title: Navigating communication with families during withdrawal of life-sustaining treatment in intensive care: a qualitative descriptive study in Australia and New Zealand.
abstract: OBJECTIVE
  To explore how nurses navigate communication with families during withdrawal of life-sustaining treatment in intensive care.
  
  
  BACKGROUND
  Death in the intensive care unit is seldom unexpected and often happens following the withdrawal of life-sustaining treatment. A family-centred approach to care relies on the development of a therapeutic relationship and understanding of what is happening to the patient. Whilst previous research has focused on the transition from cure to palliation and the nurse's role in supporting families, less is known about how nurses navigate communication with families during treatment withdrawal.
  
  
  METHODS
  A qualitative descriptive approach was used. Semi-structured focus groups were conducted with adult critical care nurses from four intensive care units, two in Australia and two in New Zealand.
  
  
  RESULTS
  Twenty-one nurses participated in the study. Inductive content analysis revealed five key themes relating to how nurses navigate family communication: (1) establishing the WHO; (2) working out HOW; (3) judging WHEN; (4) assessing the WHAT; and (5) WHERE these skills were learnt.
  
  
  CONCLUSIONS
  Navigating an approach to family communication during treatment withdrawal is a complex and multifaceted nursing activity that is known to contribute to family satisfaction with care. There is need for support and ongoing education opportunities that develop the art of communication in this frequently encountered aspect of end-of-life care.
  
  
  CONCLUSIONS
  How nurses navigate communication with families during treatment withdrawal is just as important as what is communicated. Nurses need access to supports and education opportunities in order to be able to perform this vital role.
authors.affiliation: School of Nursing and Midwifery, Deakin University, Geelong, Vic., Australia.|Centre for Quality and Patient Safety Research, Deakin University, Geelong, Vic., Australia.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Bloomer
authors.affiliation: Plymouth University, Plymouth, UK.|School of Nursing and Midwifery, Monash University, Frankston, Vic., Australia.
authors.forename: Ruth
authors.initials: R
authors.lastname: Endacott
authors.affiliation: Faculty of Health, University of Canberra, Canberra, ACT, Australia.
authors.forename: Kristen
authors.initials: K
authors.lastname: Ranse
authors.affiliation: Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand.|Capital and Coast District Health Board, Wellington, New Zealand.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Coombs
mesh_terms: D000328:Adult; D001293:Attitude to Death; D001315:Australia; D003142:Communication; D064648:Critical Care Nursing / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D024802:Nurse's Role; D009741:Nursing Staff, Hospital / Q000523:psychology*; D011368:Professional-Family Relations; D036301:Qualitative Research; D013727:Terminal Care / Q000523:psychology*; D028761:Withholding Treatment
keywords: communication; death and dying; end-of-life care; family; intensive care; life support care; nursing care; withdrawal of treatment