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.
Talaxandra.....I believe what you are referring to in this case is organ donation after cardiac death (formerly called non-heartbeating donors). What this is is when a patient is not expected to progress to brain death (as in a case of mine where a man had been shot in the head and while his brain had partially herniated, it could not completely herniate and cause brain death...because of the hole in the head that allowed brain tissue to come out). Anyway, what they do here is take the patient to OR, remove support and if the patient goes asystole within 30 minutes, then organs can be harvested. If not, well then after the person dies, they can still harvest tissues, corneas, etc. usually.
I work a LOT with organ donation in my unit, so if any of you have questions concerning organ donation and how it REALLY works (not some of these misconceptions that have been posted here), PM me and I'll answer questions as best as I can.
Anyway, some of you people are missing the point that brain death is really NO different than being asystole. There is NO coming back from being brain dead....as a matter of fact, once you are declared brain dead, your death certificate is signed because you are DEAD!!! Yes, there is specific criteria that must be met, different tests, so that there is no mistake.
I completely agree with everything you've said, and I too, often work closely with the Organ Procurement Organization in my area. I've actually done a donation after cardiac death case, and as you said, it was a GSW to the head that would never recover function of anykind, but would not progress to brain death prior to cardiac death occuring.
Brain death= dead, and as a wise, old neuro nurse once told me, as your brain dies, your body tries to die as well. We do several tests to conclusively diagnose brain death, including apnea tests and nuclear flow studies.
Referencing the OP's original question, I do talk to my deeply comatose and severely brain damaged patients. However, for patients that are asystole or have been declared brain dead, I tend to be silent and pray for the patient and their families, wishing them peace and comfort.
I'm about to begin a Masters research project about ICU nurses talking to brain-dead patients ....QUOTE]
I always talk to all patients. We do not know enough about the brain to be sure. We also do not know enought about an after-life (if there is one.)
Simple fact is... if you don't know, cover it. Talk, the worse thing that could happen is they'd talk back and scare the begeebies out of ya. The best thang that could happen is they will understand what is being done before it is done.
More than 18 years ago as a Resp Therapist I took care of a comatose man, he was a very large man and others were comment about his size ect when we were caring for him. I always talked to him and usually touched his arm or stroked his forehead when I was with him. When he woke up and I mean woke up ( he opened his eyes and just tried to talk he was oriented and alert but on a vent) when I came in to take him off the vent he knew me by my voice. I still to this day get Christmas cards from him and his wife, he told me that I made him feel like a person not a slab of fat (since he heard himself be called that he weighed over 300lbs) and he would never forget me for that reason. I have let that be my reminder when ever I deal with consious and unconsious patients. I have always been proud of myself about this because I was very young 23-24 and working with much older more experianced people who gave me a hard time about this patient and I stuck to my guns Rhonda
Specializes in Neurology, Neurosurgerical & Trauma ICU.
More than 18 years ago as a Resp Therapist I took care of a comatose man, he was a very large man and others were comment about his size ect when we were caring for him. I always talked to him and usually touched his arm or stroked his forehead when I was with him. When he woke up and I mean woke up ( he opened his eyes and just tried to talk he was oriented and alert but on a vent) when I came in to take him off the vent he knew me by my voice. I still to this day get Christmas cards from him and his wife, he told me that I made him feel like a person not a slab of fat (since he heard himself be called that he weighed over 300lbs) and he would never forget me for that reason. I have let that be my reminder when ever I deal with consious and unconsious patients. I have always been proud of myself about this because I was very young 23-24 and working with much older more experianced people who gave me a hard time about this patient and I stuck to my guns Rhonda
Good for you....NOTHING ticks me off more than when people talk about a COMATOSE patient as if they don't hear it....I never say anything to or about them that I wouldn't say directly to their face because we don't know how much a comatose patient can hear.
Specializes in Neurology, Neurosurgerical & Trauma ICU.
I'm sorry if I misrepresented the authors' position in this article, or my own - the point was not that these were case where brain-dead patients became "un-brain-dead" (for want of a less clumsy phrase). Rather it is that determinations of brain death are sometimes made when patients don't fit the criteria. In the cited cases, these reasons may have included inevitable somatic death (or perceived inevitable somatic death), a viable recipient in the wings, or perhaps even financial aspects (this last is not explicit in the text).
