Neuro ICU - Do you talk to brain-dead patients? - page 17

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   ILoveMyJobRN
    When one of my patients was "officially" pronounced brain dead, I usually stopped explaining things to them. One of our doctors would write, "Patient is dead." in the doctor's progress notes~(meaning patient was dead dead, not just brain dead). There would be no doubt as to the definition of brain death. From that note on, I would switch my thinking to 'now I am caring for a dead patient'. I think it is one of those "lines" that I have drawn for myself to help me realize that they are really dead, and I could quietly begin a grieving process. I still treated the patient with extreme respect in my manner and care, but I tried not to talk to them. I most certainly talked to the family members when they were present and usually explained to them what care I was giving to their loved one. {Often the care had now turned to preparation for organ donation.} These were never easy situations and after the patient was declared (brain) dead I felt that my primary focus was the family and helping them during the last minutes with their loved ones body. It is always difficult.
  2. by   suanna
    I talk to mostly brain dead supervisors and some appearantly brain dead medical residents- At least when I talk to brain dead patients they are the ones paying the bills. Seriously- I talk to brain dead patients and completely dead patients. I know they can't hear me but it gives me a sense of respecting thier human dignity to address them as if they were alive. Even pulsless and cold a human being is deserving of more respect that a piece of meat. People talk to thier loved ones at the grave side all the time but I doubt they expect (or want)a response. It's more a matter of respect than an interaction.
  3. by   psalm
    Quote from suanna
    I talk to mostly brain dead supervisors and some appearantly brain dead medical residents- At least when I talk to brain dead patients they are the ones paying the bills. Seriously- I talk to brain dead patients and completely dead patients. I know they can't hear me but it gives me a sense of respecting thier human dignity to address them as if they were alive. Even pulsless and cold a human being is deserving of more respect that a piece of meat. People talk to thier loved ones at the grave side all the time but I doubt they expect (or want)a response. It's more a matter of respect than an interaction.
    LOVED the first sentence! And I talk to brain dead patients.
  4. by   Easyatmidnight
    I have some of my very best talks with my brain dead patients. Are you kidding me? they are excellent listeners! Seriously, I tell them about my day, my hopes, my frustrations, yes I love talking to all of my patients. Knowing it will never leave the room, it's therapeutic.
  5. by   matt2401
    Hmmm, well the brain dead patients I have had were all organ donors and let me tell you....I was waaaaay too busy to sit and talk to them. Having said that I didn't have a desire or thought to talk to them. I did give a prayer of thanks for thier gift of life though. The last organ procurement I was in, the organ donation coordinator had everyone do a 'time out' before incision to have a moment of silence for the patient and family. That was so touching to me.

    Now I guess this kind of also applies though. When I have a patient who is in the process of dying (bradying down, agonal resps, etc) and DNR I have my own little 'ritual'. If there is no family or visitors with the patient I stop what I am doing, pull a seat next to the patient and hold their hand. I may comb their hair, do something 'nursy' (God I hated that term in nursing school, but I kind of get it now). I try and always make sure that when my patient dies, they aren't alone. Can my patient hear/feel/sense me? I don't believe so, but it just seems the 'right' thing to do in my gut.
  6. by   psalm
    ...who said anything about sitting and talking to them? LoL. While I reposition or assess, there's no harm in talking in a soothing tone. But I know what you really meant, not dissing you, just teasing.
  7. by   NotReady4PrimeTime
    Quote from suanna
    I talk to mostly brain dead supervisors and some appearantly brain dead medical residents- At least when I talk to brain dead patients they are the ones paying the bills. Seriously- I talk to brain dead patients and completely dead patients. I know they can't hear me but it gives me a sense of respecting thier human dignity to address them as if they were alive. Even pulsless and cold a human being is deserving of more respect that a piece of meat. People talk to thier loved ones at the grave side all the time but I doubt they expect (or want)a response. It's more a matter of respect than an interaction.
    I do the same. All of it. Sometimes it's a defense mechanism; being in the room with the departed in total silence is a tad bit uncomfortable. But part of me still feels the need to acknowledge the human being that was, and to demonstrate respect for the body that housed the soul.
  8. by   Chapis
    wow, i've read this whole entire thread today and i've loved it, and learned alot. very interesting topic to talk about! why don't hospitals just prounouce them dead instead of brain dead, that makes people think, are they really dead or what do they mean by brain dead. . .know what i mean?:uhoh21:
  9. by   potterstudent
    I am a student nurse, I have been taking care of a "brain dead" patient who only maintains brain stem function. We always talk to her like she can hear us. Although, I will agree that it is mostly because her family refuses to let go and believes that she is going to recover. On a side note, she groans at times and sometimes it sounds as if she's trying to clear her throat. Is this also part of brain stem function, or could this be a sign of actual recovery? However, while her eyes open at random, she does not track at all, they simply move from one side to the other.

