Practical steps for discontinuation of life-sustaining treatment.

Discontinuing life-sustaining interventions requires an artful skill perhaps even more challenging than providing life-sustaining treatments. Critical care nurses require advanced skills to provide comfort care and, ultimately, a "good death" that encompasses the family and patient. Educational focus has been placed on maintaining the living, but with increasing palliation in critical care, education must include comfort care. This article focuses on the art of discontinuing life-sustaining treatment and providing a seamless, comfortable transition for patient and family. Included in it are seven steps, derived from my own experiences, that are meant to assist new practitioners in their beginning journeys of providing a "good death". The seven steps are interconnected and, depending on the context, will flow back and forth, as needed. The seven steps are: talk with the family, ensure orders are written, prepare drugs, to extubate or not, what about the monitor, ensure readiness, and proceed.