Cara Engstrom

March 23, 2023

NURS 450

Withdrawal of Life Support Discussion Board

Initial Post:

The terminal weaning process involves withdrawing life-saving measures (also referred

to as life support) due to a patient’s critical condition that is not improving and their quality of

life is minimal (Orr et al., 2022). It includes gradually reducing a patient’s oxygen levels and

ventilation status to the point where it is their own body that controls it, which typically leads to

their inevitable passing from said health condition.

Mechanical ventilation is used to improve a patient’s ventilation and perfusion while their

underlying health condition is managed by medical staff (Hoffman & Sullivan, 2020). It does not

cure a patient’s poor respiratory status or poor tissue perfusion, but it allows the patient to

decrease their breathing workload while treating the primary pathophysiological issue at hand

(Hoffman & Sullivan, 2020). However, mechanical ventilation can be withdrawn when a patient

and their family decide to undergo the terminal weaning process and the provider places the

orders to do so. This involves first assessing the patient’s baseline status, then following the

facility’s specific protocol/provider’s orders to the terminal weaning of mechanical ventilation

(Orr et al., 2022). The respiratory team is contacted to help initiate the weaning process and

oversee ventilation management. They’ll typically give medications prior to extubating. The

physician removes the endotracheal tubing from the patient who is intubated and then the

timeline of when the patient passes is individualized. It can be a couple hours or days after

removing the mechanical ventilation when the patient passes (Orr et al., 2022). Patients are
typically given medications to ease the process and make them more comfortable and avoid

distress, like analgesics and fentanyl for pain and Ativan for anxiety (Orr et al., 2022). The

nurses will provide education to the families regarding this process and the transition to comfort

care.

An integrative nursing modality that can be used to enhance the client’s comfort during

withdrawal of care includes music therapy. Music can ease the stress and anxiety the patient may

experience when having their care withdrawn. It can provide an additional sense of comfort and

ease as they transition to comfort care. It can also be therapeutic to the families as they celebrate

their loved one and take in the last moments they may have together. It can also be done in a

spiritual/religious way for those that want a religious/spiritual experience as they pass. Music can

provide a healing environment for the family as they process their loved one’s withdrawal of care

and for the patient who is saying their goodbyes.

If the families are unable to be present during this process, what other integrative

therapies can be done to make the patient feel less alone and comforted when they are

transitioning to comfort care and in the process of passing?

Reference

Hoffman, J. & Sullivan, N. (2020). Medical-Surgical nursing: Making connections to practice

(2nd ed.). F. A. Davis.

Orr, S., Efstathiou, N., Baernholdt, M., & Vanderspank-Wright, B. (2022). ICU clinicians’

experiences of terminal weaning and extubation. Journal of Pain and Symptom

Management, 63(5), e521-e528. Https://doi.org/10.1016/j.jpainsymman.2022.01.016.

Response Post:

Hi Nellie. Great job on this week’s discussion post. A possible ethical dilemma that can

occur during the weaning process of vasoactive medications is the families of the patient/medical

power of attorney not understanding that the quality of their loved one’s life is minimal and their

health condition is deteriorating regardless of treatment. It is completely understandable that

making the choice to withdrawal a loved one’s care is emotionally difficult and heartbreaking.

However, as the nurse, it is important to educate the families on the patient’s condition and how

their best chance to say their goodbyes could be withdrawing their care and allowing them a

chance to be more alert and oriented when transitioning to pass away. It can provide closure to

both the families and the patients.

I agree that the use of therapeutic touch, like through Reiki, can be an integrative

technique used to support the patients and their families during this process. This is because of

the integrative nursing principle #2, that refers to humans having the innate ability for healing

and improving their health and wellbeing (Kreitzer & Koithan, 2019). A therapeutic touch to the

patient or their family can ground them and provide a sense of comfort and ease during this

emotionally difficult time for everyone involved.

I also found that music therapy can provide this same sense of comfort and ease. People

listen to music in every aspect of their life, for every emotion- happiness, sadness, celebration,

etc. It can be used as a form of therapy for the families grieving the loved one being withdrawn

from care and the patients who are experiencing this transition and saying their goodbyes to their

loved ones.
How would withdrawing vasoactive medication affect healthcare costs of the patient

transitioning to comfort care? And when would withdrawing vasoactive medications be

considered best practice?

One thing you did well on this week was introducing a new form of integrative therapy,

Reiki, that I was previously unfamiliar with. Something to work on is to offer further questions

for discussion in your post. A pearl of wisdom I have learned from this week is the importance of

family support from the nursing staff. This can be done by keeping them continuously updated

on their family member’s condition and conducting therapeutic communication with them when

having those difficult conversation.

Reference

Kreitzer, M. J. & Koithan, M. (2019). Integrative nursing. New York: Oxford Press.