Neuro ICU - Do you talk to brain-dead patients? - page 10

I'm about to begin a Masters research project about ICU nurses talking to brain-dead patients (oh the joys of ethics approval committees!). My interest in this started when I read 'Rethinking life... Read More

  1. by   talaxandra
    Hi Bess.
    So far in my research I've found that all the nurses who speak to their brain dead patients also speak to their dead patients, and the one nurse I (accidentally) interviewed who doesn't speak to brain dead patients doesn't speak to dead patients either. To me this suggests that nurses who speak to the brain dead do so for reasons other than thinking they're still alive.
    The reason I focused the question on brain death is that it was this behaviour (speaking to the brain dead) which was identified as an example of ICU nurses' misunderstanding of the brain death concept.
  2. by   CCU NRS
    Quote from NeuroICURN
    Ok Mandy....first of all the reason I quoted you was this. If someone is brain dead, then they are dead. Completely dead. Bought the farm. It is no different than if they are asystolic. At the point of brain death, organs may be harvested. Just because the heart has not stopped does not mean they are still alive. So there is no "coming back" from that. However, yes, patients may come back from a comatose state. But honestly, I have yet to ever see one that remembers things from the comatose state.

    Now back to the subject at hand. Yes, I do talk to my patients. I don't think I have to explain why I talk to the alive and comatose ones. I don't always talk to the brain dead ones. As for why I occasionally talk to the brain dead ones....well, I guess it's more of a habit. You know, as an ICU nurse, you just get used to talking about what you're doing as you do it. But I don't talk to them as if they were alive....because they're NOT!

    As for the ICU educator who always corrects students for doing that...well that's wrong. She should educate them that brain death IS death, but if they want to talk to the patient, then that is their right...no matter what their motive may be.

    Also....no, the (true) definition of brain death does not vary from place to place....the term is just misused at times!

    I've probably already done more brain death criteria testing in my short career in nursing, than other nurses have in 30 years!!! So if anyone has any questions, please feel free to ask.
    I agree with your points. I also work CCU/ICU and Brain dead is dead. However we recently had an issue that involved our speaking to Pts in this state. Many nurses as you mention do talk to Pts out of habit and explain what they are doing. I am one of these. I also explain to families what I am doing. We had a case recently where the family felt they were recieving conflicting messages. Brain death was explained and they were informed of their family members brain death, but nurses continued talking to the Pt which made the family feel that nurses still felt hope or felt there was cognition. I no longer talk to brain dead pts I speak directly to family if present and I explain that the soul if you like has already departed and the body is an empty shell at this point. I always say my regular prayer of loss over brain dead pts just as I do over any pt that dies in my presence.

    This my be where the instructor is coming from because I hear there were major cases concerning speaking to brain dead Pts causing families to feel hope.
  3. by   Good_Queen_Bess
    Quote from talaxandra
    Hi Bess.
    So far in my research I've found that all the nurses who speak to their brain dead patients also speak to their dead patients, and the one nurse I (accidentally) interviewed who doesn't speak to brain dead patients doesn't speak to dead patients either. To me this suggests that nurses who speak to the brain dead do so for reasons other than thinking they're still alive.
    The reason I focused the question on brain death is that it was this behaviour (speaking to the brain dead) which was identified as an example of ICU nurses' misunderstanding of the brain death concept.

    I agree. IMO, whoever thinks that nurses who speak to brain dead patients means that we misunderstand brain death, are patronising and insulting.
  4. by   KR
    I talk to all my patients regardless. And yes, that even includes my patients that are dead, that I am doing post mortem care on. Hope this helps!
  5. by   akcarmean
    I have never had the opportunity to be in this type of situation but my feelings are that I would talk to them. I am someone who believes in afterlife and meeting again one day. Even though they are dead who can say that their spirit isn't still around. Just my 2cents.


    Angelia
  6. by   elnski
    Quote from chris_at_lucas_RN
    Sounds very healthy to me. It would be a different story if you were annoyed that "Jane" didn't answer you!


    teeeehheeeeeee!!!

    (sorry, got carried away)
  7. by   talaxandra
    I want to thank everyone for their thoughtful and interesting responses. I'm in the final stages of my thesis - I am so very, very over it by now! - and this discussion has been amazingly helpful. I'm thinking about revisiting the area for a PhD in 2006, so if anyone has further comments, please keep them coming!
  8. by   zenman
    Just for the record, I talk to brain dead patients...and staff! :uhoh21:
  9. by   Joshi
    Quote from StephanieMc
    I APPLAUD you Kyriaka.....I give you a standing ovation for being able to survive all you have endured..

    With tears in my eyes... I applaud you too!!
  10. by   CHATSDALE
    in a ltc facility there was a woman in a persistent vegatative state...during state survey the nurse was wrote up for failing to talk to resident while doing a tube feeding...
    those who believe that the nurses were so stupid that they could not see the condition of the patient are just giving them a pat on the back...the big me little you syndrome
  11. by   mandyjolpn
    I really do believe that a person should be spoken to no matter what condition they are in. They may not be able to hear us, but it helps us remember that they are a human being not an object and they should be respected in life and death.
  12. by   NurseFirst
    Quote from NeuroICURN
    And how are we supposed to know your personal beliefs??? I may know that the Jewish faith is listed....but does that mean that you are a practicing Jew? And....what's the harm in asking??? Just because you are Orthodox...does that mean that we should automatically not even ask??? How ridiculous is that? How ridiculous of you to even suggest it!

    NeuroICURN
    Well, maybe you could ask a clergyman of SOME faith. They would probably recognize that the kind of Orthodox the poster is is NOT Jewish, but Christian. (The Greek population is primarily Greek Orthodox; the Romanians, Romanian Orthodox. There might have been a few other clues: Jewish clergyfolk are called rabbis and not priests; Jews generally don't talk about "salvation"; and why would a Jew compare himself to Roman Catholics?

    And when someone is facing the death of a loved one, yes, there can be harm in asking. Like I say, why not try asking a clergyperson, who could put you in touch with the clergyperson from that faith, of whom you could ask questions. Really. Is a few minutes like that such a big deal when someone is facing the death of their loved one???

    As for heart transplants, Orthodox believe that the heart is where sanctification takes place. Since sanctification is the "work" of the individual person (in cooperation with God), transplanting that sanctification into another person is deemed incorrect. May seem stupid to you, but is that what matters?

    NurseFirst
  13. by   Kyriaka
    [QUOTE=NeuroICURN]Actually Earle, an EEG is NOT a must before removing support. Perhaps in your facility it is, but not in mine.

    ___________
    You are correct.

    I was in a coma and my parents were under a great deal of pressure to remove me from life support...and look at me now!

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