Neuro ICU - Do you talk to brain-dead patients? - page 12

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   lionkore
    [font=Lucida Sans Unicode]I know that the OP has already completed the thesis (congrats!), however I'm still responding because I find this a fascinating topic; both birth transitions and death transitions fascinate me.
    [font=Lucida Sans Unicode]
    [font=Lucida Sans Unicode]As many of you here do, I talk to all of my patients, alive, comatose, dead, what-have-you. I had a strep-septic patient a week ago, FTD slowly but steadily, non-responsive to pain, pupils fixed/dilated, etc. and her granddaughter asked me if the patient was brain-dead, or would she be able to hear her gdtr if she talked to her. I told the gdtr my basic take on the situation, which is that there was no way for us to know at the moment whether she was brain-dead (did not have order for an EEG, or reason to request one at 3am), and that hearing is the last sense to go. I also told her that when I am in the room with a patient that cannot respond, I talk to the patient, because it never hurts to do so, and whether the patient can hear me or not, it puts me at ease. Like others here, I believe that the spirit of a person remains in the room for a (short? long?) time after death, though I cannot say whether the spirit can hear the words as living people would. However, to paraphrase another poster, there is certainly no harm in sending positive energy.
    [font=Lucida Sans Unicode]
    [font=Lucida Sans Unicode]and certainly I know that when a person is dead, that's it. but since I don't know what being dead is like, who's to say they cannot hear us, or at least sense our intentions as we speak.
    [font=Lucida Sans Unicode]
    [font=Lucida Sans Unicode]peace,
    [font=Lucida Sans Unicode]kori
  2. by   liz Martin
    I would ask the question when does the human spirit leave the body? that is if we beleive that we have a Spirit therefor I would think it important to continue to speak till all organs cease functioning
    Quote from talaxandra
    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 and death' by ethicist Peter Singer - he described observing nurses in ICU talking to brain dead patients as though they were alive, and from that decided they did it because they didn't understand that the patients were clinically dead.
    I think that nurses who talk to their brain dead patients do it for a variety of reasons, which may included (but are not limited) to issues about reconciling the apparently living body (sensory knowledge) with knowledge about brain death (intellectual knowledge). I don't work in ICU, though I do work on a nero unit; I always talk to the unconscious, and sometimes talk to patients who have died.
    I was at a conference in the UK last year, and an ICU nurse educator said that she not only never talks to brain dead patients, she corrects any students who do. However, one of the anaesthetists there always speaks to his brian dead patients. They're ruining my research!
    What do you all think? This isn't something that will make it into my thesis, BTW, but I'm interested in what you think about the project idea, and about your own practice.
  3. by   OntCaRPN
    Yes, I do.
    Many years ago we had a pt in chronic care who was exhibiting only minimal signs of response. Blinking, sucking. We had a neuro specialist come to assess him. Although the neuro doc said he was indeed brain dead ... he would not talk in front of him. He assessed the pt and had us remove him before he told us his findings.
  4. by   rogramjet
    We had a patient on the floor who was non-responsive for days. He needed to have his foot amputated but the family wouldn't sign the consent, he was going septic. Every night when I did my assessment, I would talk to him. One night I went in there and said, "Good Evening, Mr. _____." He started talking. It really startled me. He was coherant. My charge nurse wouldn't believe me until she went in and talked to him. You just never know.
  5. by   LPNnurse
    I do talk to them. I had a close family member get into a MVA and she was considered brain dead. I spoke to her and she would move around her legs and arms when I did. You never know so I am always careful when around the pat. to make sure I am sensitive to what I say because they may hear me.
  6. by   stevierae
    Quote from LPNnurse
    I do talk to them. I had a close family member get into a MVA and she was considered brain dead. I spoke to her and she would move around her legs and arms when I did. You never know so I am always careful when around the pat. to make sure I am sensitive to what I say because they may hear me.
    Well--WAS she brain dead? That is, was she determined by lack of cortical function to be brain dead? Or serial EEGs? Or whatever the state she was hospitalized in defines as criteria to establish brain death?

    Let's all remember that chronic vegetative state and brain death are two very, very different conditions--and there are several "in-between" states we've described in earlier posts in this thread. Some people don't seem to understand the difference in "chronic vegetative state" & "brain death--" -----witness the Schiavo case.

