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

Vacating an ICU bed is the last thing on my mind.

What I am saying is that if she is given a choice, then she will always feel as tho it was she who decided to stop care, and she will have to live with that decision for the rest of her life. Whereas in reality there is no care to give (other than the proverbial TLC of course). I think it is unfair to the family to expect them to agree or disagree - it should be, "this is the situation and this is what WE are going to do." Not saying you can't wait a couple days for religious reasons, close family to get in from timbucktoo, etc., but not because the family hasn't reached a decision yet. I thinkg in most cases it just muddies the water to allow them to think they are still alive those extra days. JMO. Trust me, I've been this route too many times to think about in the last 35 years!

I work in a Level II Trauma ICU. We get the occasional brain dead patient on a vent secondary to an accidental trauma, heart attack, or some other event leading to that person's brain death. In determining brain death there are very, very specific criteria that have to be met. Most often at my facility we do a brain flow study. That is a quick and accurate verification of what the neurologist already suspects from signs on assessment of the patient.

Like many others with Neuro ICU experience have said, brain dead IS dead. Period. There is no possible way for that patient to have conscious thought processes. There is no possible way for that patient to 'wake up' ever again. At the point in time when their injury or whatever disease process they have caused a cessation of blood flow to the brain - that person was no more. They died right then and there. They will never be the person they were before that event happened. It is SO hard to explain that to families. Just look at how much disinformation is out there, even among us nurses!

As for talking to the brain dead patient. I do not. It is my belief that the person, the 'soul' of that body, has already left this Earth and is not 'hanging around' in the hospital room. It is my belief that the concsious person has 'left the building' and is long gone. At that point in time, I am working on constant resucitation of a body and nothing more. I am trying to keep organs alive in the case that we have gotten consent from the family in order to harvest. I do remain professional and respectful while doing that job, but I do not speak with the dead as though they are still alive.

The responses to this post have been very interesting.

I am one that does talk to brain dead and occasionally post-mortem bodies. It is not at all because I don't understand that they are dead and gone, but just out of habit-I'm used to explaining what I am doing to a sedated/vented patient (and even awake and oriented patients), so I just automatically do it in the room with a bd pt. Just like I always knock before entering the room-I do it even in the rooms with bd or dead bodies. Although I have learned to beware with family present in organ donation cases so that I do not lead them to think I am talking to the person because they are alive and get everyone confused. JMO.

I always talk to my brain dead pts., especially when family is present. Just a show of respect.

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.

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.

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.

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.