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

  1. 1
    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.
    haitham abo majed likes this.
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  5. 1
    Quote from talaxandra
    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.
    Brain dead patients??

    Aren't they all...


    When I do talk to them, I make sure to tell them they are my favorite patients.
    mskate likes this.
  6. 6
    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
  7. 1
    Yes.

    But then I have been known to talk to patients while doing post mortem care.
    DeLanaHarvickWannabe likes this.
  8. 4
    Quote from caroladybelle
    Yes.

    But then I have been known to talk to patients while doing post mortem care.
    dig that carol....always. the soul never sleeps.

    leslie
  9. 0
    I always fins myself talking to brain dead patients, but a colleague of mine brought up an interesting theory a few weeks ago.

    As we all know the term 'brain dead' differs in definition depending on where you practice... my colleague suggested that those nurses that talk to their BD patients perhaps do not understand or believe the finality of the situation they are in .
  10. 20
    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 ...
  11. 3
    Quote from MandyInMS
    ..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..
    Ok Mandy....first of all the reason I quoted you was this. If someone is brain dead, then they are dead. Completely dead. Bought the farm. It is no different than if they are asystolic. At the point of brain death, organs may be harvested. Just because the heart has not stopped does not mean they are still alive. So there is no "coming back" from that. However, yes, patients may come back from a comatose state. But honestly, I have yet to ever see one that remembers things from the comatose state.

    Now back to the subject at hand. Yes, I do talk to my patients. I don't think I have to explain why I talk to the alive and comatose ones. I don't always talk to the brain dead ones. As for why I occasionally talk to the brain dead ones....well, I guess it's more of a habit. You know, as an ICU nurse, you just get used to talking about what you're doing as you do it. But I don't talk to them as if they were alive....because they're NOT!

    As for the ICU educator who always corrects students for doing that...well that's wrong. She should educate them that brain death IS death, but if they want to talk to the patient, then that is their right...no matter what their motive may be.

    Also....no, the (true) definition of brain death does not vary from place to place....the term is just misused at times!

    I've probably already done more brain death criteria testing in my short career in nursing, than other nurses have in 30 years!!! So if anyone has any questions, please feel free to ask.
  12. 1
    I'm only a student nurse now, but I was a nurse previously in my life (too many years ago to remember )....I only dealt with one brain dead patient in the past, and I continued to talk to them. Not because I'm too daft to understand they're dead, or because I think they might `come back' but because I'm not sure that they're not still there in the room somehow.

    I don't know if I believe in an after-life or not...but if there *is* one then I want that patient to continue to know their body and soul is cared for, and about. It harms no-one, and I think it helps *me* to keep treating them that way. My way of `letting go' if you like...

    Unconscious/comatose patients I will always talk to. One of our nursing educators spent 5 days in a coma and she says she can remember conversations and procedures that were done to her. She doesn't remember clearly, and certainly not everything, but it makes you think....I guess I have to believe her, I've no reason not to! So I will talk, and talk, and talk.......just because I can, and because it might make a difference somewhere, somehow.....
    ilovetinyeye likes this.
  13. 0
    Quote from UK2USA
    I always fins myself talking to brain dead patients, but a colleague of mine brought up an interesting theory a few weeks ago.

    As we all know the term 'brain dead' differs in definition depending on where you practice... my colleague suggested that those nurses that talk to their BD patients perhaps do not understand or believe the finality of the situation they are in .
    uk2 - brain dead is brain dead. even when you're in a pvs, the brain stem is still functioning. but there are are spiritualists that continue to talk, whether dead or alive.

    leslie


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