Neuro ICU - Do you talk to brain-dead patients? - page 13

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   dgudmestad
    I bathe dead people......why shouldn't I talk to them, even if only to hear the hum of my own voice. Doesn't really matter either way. :angel2:








    Quote from nckdl
    This past january, my family was told that my father would never "wake up" after having a quadruple bypass. The neurologist said it was a lost cause and the icu nurses told my mother that we should consider pulling the plug and i did not once see them talking to him, until....... we kept talking to him for hours and hours every day and low and behold he AWOKE. My my, that was a quick trip from brain dead to alive and well huh!!! To make a long story short, Doctors do not know everything, and we as nurses should make a point of ALWAYS talk to the patient, no matter what the condition. And yes, my father remembers hearing voices and could recognize our voices but could not really understand what we were saying.
  2. by   psalm
    ...I talk to the pt. and I talk during postmortem care. I do this with family present and/or with nurse aide or new nurse AND when I am alone as respect to this person who has departed this life. Also, when I was a new nurse it helped ME thru the death of my pt., to focus on her needs. My job doesn't stop with the last beat of the heart.
  3. by   ptadvocate81
    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.
    I work in SICU, and unfortunately I see quite a few brain dead patients, and yes, I always talk to them as I would a regular patient. Why? I have found that it is comforting to the families to hear you talk to them as though they are still with us, and I figure the only way to remember to do that during the brief visiting hours is to do it all the time. Besides, no one really knows where their soul is during this time...
  4. by   Jessy_RN
    Quote from MandyInMS
    I always talk to unresponsive pts..because even with the technology we have today, the mind/brain still has much that is NOT understood..so I always explain what I am going to do with/to them..treat them as if they CAN hear/understand me..how many times have you heard of a pt who was in a coma/brain dead that has eventually 'come back' and recalled many things..not often..but on rare occasions..I'd like that pt to remember staff/family talking to them and treating them respectfully..that's just me

    You are definetly right, there is so much we don't know, so it serves to "just in case".
  5. by   jmgrn65
    [QUOTE=elkpark]I have done so when in that situation (which hasn't been all that often), just as a gesture of respect to the person (and family, if present), and because I just don't KNOW what may or may not be going on inside the person. The research I have read indicates that hearing is the last sense to "go" when one is dying, and, although I haven't read anything about how that applies in the case of brain death, it seems like a useful thing to keep in mind.

    To me, it seems like a question of practicing the principle of nonmaleficence -- if I talk to the person and s/he can't hear me, no harm is done -- but if I go in the room and treat the person like a slab of meat and s/he does still have some primitive, basic level of awareness, then I have done harm ... I try to treat patients with the same care and respect that I would want someone to show me.

    It isn't that I don't understand the principle of "clinically dead" -- it's that I do understand that we don't always have all the answers, and don't always know as much as we like to think we do ... [/QUOTE


    I like how you stated it, that is my feeling also, you have put it words better than i could have.
  6. by   grannynurse FNP student
    I have always spoken to unresponsive patients. It has been a matter of respect, for them, and their family. And I had the experience of having a patient regain consciousness and relating all of the inappropriate conversations that had taken place at her bedside, including some members of the medical staff referring to her as a gork. I made sure she repeated her conversation to the house staff.

    Grannynurse
  7. by   mandrews
    Yes I do. I had a patient with a brain tumor and I would read her cards to her from her Church family and sometimes she would kind of wiggle her body around. I know she could hear me.

    I was assessing a patient last week and a family member said nurse she can't hear you. I cheerfully said the hearing is usually the last thing to go.
    I received a very funny look, but I kept on talking.

    melissa
  8. by   kea6783
    I would and applaud those who do. I hope if I was ever the pt my nurse would talk to me. I don't care who tells me just how dead my brain would be in that case, even if you put it in bold!
  9. by   utahliz
    Sarah Scantlin, recently emerged from a 20-year coma, was able to recall events that happened while she was comatose, such as 9/11.
  10. by   papawjohn
    Hey Y'all

    New here. Old nurse, though. Lots of NeuroTrauma background.

    Think it's sorta surprising that there's so much (17pages!!) of chat regarding coma, vegetative state, etc when the subject was brain-death. (Interesting chat--no offense intended).

    A few years ago when I was young and knew alot, the DX "brain death" was (note--medical diagnosis!!!) done like this:

    Ice Water Calorimetrics--large syringe of ICED water drawn up by Neurologist/N-surgeon. Forcefully (FORCEFULLY!!!) injected into Pt's ear. Functioning brain-stem will cause the Pt's eyes to jerk toward the side getting the iced h2o bath. No deviation of eyes = no function of brain stem = brain death.

    Apnea test--Pt is hyperventilated for 15-30min to blow off CO2. ABGs are drawn. Pt is taken off VENT. Pt is put on Nasal Cannula at high flow. (Everyone understands--these Pts are ALWAYS on vents, yes?) Serial ABGs are drawn (usually an A-Line is put in for this test if not already in). Lack of respirations is shown by progressively increasing pCO2 levels. (The pO2 level stays high because the Oxygen is passively swirling in the airways.) Lack of respirations = lack of brain stem = brain death.

    EEGs can confirm the DX but are not necessary in the two states where I practiced in these units (TN & MD).

    Transplantation vultures descend AFTER all the above.

    Like others, I have had distastful experiences with vultures. (I'm sure there are lots of wonderful transplantation-nurses. No personal attack intended.)

    The original question: "Do you talk to your brain dead Pt?"

    Answer: Of course!!! I care for a person. I always talk to persons.

    Never had a NDE myself but was put to sleep once in a hospital where I worked and the folks all knew me. They assumed I was 'under' and had a few laughs at my expense. Nothing they'd be ashamed of if they'd known I was eavesdropping--but not intended for my ears!

    Papaw John
  11. by   utahliz
    Quote from papawjohn

    Think it's sorta surprising that there's so much (17pages!!) of chat regarding coma, vegetative state, etc when the subject was brain-death. (Interesting chat--no offense intended).

    Papaw John
    Good point, I guess I was lumping them together.
  12. by   GenaRN
    But I don't recall talking to brain dead patients. It seems odd, I wouldn't talk to a dead body, it seems disrespectful to say "Mr So-So, we are going to turn you now" to a dead body, just a it would be to not say the same thing to a comatose patient. It's an interesting topic of discussion for sure.
    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.
  13. by   RoadRunner
    I just saw this thread and didn't took the time to read all the post, so I'm sorry if what I say have been said before!

    It's just that I'm working in an organ donation team (not the transplant team or the OPO, only the donation one, sounds a bit complicated but it's unique to our center) Anyway... I work very closely with the families of patients who are asked about organ donation, thus brain dead patients.

    With time, it became obvious that once it's clear for the family that brain death really means death, they don't really get why nurses still talk to the patient... I think we have to be very cautious about not getting the family confused. We cannot treat brain dead patients as comatosed ones! The best is to see with the family how they feel about you reacting to the patient. Stating that FOR YOU, it's a matter of respect to keep talking to the patient, even if he's dead, would erase a lot of interrogations.

    And we should stop talking about "brain death" and start saying "death" instead, just as we do for death by cardiac arrest... but that's another debate!

    By the way, I really liked your answer NurseICURN!

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