Kathleen M. Stacy

Withdrawal of life support is an option for patients with prolonged mechanical ventilation when all attempts at weaning have failed and it is deemed futile to continue the therapy, when quality of life is unacceptable, or when it is perceived that the patient is suffering. The purpose of this article is to present the nursing aspects of managing an adult patient undergoing the withdrawal of mechanical ventilation as an end-of-life procedure. Withdrawal of mechanical ventilation is a complex and difficult process that requires meticulous planning and management. Conferences with the patient and the patient’s family are critical to addressing emotional support and ensuring that everyone understands the process and is provided an opportunity to gather information. Clear communication with patients and their families can ensure that the process goes smoothly. Having an organized approach can ensure that patients experience a peaceful death and staff experience closure regarding the event.

Progressive care units are increasingly common in hospitals in the United States. These units are often used to bridge the gap between intensive care units and medical-surgical units, with the goal of providing cost-effective, high-quality, safe care. Although progressive care units today may seem to provide care for a wide variety of patients, these patients do share certain typical features: they require a high intensity of nursing care and/or a high level of surveillance. Nurses working in progressive care units all must have certain basic competencies. Those core competencies have been identified and should form the basis for education and training of progressive care nurses.