduction. The median age of children for whom treatment was withdrawn increased from 14.5 months (interquartile range: 4.0–72.0) in 2006 to 40.5 months (interquartile range: 8.0–99.0) in 2017. Among the reasons given by guardians of children whose treatment was withdrawn in 2011–2017, “illness is too severe” ranked first, accounting for 66.3%, followed by “condition has been improved” (20.9%). Only a few guardians ascribed treatment withdrawal to economic reasons. Conclusions: The frequency of withdrawal of medical therapy has changed over time in this children’s hospital PICU, and parental decision-making has been a large part of the change.

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Compassionate care during withdrawal of treatment: A secondary analysis of ICU nurses' experiences

Nursing Ethics ◽

10.1177/0969733016687159 ◽

2017 ◽

Vol 25 (8) ◽

pp. 1075-1086 ◽

Cited By ~ 2

Author(s):

Nikolaos Efstathiou ◽

Jonathan Ives

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Secondary Analysis ◽

Treatment Withdrawal ◽

Primary Study ◽

Compassionate Care ◽

Large Hospital ◽

Data Set ◽

Withdrawal Of Treatment ◽

The Family

Background: Withdrawal of treatment is a common practice in intensive care units when treatment is considered futile. Compassion is an important aspect of care; however, it has not been explored much within the context of treatment withdrawal in intensive care units. Objectives: The aim was to examine how concepts of compassion are framed, utilised and communicated by intensive care nurses in the context of treatment withdrawal. Design: The study employed a qualitative approach conducting secondary analysis of an original data set. In the primary study, 13 nurses were recruited from three intensive care units within a large hospital in United Kingdom. Deductive framework analysis was used to analyse the data in relation to compassionate care. Ethical considerations: The primary study was approved by the local Research Ethics Committee and the hospital’s Research and Development services. Findings: Compassionate care was mostly directed to the patient’s family and was demonstrated through care and emotional support to the family. It was predominantly expressed through attempts to maintain the patient’s dignity by controlling symptoms, maintaining patient cleanliness and removing technical apparatus. Conclusion: This study’s findings provide insight about compassionate care during treatment withdrawal which could help to understand and develop further clinicians’ roles. Prioritising the family over the patient raised concerns among nurses, who motivated by compassion, may feel justified in taking measures that are in the interests of the family rather than the patient. Further work is needed to explore the ethics of this.

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