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

Specialties Neuro

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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.

Specializes in Medical.

If any of you who speak to the brain dead also speak to the dead, I'd love to hear your thoughts about that on the death work thread. I've started a PhD looking at why health care providers who talk to the dead do so and think your insight would be valuable, just as it was for the Masters that this thread assisted. I didn't use anything from here directly, but the vigorousness of the thread, particularly without my input, several years on is a demonstration of how significant this is for ICU nurses, even those who don't talk to their brain dead patients.

Specializes in PICU/CVICU/Ped Nursing Faculty/TSICU.

Couldn't pass on this even though it is really old. I do not talk to them, especially if it is a donor case. The family must realized that the child or adult is no longer there just because there is a body there. I believe and have been taught that this causes some misrepresentation to the family that you are speaking to a pt that is no longer alive. Clinically Brain dead=DEAD that's the time of death not when the heart actually stops.

So, for continuation of the diagnosis the pt is no longer a pt just a donor. Once they are pronounced your attitude must change from saving to slavaging organs if donors. IF they are not donors, it is still important to change your care (ie not explaining to the dead body what your doing. not saying johnny i m going to turn you stick you or whatever) and help the family with the greiving process.

I dont believe it is show of respect it can actually make the process of acceptance take much longer.

From reading some more of this super long thread, it seem alot of people do this for themselves and not so much for the family or the pt.

anyway to each their own.

Specializes in ICU.

I am an ICU nurse and have been for almost 3 years. I've worked my share of brain death cases. I speak to my patients. I feel it is the respectful thing to do.

In nursing school and during my precepting period, I was taught to always explain to my patients what I was doing and why whether they could understand me or not (out of respect for those intubated/sedated/paralyzed, etc.) It's a habit I never got out of.

The medical profession in general has a tendency to talk over our patients or about our patients in the ICU setting instead of to our patients. (I say ICU because that is my experience - may happen elsewhere - not sure).

I understand brain death. I understand death. But I also have respect for the body, so I talk. They are still my patient until I have discharged them to the morgue and I strive to treat patients the way that I would want to be treated.

Although I have to say that if family is at the bedside in a brain death case, I talk to the family rather than to the patient (I make an exception) so that the family doesn't misinterpret my actions as being toward a living patient. A brain dead patient is legally dead. It seems to be a natural transition to me, not one I have to think of. If the family is not there, I talk to the patient.

Specializes in Geri-psych Nursing.

I'm only a nursing student, but we are taught to treat even deceased patients who are being prepared for a family viewing with dignity and respect, and to continue speaking to them and explaining to them what is being done. I think it's a way of honoring the person who was. How would you want your body to be treated? Like a slab of meat, or the body of the wonderful human you were not long ago?

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.

Specializes in Post Anesthesia.

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.

Specializes in Staff nurse.
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.

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.

Specializes in ICU.

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.

Specializes in Staff nurse.

...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.

Specializes in NICU, PICU, PCVICU and peds oncology.
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.

Specializes in interested in NICU!!.

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:

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