Neuro ICU - Do you talk to brain-dead patients? - page 14

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   RoadRunner
    Quote from 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.
    Me again, sorry but couldn't pass this one.
    Sarah was COMATOSE!!!!! not DEAD!!!

    Comatose means you still have some reflexes, some brain activity, something!
    When you're dead, your not comatose! You're... DEAD!

    Sorry again!
  2. by   GenaRN
    That's a totally valid point, actually reminded me of an instance where I specifically DID NOT speak to a brain dead patient. We had a 40-somthing man who died from an ICH and was on the vent pending organ procurement as his sister (presumed next of kin) had consented to organ donation. In comes father (possibly estranged but certainly vocal) who despite protracted efforts of coordinator in counseling him, refused donation, stating that the hospital was "trying to make money by selling his son's organ". His father wanted to know what we would do next to "cure him" and the intensivist said "your son is dead", we then extubated him and allowed time for the father with his dead son. I remember thinking that I was compelled to tell the man that I would be taking out the ET tube, but stopped myself so as not to muddy the issue in the fathers mind.

    Quote from RoadRunner
    Me again, sorry but couldn't pass this one.
    Sarah was COMATOSE!!!!! not DEAD!!!

    Comatose means you still have some reflexes, some brain activity, something!
    When you're dead, your not comatose! You're... DEAD!

    Sorry again!
  3. by   Nathalie
    im not a nurse yet but I probably would if I were in that situation
  4. by   NurseyNurse19
    Quote from 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 ...


    Just for my pennies worth, I agree with all of the above. During my first hospital placement as a student, I was told it was a sign of respect to always talk to the patient after they have passed away. Now, as a 3rd yr student, I still agree with and have continued to do so.
  5. by   Spritenurse1210
    I always talked to them while i was working in the hospital. I believe that even if the brain is no longer functioning, the soul is still around and can still hear me.
  6. by   DaFreak71
    I agree with the poster who said that talking to brain dead or dead patients might not be appropriate to do in front of the family. I think it's a bit presumptuous to assert my belief in an afterlife (or presence of a soul) onto the family. What if that is not what they believe? And isn't is suppose to be all about the patient (or patients family when they die), not the nurse and what his/her personal beliefs are?

    I would speak to a brain dead patient in the presence of other health care workers, but not in front of the family unless the family had also been talking to the patient.

    Adri
  7. by   DutchgirlRN
    Absolutely I talk to brain-dead patients, even if they don't know, I do. I treat all patients with the same respect.
  8. by   kea6783
    Why now? I talk to myself..
  9. by   mmsparkle
    Quote from 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 ...

    Exactly! To me, talking to my patients, whether they're in a come, brain dead, or after cardiac death, is an act of respect towards them. I don't think we should treat them any differently than if they are awake and can hear us. It is a ridiculous assumption that just because nurses talk to brain dead patients that means we don't understand that they're dead!
  10. by   mrsalby
    I talk and sing (quietly and with respect to cultural wishes) to my brain dead and coma patients. I do not know if the patient is watching from above etc. I want the patient and family to know I gave the best care possible.
  11. by   GrnHonu99
    Sure. I often have unconscious and brain dead patients. Do I know they probably can't hear me? Yes, but I still talk to them. It's respectful. In some small way it helps me deal with it as well. I see a lot of death in the neuroicu. Plus, you never know...
  12. by   OneSmartIndian
    I have to say yes I talk to my brain dead patients. Not only for myself but at times for the family also.

    After seeing my mother laid out in the chaple of rest at the funeral home with my dad and daughter who was 6yrs at the time, it was the most natural thing to do. Even though she was obviously dead I still spoke of her in present tense as did my dad. I was not present at her death which was very sudden so none of us were prepared for it, talking helped to get out all those feelings and say things I never got to.

    Talking to brain dead patients with the family can be comforting to them and help them with the proccess of acceptance of their loved ones death.

    Dead or alive patients should always be respected but I understand some situations do call for 'silent' care.
  13. by   Indy
    I'm new to ICU so I have not seen one case of verified, diagnosed brain death. I have had one vented patient whom I believed was brain dead, but since she was also septic, had a dying bowel and took up every second of two shifts I worked with her, I did not wind up suggesting that testing be done. I could not talk to her. I didn't feel there was a her present to talk to. I talked to her family. I took good care of her and although some of the talking about her was done in her presence, I did not say things that were disrespectful. It was upsetting to me though, that the doctors were dancing around the subject of death. When we keep people's bodies alive, for the sake of "the family will be ready for them to go tomorrow", it strikes me almost as an abuse of power. If this particular patient was actually in there, or if her spirit was able to be aware, she went through some things in her last 6 hours that were nothing short of horrific.

    For my dying patients, I pour out quite a bit of myself and that's a whole different ballgame. Once they are gone, my voice usually is too; I can't bring myself to talk to them. I try not to talk about them either while doing post mortem care. I don't know if it's respect, fear, repulsion, grief, or a case of thinking too much that brings on such silence. It certainly isn't a desire for doctors to think that I don't know what death is or isn't.

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