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

happthearts · Feb 25, 2005

Yes I always talk to the brain dead. I found one thing very intresting over the years ,when I would tell the Pt what I was about to do they had a tendancy to relax more .Example Mr Garicia I am going to place you over on your left side for awhile. There would be no stiffness . But if someone would just start flipping him over without saying any thing It would take sometimes 10 minutes he would stiffen up.Maybe when the mind goes we speak to the soul or the inate withen a person. I always told PT's what and how I was going to do care.

NurseFirst · Feb 25, 2005

Yes I always talk to the brain dead. I found one thing very intresting over the years ,when I would tell the Pt what I was about to do they had a tendancy to relax more .Example Mr Garicia I am going to place you over on your left side for awhile. There would be no stiffness . But if someone would just start flipping him over without saying any thing It would take sometimes 10 minutes he would stiffen up.Maybe when the mind goes we speak to the soul or the inate withen a person. I always told PT's what and how I was going to do care.

Don't remind me. My poor, dear, belated father who was by no means comatose was "rolled" insnsitively and without warning by a hospice nurse. :angryfire My poor father, as he was being rolled reached out and weakly said "help! help!" (Makes me cry just thinking about it.) Needless to say, neither my sister nor I were very pleased with that hospice experience.

NurseFirst

p5a7t4 · Feb 25, 2005

I'm a student nurse. I talk to the brain-dead because I believe that talking to the patient is part of care, and I believe that I give better care if I do talk to them. Long ago, I assisted on autopsies and (for me at least) there is a big distinction between brain-dead and dead-dead. On the off chance that one of my brain-dead patients was to ever recover, I want them to feel that they got the same quality of care that I would show to any other patient.

happthearts · Feb 26, 2005

Question has anyone done a study or heard of a study of when brain death occurs I often wonder when that is .

I Had a MD come up from the ER to pronounce a cancer PT on my wing .Pt had no vitials was blue in the lips eyes rolled back mottling blue on the back .No fog on the mirror .(We used to test that way 20 years ago).

MD says PT is dead .We began post mortum care and the PT sits up from a lying postion turns looks at me ,then then turns and looks at the other nurse and lays back. That's why I have wonderd. This PT turn his head and looked .Scared the BEE-Gees out of me .

NurseFirst · Feb 27, 2005

Question has anyone done a study or heard of a study of when brain death occurs I often wonder when that is .
I Had a MD come up from the ER to pronounce a cancer PT on my wing .Pt had no vitials was blue in the lips eyes rolled back mottling blue on the back .No fog on the mirror .(We used to test that way 20 years ago).
MD says PT is dead .We began post mortum care and the PT sits up from a lying postion turns looks at me ,then then turns and looks at the other nurse and lays back. That's why I have wonderd. This PT turn his head and looked .Scared the BEE-Gees out of me .

I remember years ago reading something about the number of people who were considered dead who really weren't dead yet. It was scary. People with heartbeats that were not detectable. I'm sure the technology is more advanced now (esp. with dopplers and u/s) than when I read the article, but they apparently had done studies comparing people who had been declared dead (in the U.S., with fairly sophisticated technology), and used even more sophisticated technology--except really expensive, and found these people had these non-detectable heartbeats. Surely makes you wonder.

NurseFirst

sofaraway04 · Feb 27, 2005

I am a student nurse and am working in NITU at the moment. i have had the experience of looking after one pateint who was expected to become brain stem dead. in that she was failing the tests apart from the apnea test for a few days. then one day after sh had been on the unit for about 2 weeks she failed all the tests and was brain stem dead. I continued to talk to her and say what i was doing. partly for the family, and to respect the person that she was. It wasn't because i didn't understand that she was dead, or there was any chance of her 'coming back'. I have also talked to my pateints when carrying out last offices and i see this as no different to talking to brain stem dead patients

nurse lucky · Apr 7, 2005

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.