I agree with you, NeuroICURN, that these cases describe patients who are not brain-dead - that was the point of the article. The reason I posted it is that, if relatives are told that a patient is brain-dead and s/he isn't, or isn't yet, or is brain damaged, then this muddies the waters for everyone. The term 'brain dead' is thrown around a lot, and as we can see from the discussion thus far, informed and interested health professionals are not always any clearer about it than lay people. For example, on my unit (which incorporates neurosciences), staff refer to patients as being 'brain dead' when they mean unconscious, unresponsive or hypoxically brain damaged, although they know that part of the definition of brain death is that the patient is ventilator-dependant.
About the third case: although van Norman does not specify that the patient had been declared brain dead, she does say: "On the day of anticipated organ collection..." and "Vital organ collection was canceled..." These phrases seem to indicate that organ collection was planned, timed, rather than related to withdrawal of treatment. It is possible, of course, that treatment was planned to be withdrawn that day, with post-mortem organ retrieval, which would seem to be premature. However, as the article is specifically about declaring brain death, I think it's safe to presume that the third patient had been declared brain dead like the other two.
Oh, ok. Well, there again, I think it all comes back to the fact that perhaps it is the MDs that need a lesson in what brain death is and how to accurately declare it! I certainly wouldn't want my OB-GYN declaring brain death any more than I would want a neurosurgeon doing a C-section on me! :)
It also seems that perhaps RNs need education too if they're throwing the term around, when the patient is actually only brain damaged or in a comatose state.
So, if these docs are declaring brain-death, when in fact, a person has not properly met the criteria for brain-death, then YES, that's very scary! :uhoh21: I guess that's why I consider it part of my job to know what the criteria are, what's to be done, what to look for and to be present when it's done....because it's my job to be that patient's advocate!
Specializes in ICU, PICC Nurse, Nursing Supervisor.
Hearing is the last to go . Brain dead patients deserve the same dignity and respect that you would give to any other patient .
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.
Absolutely! It comforts me...and I somehow feel they hear. Until that 'spark' leaves the body - there is some essence of life there no matter how or under what means it is hanging on.
Clinically - we may know. But there are many other areas we are yet to be made knowledgeable on. Go with what your heart is telling you. That's a big part of being a nurse.
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.
This past january, my family was told that my father would never "wake up" after having a quadruple bypass. The neurologist said it was a lost cause and the icu nurses told my mother that we should consider pulling the plug and i did not once see them talking to him, until....... we kept talking to him for hours and hours every day and low and behold he AWOKE. My my, that was a quick trip from brain dead to alive and well huh!!! To make a long story short, Doctors do not know everything, and we as nurses should make a point of ALWAYS talk to the patient, no matter what the condition. And yes, my father remembers hearing voices and could recognize our voices but could not really understand what we were saying.
Often brain dead people are in the ICU because that's where they progressed to brain death (it sometimes takes a while to happen)...or they may be there to be stabilized and prepared for the OR for organ donation. Brain dead patients can be the MOST unstable patients you've ever had to deal with (Think about it, their most basic brain functions are no longer working...I've had times where the patient is SOOOO unstable that 2 nurses were assigned to a single patient). Anyway, certain things have to be in order before they go to the OR.....For instance, we use the rule of 100s (SBP above 100, UO above 100, etc). They have to be a certain body temperature (not only to be declared brain dead, but also to go to the OR) and certain lab values have to be within certain limits. It's not unusual for it to take care of these people for 12, 16 hours or more to stabilize them before taking them to OR.
I realize it's hard to understand this if you've never been a Neuro/Trauma ICU nurse that's involved in the process....but it's really a complicated process. There again, if anyone has any questions, feel free to PM me.
NeuroICURN
Oh, I guess I should have clarified: What I meant to say is, I can't understand why brain dead persons who are not going to be organ donors are still in the ICU. I know that kidney donors have to be maintained on all kinds of drips, etc. and that renal perfusion has to be esentially perfect before we proceed--I have had more than one scheduled donor nephrectomy cancel at the last second to try to make things perfect.
I just wondered why, when someone has already been declared brain dead by whatever criteria is used in that facility to determine absence of cortical function, they could not be moved to a quiet, private room perhaps in med-surg, kept on the ventilator until the family has said their good-byes and taken as much time as they needed, and then disconeected when they are ready, and then allowed to stay as long as they needed to--however long it took the heart to stop beating--and even longer, should they choose to do so.
To those who insist that brain dead does not necessarily mean "dead-" If they were not dead, we would not be taking their organs. To do so would be murder.
Tweety, BSN, RN
36,295 Posts
What a cold hearted response. I won't even get on my soap box either.