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.

[mykrosphere]

always

who am i to say if they are really "there" or not?

sometimes i wonder....

i think talking to someone is just natural anyway.

it makes the situation a bit more "real" as opposed to "surreal"

[SusanKathleen, RN]

dig that carol....always. the soul never sleeps.

leslie

I was participating in a code a few weeks ago (my first one - I'm a new nurse, but an old lady:lol2:) and the dear woman I was doing compressions on had been in MODS for most of the day. As I was compressing her, I looked at her face, and she was already gray. I began talking to her, but in silence as there were 8 other people in the room doing their work. I told her that I was sorry that we were 'beating her up', and that I knew she was already gone. I looked up in that moment toward the corner of the room, which was slightly behind my left shoulder, and she was standing in the corner watching me.

How wonderful.

[NotReady4PrimeTime, RN]

For me it's a humanity thing. Until a few minutes or hours ago, the deceased was pink, warm, breathing by one means or another (most of the time) and there was someone who loved them. It feels wrong to just let all of that go so abruptly. I once was assigned to a young person who has been killed by an accidental GSW to the head and had expired about 20 minutes before I arrived. I hadn't ever seen him "alive" but it still felt wrong not to apologize to him for the indignities he'd experienced. I don't know if the essence of a person remains in the room for a while or not but there's no harm in talking to a corpse.

When I talk to my seriously brain-injured patients, my deeply sedated ones, the comatose ones, it's partly for the family, so they can see that I acknowledge the person's value to others. It's partly because through personal experience I know that a person who seemingly is "not there" can still hear and remember what is said. I would have a much harder time thinking that I'd frightened a person by doing something unpleasant and unexpected so I warn them first. Maybe I'm doing it for me, but there's nothing wrong with that either.

[RN Joe 86]

Yes. They always have the best advice.

[kvsherry]

First off, let me correct Mr. Singer's 'research'. ICU nurses do, in fact, know the difference between clinically dead/brain dead. Those of us that do talk to our dead patients do so for many of the reasons laid out below. However, the reason that I have seen is habit. We talk to our unresponsive patients all the time, see a body, talk to it. That is what we are trained to do and that is our knee jerk reaction.

For what I do? I never talk to my dead patients, and I correct any staff members (tech, RN, RCP etc.) that do. I unfortunately can not find the article, but it reminds nurses that by talking to a brain dead patient, the family can be easily confused. They may already be having trouble reconciling the heart beat on the monitor with dead, and they can be made to wonder, "If he is dead, why is everyone talking to him?"

I hope this helps.

[jagatx]

Thank you, kvsherry!

I work for an OPO educating nursing staff and that is exactly why we ask nurses not to talk to brain-dead patients...because many families already have difficulty accepting the passing of a loved one, and they expect a nurse to know whether a patient is brain dead or not. Please, do not talk to brain-dead patients as you make the job of the OPO much more difficult in consenting the family. We sometimes have to order a CBF to show them a visual because they'll say, " well, the nurse is talking to him so he must be able to hear her," etc.

To the person who miraculously recovered from being brain dead - find a neurologist who knows how to properly conduct clinical and confirmatory exams. When done CORRECTLY, there has never been one case of a person "coming back" from brain death. Check with the American Academy of Neurology on it in the August 2010 article reviewing brain death testing. We still see patients "pronounced" whose pupils are reactive, or who are breathing over the vent. It's called physician error. If you're truly brain dead according to the two clinical exams, especially if they're required to be done twice in your state, and confirmed with an ancillary test, there is no coming back because you are dead.

Here's the article:

Evidence-based guideline update: Determining brain death in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology Neurology June 8, 2010 74:1911-1918

Just a note: Less than 2% of all hospital patients die from brain death, and even fewer than that can qualify as organ donors, so it's very rare to be a donor. That's why we try so hard not to miss one, as one donor can save up to eight lives through organ donation!

Thanks for all you to do refer patients and save lives!

[xx--RN--xx]

I work in a Neuro ICU and I got to say I don't talk to brain dead patients. We care for our organ donors up until they go to surgery for harvest. To me, after brain death the person is just a big "ice chest" full of organs that I must keep in stable condition so that they may be passed on to the organ recipient. Honestly, I've never even thought about the question of talking to a brain dead pt. Brain dead is dead.

I don't even talk to dead family members at funerals or viewings. They don't get so much as a "good bye". They are gone...what is the point?

I don't get it. I'm there to do a job. Talking to dead people serves no purpose for that job and would only reflect my coping with death if I were to do it.

JMO