    That said, whenever I come upon a fatal accident, or even see a dead animal in the road, for that matter, I always make the Sign of the Cross, (having been raised Catholic) and I also say "Om Mani Pa Me Hung" (following Tibetan Buddhist philosophy, which I also embrace.) Can't hurt--never know if the spirit is hovering in some netherworld, unsure of where to go. I think I'd do the same with a hospitalized patient who was hovering in one of those "in between" states.
    Last edit by stevierae on Jun 2, '05
  7. by   stevierae
    Quote from rogramjet
    We had a patient on the floor who was non-responsive for days. He needed to have his foot amputated but the family wouldn't sign the consent, he was going septic. Every night when I did my assessment, I would talk to him. One night I went in there and said, "Good Evening, Mr. _____." He started talking. It really startled me. He was coherant. My charge nurse wouldn't believe me until she went in and talked to him. You just never know.
    If he needed to have his foot amputated, and they were waiting for family consent, then he was NOT brain dead. What good would a foot amputation do a brain dead patient? He is DEAD--pure and simple.

    The only operation that can be done on a brain dead person is organ retrieval (I just hate the word "harvesting") for purposes of transplant into a living human being who can make use of whatever organ is viable and compatible once transplanted. The donor--the brain dead person---is a cadaver. Cortical function or brain stem activity ceases; life ceases----it simply does not matter if the heart continues to beat and give the IMPRESSION of life. It, too, will soon stop once multi-system organ failure (including cardiac failure) sets in.
  8. by   LPNnurse
    Yes she was. She had NO brain activity. She died two weeks later. I guess no one person will ever know the answer if they can hear you or not. I like to think in one way they can so you can give ease if needed but on the other hand I like to think they can't because to be aware that you are in that state must be horrible. I understand there are two different conditions and states. I believe most of us do understand that.
    Quote from stevierae
    Well--WAS she brain dead? That is, was she determined by lack of cortical function to be brain dead? Or serial EEGs? Or whatever the state she was hospitalized in defines as criteria to establish brain death?

    Let's all remember that chronic vegetative state and brain death are two very, very different conditions--and there are several "in-between" states we've described in earlier posts in this thread. Some people don't seem to understand the difference in "chronic vegetative state" & "brain death--" -----witness the Schiavo case.

    That said, whenever I come upon a fatal accident, or even see a dead animal in the road, for that matter, I always make the Sign of the Cross, (having been raised Catholic) and I also say "Om Mani Pa Me Hung" (following Tibetan Buddhist philosophy, which I also embrace.) Can't hurt--never know if the spirit is hovering in some netherworld, unsure of where to go. I think I'd do the same with a hospitalized patient who was hovering in one of those "in between" states.
  9. by   OntCaRPN
    I wasn't thinking in specifics. I assumed the original question to mean ... do we talk to unresponsive patients .... and yes, I do.
    The incident I related was regarding a fellow with a brainstem injury.
  10. by   LPNnurse
    No worries, it is a wonder of the world.
  11. by   stevierae
    Quote from LPNnurse
    Yes she was. She had NO brain activity. She died two weeks later. I guess no one person will ever know the answer if they can hear you or not. I like to think in one way they can so you can give ease if needed but on the other hand I like to think they can't because to be aware that you are in that state must be horrible. I understand there are two different conditions and states. I believe most of us do understand that.
    I know; I was not talking about you --was referring to all the controversy surrounding the Schiavo case, in which various doctors who had not even seen or examined the woman were making pronouncements of which state she was in--and they all conflicted with each other's. Of course, the non-health care professionals out there protesting had only what the media told them to go by, and therefore were not well-informed--how could they be? They are not health care professionals, as we are, with knowledge of the various "in between" states or those neurological states other than chronic vegetative state and brain death.
  12. by   OntCaRPN
    News stories like that just make me sad. We teach and teach our little hearts out and then along comes a media mess like that one! it's soooo disheartening.
  13. by   Anthonyshamoun
    Dear talaxandra
    i am a clinical educator at a medical center in the middle east, i got interested with what you mentioned about addressing brain dead patients.
    based on my experience in this field(i have a 4 year experience in ICU) i guess that RNs possess great knowledge about the patient's conditions though they keep talking to him/her if he/she is brain dead.
    i used to do that and still doing it when i have the chance. You should keep in mind the cultural variations with respect to such matter.
    Have a nice day

    Quote from talaxandra
    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 and death' by ethicist Peter Singer - he described observing nurses in ICU talking to brain dead patients as though they were alive, and from that decided they did it because they didn't understand that the patients were clinically dead.
    I think that nurses who talk to their brain dead patients do it for a variety of reasons, which may included (but are not limited) to issues about reconciling the apparently living body (sensory knowledge) with knowledge about brain death (intellectual knowledge). I don't work in ICU, though I do work on a nero unit; I always talk to the unconscious, and sometimes talk to patients who have died.
    I was at a conference in the UK last year, and an ICU nurse educator said that she not only never talks to brain dead patients, she corrects any students who do. However, one of the anaesthetists there always speaks to his brian dead patients. They're ruining my research!
    What do you all think? This isn't something that will make it into my thesis, BTW, but I'm interested in what you think about the project idea, and about your own practice.

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