BACKGROUND: Nurses are present at the bedside of patients undergoing withdrawal of life support more often than any other member of the health care team, yet most publications on this topic are directed at physicians. OBJECTIVES: To describe the training, guidance, and support related to withdrawal of life support received by nurses in intensive care units in the United States, how the nurses participated, and how the withdrawal of life support occurred. METHODS: A questionnaire about withdrawal of life support was sent to 1000 randomly selected members of the American Association of Critical-Care Nurses, with 2 follow-up mailings. RESULTS: Responses were received from 48.4% of the nurses surveyed. Content on withdrawal of life support was required in only 15.5% of respondents' basic nursing education and was absent from work site orientations for 63.1% of respondents. Nurses' actions during withdrawal were most often guided by individual physician's orders (63.8%), followed by standardized care plans (20%) and standing orders (11.8%). Nurses rated the importance of emotional support during and after the withdrawal of life support very highly, but they did not believe they were receiving that level of support. Most respondents (87.5%) participated in family conferences where withdrawal of life support was discussed. After physicians, nurses were most influential concerning administration of palliative medications. Patients' families were present during withdrawal procedures between 32.3% and 58.4% of the time. CONCLUSIONS: To improve their practice, intensive care nurses should receive formal training on withdrawal of life support, and institutions should develop best practices that support nurses in providing the highest quality care for patients undergoing this procedure.
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