I talk to my brain dead patients and actually to every patient, dead or alive. I know that dead is dead and there is no misperception on that front. I take offense to anyone who suggests that I don't get that they are DEAD. I do it because it makes me more comfortable. My mom had a near death experience and she had an out of body experience and watched her code in great detail. She even asked why they didn't clean off the IV tubing before pushing some meds!!!

So I have great respect for the dead and feel that if I am being watched that I will do it in a respectful way and continue to talk to the body of the deceased. I am not religious by any means, but I am spiritual and this makes me feel better.

I would never correct a student or coworker. I might ask them their feelings about it and explore the stress that death causes them.

head injury unit RN · Apr 21, 2005

I Talk To All My Pt's No Matter How Badly They Are Injured. We Had A Pt For Weeks Didn't Talk Or Respond To Us Talking To Him. Lots Of Nurses Quit Trying To Communicate With This Pt. I Never Did--i Knew He Was There All Along Or At The Very Least Treated Him As If He Were. While Nurses Continued To Write Pt Is "non-verbal" On There Assessments And Notes. I Came In One Day And He Spoke To Me As Clear As Can Be. Wrote It In My Note Passed It On To The Next Shift. This Went On For Several Days Almost A Week--when I Got Questioned As To Why I Was Documenting This. At That Point I Took Another Staff Member In To The Pts Room. And Said Hi To Him And He Said Hi Back. Then He Looked At Other Staff Member(who Was Off For 1 Wk Vacation And Just Came Back) And Said Hi Kelly Where Have You Been. His Entire Stay In Of Hospital He Only Spoke To Us. And He Told Us Why---- We Were The Only Ones Who Always Talked To Him. Therefore I Think Communication On The Nurses Part Is One Of The Most Important Parts Of The Job Reguardless Of The Pt's Status.

talaxandra · Apr 22, 2005

Thank you all for your insights and opinions. I submitted my thesis in February and got word back this week that I got an H2A. I'm planning on sibmitting a couple of articles for publication, and thinking about a PhD candidature next year - although I haven't settled on a decisive topic, it will cetrtainly been in this area. I'm also considering interviewing nurses in the US, Canada and the UK.

Will keep you all posted, and if anyone has anything else to add I'm still interested :)

pfitz1079 · Apr 24, 2005

No, but I've talked to a few brain dead residents. :)

Pete Fitzpatrick

RN, CCRN, CFRN, EMT-P, MFN

OneSmartIndian · May 27, 2005

No, but I've talked to a few brain dead residents. :)
Pete Fitzpatrick
RN, CCRN, CFRN, EMT-P, MFN

Nice one I know what you mean

But I must admit I have only cared for 1 BD patient over my training, and started to question myself why?

I guess it's because you get so used to talking to patients and relatives whatever state they are in it just comes naturally. After reading everyone's bit (well almost everyone's) I'm not sure if I would talk to another BD patient or not :uhoh21:

lionkore · May 28, 2005

I know that the OP has already completed the thesis (congrats!), however I'm still responding because I find this a fascinating topic; both birth transitions and death transitions fascinate me.

As many of you here do, I talk to all of my patients, alive, comatose, dead, what-have-you. I had a strep-septic patient a week ago, FTD slowly but steadily, non-responsive to pain, pupils fixed/dilated, etc. and her granddaughter asked me if the patient was brain-dead, or would she be able to hear her gdtr if she talked to her. I told the gdtr my basic take on the situation, which is that there was no way for us to know at the moment whether she was brain-dead (did not have order for an EEG, or reason to request one at 3am), and that hearing is the last sense to go. I also told her that when I am in the room with a patient that cannot respond, I talk to the patient, because it never hurts to do so, and whether the patient can hear me or not, it puts me at ease. Like others here, I believe that the spirit of a person remains in the room for a (short? long?) time after death, though I cannot say whether the spirit can hear the words as living people would. However, to paraphrase another poster, there is certainly no harm in sending positive energy.

and certainly I know that when a person is dead, that's it. but since I don't know what being dead is like, who's to say they cannot hear us, or at least sense our intentions as we speak.

peace,

kori