    Any thoughts?
  10. by   ghillbert
    If she has brain stem function, she's not brain dead.
  11. by   AliRae
    Almost 11 years ago now, my cousin (17 at the time, and he might as well have been my brother) was admitted to the CCU at Sick Kids in Toronto after a near drowning. It was one of those freak accidents; he was under no more than 5 minutes, but he was completely brain dead as a result. My aunt and uncle were in France at the time, and the rest of our family is spread around the States and Canada, so it took a day or so for everyone to get there - my family was one of the first to arrive.

    The way his nurses treated him is a huge part of the reason that I became a PICU nurse after graduating. I ended up unofficially being the "death and dying" nurse in our PICU, and I dealt with many brain dead children in just 2 years. I know exactly how much work and technology goes into sustaining those kiddos until support is withdrawn, especially if they're going to donate. Sometimes it feels like there's nowhere to turn around in their rooms.

    But I remember Johnny's room so clearly. The nurse had all the pumps and wires tucked away behind his bed. The curtains were open to let in the sunshine, and she moved quietly around his bed, putting lotion on his hands and vaseline on his lips, chatting to him. "It's a beautiful day, Johnny. Your cousin is here to see you. She wants to say goodbye. Everyone's here to say goodbye."

    I knew that he was dead. We all did, and his nurse, even though she talked to him, reinforced that by "telling" him that we were there to say goodbye. Every single time I take care of a brain dead or otherwise dying patient, I think of her. And I always talk, as long as it's a family that understands what's going on, that brain dead is dead. As others have said before, if it's a family who isn't getting it or can't let go of their hope, I'll tailor my interactions to whatever is going to make the experience easiest for them. I think that only happened once; every other time, I've been part of withdrawls on brain dead kids who I've spent the day talking to, singing lullabyes to, and praying over if the family wants me to.

    I've spent the last 11 years wishing I knew who that nurse was that took care of my cousin and wishing I could thank her for what she did for me and for my family by talking to my cousin. "It's a beautiful day, Johnny."
  12. by   ILoveMyJobRN
    Thanks for sharing your personal family experience. Sounds like it has given you a gift that you have given to other families going through this heart-wrenching experience. Would you share how "you tailor my interactions" for those who don't quite get the "brain dead is dead" patient? Wish I could sing better...
    So glad to have you as a fellow nurse!!!
  13. by   AliRae
    Quote from ILoveMyJobRN
    Would you share how "you tailor my interactions" for those who don't quite get the "brain dead is dead" patient? Wish I could sing better...
    It was mostly refraining from talking to the kids in front of their parents. If the parents were holding out hope in the face of properly-done brain death criteria and a signed death certificate, my talking to their kid was only going to confuse them. Those parents tended to get more agitated if I spent much time out of the room, in case I "missed" something or failed to do something for their kid that would help them get better. I would spend extra time IN the rooms, but would try to make a point of sitting down to talk to the parents, giving at least the unconscious impression that my work was finished (if that makes sense).

    But like I said, for a family like mine, who had a grasp on the finality of the situation, I always talk. And I'll do pretty much anything that makes the family feel better. I've held hands with the priest and said prayers, I've shaved a baby's head, I've made pink and purple hand prints of a 16 year-old girl because her mama wanted them.

    The biggest thing is education. I find that most people have no idea what death is going to look like, especially death after withdrawl on a brain dead kid. They often expect gasping and moaning, and the eerie stillness after that tube is pulled can be really scary for them. I always make sure I explain that they won't breathe, but that it could take some time for the heart to stop. And then we decide together how long they want to stay. I had one daddy decide that he wanted to be the one to know first, and he didn't want me telling him. So when we pulled the tube, he curled up next to his daughter, his head on her chest, not moving a muscle. Ten minutes later, he finally lifted his head to tell me that she was gone, that he couldn't hear anything anymore. I saw him later that year at our memorial service, and he told me that being able to do that let him feel like he had some tiny measure of control when his life was spinning out of his grasp.

    I've been out of the PICU world for almost 2 years now, working on a hospital ship in West Africa, and I really do miss it sometimes.

close