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

[talaxandra]

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.

[RoadRunner]

I just saw this thread and didn't took the time to read all the post, so I'm sorry if what I say have been said before!

It's just that I'm working in an organ donation team (not the transplant team or the OPO, only the donation one, sounds a bit complicated but it's unique to our center) Anyway... I work very closely with the families of patients who are asked about organ donation, thus brain dead patients.

With time, it became obvious that once it's clear for the family that brain death really means death, they don't really get why nurses still talk to the patient... I think we have to be very cautious about not getting the family confused. We cannot treat brain dead patients as comatosed ones! The best is to see with the family how they feel about you reacting to the patient. Stating that FOR YOU, it's a matter of respect to keep talking to the patient, even if he's dead, would erase a lot of interrogations.

And we should stop talking about "brain death" and start saying "death" instead, just as we do for death by cardiac arrest... but that's another debate!

By the way, I really liked your answer NurseICURN!

:yelclap:

[RoadRunner]

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!

:chair:

[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.

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!

:chair:

[Nathalie]

im not a nurse yet but I probably would if I were in that situation

[NurseyNurse19]

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. :)

[Spritenurse1210, BSN, RN]

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.

[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

[DutchgirlRN, ASN, RN]

Absolutely I talk to brain-dead patients, even if they don't know, I do. I treat all patients with the same respect.

[kea6783]

Why now? I talk to myself..

[mmsparkle]

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!

[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.

[GrnHonu99, RN]

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...