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.

[OneSmartIndian]

I have to say yes I talk to my brain dead patients. Not only for myself but at times for the family also.

After seeing my mother laid out in the chaple of rest at the funeral home with my dad and daughter who was 6yrs at the time, it was the most natural thing to do. Even though she was obviously dead I still spoke of her in present tense as did my dad. I was not present at her death which was very sudden so none of us were prepared for it, talking helped to get out all those feelings and say things I never got to.

Talking to brain dead patients with the family can be comforting to them and help them with the proccess of acceptance of their loved ones death.

Dead or alive patients should always be respected but I understand some situations do call for 'silent' care.

[Indy, LPN, LVN]

I'm new to ICU so I have not seen one case of verified, diagnosed brain death. I have had one vented patient whom I believed was brain dead, but since she was also septic, had a dying bowel and took up every second of two shifts I worked with her, I did not wind up suggesting that testing be done. I could not talk to her. I didn't feel there was a her present to talk to. I talked to her family. I took good care of her and although some of the talking about her was done in her presence, I did not say things that were disrespectful. It was upsetting to me though, that the doctors were dancing around the subject of death. When we keep people's bodies alive, for the sake of "the family will be ready for them to go tomorrow", it strikes me almost as an abuse of power. If this particular patient was actually in there, or if her spirit was able to be aware, she went through some things in her last 6 hours that were nothing short of horrific.

For my dying patients, I pour out quite a bit of myself and that's a whole different ballgame. Once they are gone, my voice usually is too; I can't bring myself to talk to them. I try not to talk about them either while doing post mortem care. I don't know if it's respect, fear, repulsion, grief, or a case of thinking too much that brings on such silence. It certainly isn't a desire for doctors to think that I don't know what death is or isn't.

[deeDawntee, RN]

I believe that the body is temporary, but the soul lives on forever. I also believe that the soul may and probably does hang around for awhile after it has left the body. So when I talk to my brain dead patient, I am talking to what I consider to be their spirit in the room with me, observing what I am doing. I like to tell them things like acknowledging their life, and that their journey is over and they get to go home now. Or acknowledge what a good job they did with their kids, if I had met them, etc. I have done some reading on near death experiences, and I do believe that it does describe the death process.

Of course, if family is in the room, I don't do this kind of thing, but will send them thoughts instead. Very positive thoughts. If they are going to be an organ donor I send huge thoughts of thanks to them, or say it to them if I am alone with them.

Hopefully that isn't too weird for some of you...but we all do what we have to do to cope with death, I guess....

[bethin]

I realize this is an old thread but I have to throw my 2 cents in.

Are we causing any harm by talking to brain dead pts? I'm not seeing the harm. The pt is dead and I don't think that we are dillusional if we do.

I do talk to the brain dead and comatose pts. If I don't I feel like I'm a robot sent to do a job and they are the job, and I'm just there to get done with as little effort as possible.

As an aide sometimes I don't know the latest prognosis. I'd rather look like a fool talking to a dead person than not talking to a live one.

[Sabby_NC]

Wow this has been an interesting thread to read.

I have only ever been in contact with one brain dead person waiting on organ harvesting and I remember I was speaking to her as I was attending to the 'machines'.

[NeuroMedic]

Absolutely. Just because they are brain dead does not mean that I will treat them with any less respect than I would when they were cognizant(if they were cognizant). Respect is an important part of nursing. Would you leave a cadaver nude in the middle of the hallway? After all, they do not know they are nude. This is definately something to think on.

[mammoset]

I strongly agree with Elkpark, thanks for sharing.

[blueheaven]

Yes.

But then I have been known to talk to patients while doing post mortem care.

Amen to that! I talk to everyone that has ears! I talk to the "brain dead" ones just as I do to the comatose ones. It is just me, and has nothing to do with "not accepting the fact" that they are dead etc. My personal belief is that if the body itself is still breathing, heart is pumping, the soul who lived there may still be connected.

[algRN]

I talk to my unresponsive pts. in case they may be able to hear us. But as mentioned above, brain dead is dead.

[Zookeeper3]

for me, I talk to them simply because they are still my patient and I'm providing care (harvesting or awaiting withdrawl with the family grieving time). I just can't perform care and not "discuss" it with the patient because of a brain death declaration, sometimes we have them 24 hours while harvesting. It's part of my practice but I don't feel it's a negative with those who don't, just a different belief system about end of life.

this was a great thread to read, learned from everyones input!

[valkyria, BSN, RN]

i can tell you that as a coma patient who came back after i was resusitated twice, i thank you nurses who do treat all your patients as if they are really there. in case you are not sure, what harm would it do? for those who get the willies with post mortem care, talk to them about how wonderful the journey is they are on, it really is. talk about how beautiful the place they are going is, it really is.that will make them human again and you will not be nervous anymore. i had to do post mortem care on a patient the day i came back to work after i held my grandmothers hand as she died in our home. i talked. trust me. when i was chosen to pack my grandmothers things away, i talked to her as if she were still there. she may not have been but it made what i was doing easier for me. they do not stop being our patients after they are gone. that is perhaps the most important nursing care we will ever do for our patient or their family. we must care for the living that are left behind. those are the memories i hold most dear in my short career. now i am doing research, that sensitivity is still important to hold on to when talking to patients and their families.

[Zookeeper3]

After organ percurment comes and we're harvesting, family says goodbye and leaves... it's just me and the brain dead patient... fighting to keep every organ going... to keep another alive, what an outstanding process!

Might sound creepy, but I give encouragement, talk... rub an arm.... talk about continuing to live through another... giving life to another. I KNOW, the brain does not compute and I'm not religious but a part of me believes in a soul... a part of a human being living on. Don't we all have hopes that that finality isn't that final? Don't we all worry that this can't just be it?? We're done and gone?

I am unable to do anything to a "living" body, sentient or not.. and not explain my actions in advance. We lack so much truth and understanding that to not do so, to me, would be well strong word forgive me for it, but violating my pt. And Yes, I know they are brain dead.. but I still am caring for a physical body and I've been taught better than that. Until I know for certain brain death is the end all and be all and that's it... ashes to ashes.... no more.... we'll I'll just chat away mean while in attempts to provide comfort, no matter how ill placed it may seem. It didn't cost me any more work or time and I feel better about myself for the effort.

I love this thread, read it twice, responded twice. It reminds me of why I clock in... I'm a better person with these experiences and I'm proud of my practice. Maybe talking to brain dead patients gives me personal closure, but I've never felt incomplete when I've left.