title: An integrative review of how families are prepared for, and supported during withdrawal of life-sustaining treatment in intensive care.
abstract: OBJECTIVE
  The aim of this study was to conduct an integrative review on how nurses prepare families for and support families during withdrawal of life-sustaining treatments in intensive care.
  
  
  BACKGROUND
  End-of-life care is widely acknowledged as integral to the practice of intensive care. However, little is known about what happens after the decision to withdraw life-sustaining treatments has been made and how families are prepared for death and the dying process.
  
  
  METHODS
  Integrative literature review.
  
  
  METHODS
  MEDLINE, CINAHL Plus, PsychINFO, PUBMED, Scopus, EMBASE and Web of Knowledge were searched for papers published between 2000-May 2015.
  
  
  METHODS
  A five stage review process, informed by Whittemore and Knafl's methodology was conducted. All papers were reviewed and quality assessment performed. Data were extracted, organized and analysed. Convergent qualitative thematic synthesis was used.
  
  
  RESULTS
  From an identified 479 papers, 24 papers were included in this review with a range of research approaches: qualitative (n = 15); quantitative (n = 4); mixed methods (n = 2); case study (n = 2) and discourse analysis (n = 1). Thematic analysis revealed the nurses: equipped families for end of life through information provision and communication; managed the withdrawal of life-sustaining treatments to meet family need; and continued care to build memories.
  
  
  CONCLUSIONS
  Greater understanding is needed of the language that can be used with families to describe death and dying in intensive care. Clearer conceptualization of the relationship between the medically focussed withdrawal of life-sustaining treatments and patient/family-centred end-of-life care is required making the nursing contribution at this time more visible.
authors: Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, New Zealand.
authors: Maureen A
authors: http://orcid.org/0000-0001-6674-0093
authors: MA
authors: Coombs
authors: Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, New Zealand.
authors: Roses
authors: R
authors: Parker
authors: Faculty of Health, University of Canberra, Australian Capital Territory, Australia.
authors: Kristen
authors: K
authors: Ranse
authors: Plymouth University, UK.|School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
authors: Ruth
authors: R
authors: Endacott
authors: School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
authors: Melissa J
authors: MJ
authors: Bloomer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D003422:Critical Care / Q000379:methods*; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008020:Life Support Care / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D009741:Nursing Staff, Hospital / Q000523:psychology*; D013727:Terminal Care / Q000523:psychology*; D028761:Withholding Treatment
keywords: end of life; families; integrative review; intensive care; nursing role; treatment withdrawal