Neuro ICU - Do you talk to brain-dead patients? - page 16

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... Read More

  1. by   judytheoldrn
    Absolutely, they are the ones we are caring for, rather than the patient once brain death has been established.
  2. by   sarahrain
    There is a 4 year old boy was confirmed brain death few days ago. Everyone of the family members want to stop all the support except his mother. She said she dreamed that the boy would return on Monday. And she played his favourite songs, talked to him.. And still cling on the a slight chance of him coming back to life..
  3. by   judytheoldrn
    OK, this is what I don't get. Why are these people given a choice? If he's dead, he's dead. You can't treat dead. Why put the burden of choice on the family? You tell them you are taking him off the vent and then you do it - it doesn't solve anything to leave him on.
  4. by   judytheoldrn
    valkyria - thankfully you were not brain dead. Coma is soooo different. I of course always talk to my comatose patients and encourage the families to do so as well - with good aliquots of rest!
  5. by   talaxandra
    Quote from judytheoldrn
    OK, this is what I don't get. Why are these people given a choice? If he's dead, he's dead. You can't treat dead. Why put the burden of choice on the family? You tell them you are taking him off the vent and then you do it - it doesn't solve anything to leave him on.
    If this is in response to the post above, I imagine it's because allowing a grieving mother to think for the rest of her life that, if only she'd pushed harder, her son might still be alive seems more important than vacating the ICU bed as soon as possible.

    I once withheld morphine from a woman in great distress, minutes before death, even though I strongly believed it would make her last moments more comfortable, because her son was in such concrete denial about her dying. I was certain that if I gace the morphine he would forever believe that, if only he'd been more forceful about stopping me, his mother would have survived.

    I once looked after a young Indian guy who'd drowned at a local pool. He had an unknown down time and massive hypoxic brain damage - GCS of 3 and a rapidly increasing core temp (by the end, when he was 42oC/107.6F, you could feel it when you entered his room). His family said they understood he was, to all intents and purposes, already dead and that there was no hope. But several years earlier he'd had a very vivid dream that he's drwoned, the doctors said he'd die, and six days later he woke up. He made his family promise that, if he ever did drown, they would do everything to keep him alive until the sixth day. Even though they knew if was futile (one brother was a neurologist, another a neurosurgeon) they asked if we could do everything possible to extend his life until that sixxth day. We did, he didn't wake up, and we pulled out.

    Maybe the mother in sarahrain's story needs that much time to come to terms with what is undoubtedly a shocking loss. Maybe this is a form of bargaining, and when Monday comes she picks a new deadline - in which case withdrawal anyway is reasonable. But when the media's full of stories about people being told their loved ones will die, are already really dead, and the patient survived, it's not too hard to understand why some people are reluctant to accept this as fact.
  6. by   judytheoldrn
    Vacating an ICU bed is the last thing on my mind.

    What I am saying is that if she is given a choice, then she will always feel as tho it was she who decided to stop care, and she will have to live with that decision for the rest of her life. Whereas in reality there is no care to give (other than the proverbial TLC of course). I think it is unfair to the family to expect them to agree or disagree - it should be, "this is the situation and this is what WE are going to do." Not saying you can't wait a couple days for religious reasons, close family to get in from timbucktoo, etc., but not because the family hasn't reached a decision yet. I thinkg in most cases it just muddies the water to allow them to think they are still alive those extra days. JMO. Trust me, I've been this route too many times to think about in the last 35 years!
  7. by   VizslaMom
    Quote from 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.

    I work in a Level II Trauma ICU. We get the occasional brain dead patient on a vent secondary to an accidental trauma, heart attack, or some other event leading to that person's brain death. In determining brain death there are very, very specific criteria that have to be met. Most often at my facility we do a brain flow study. That is a quick and accurate verification of what the neurologist already suspects from signs on assessment of the patient.

    Like many others with Neuro ICU experience have said, brain dead IS dead. Period. There is no possible way for that patient to have conscious thought processes. There is no possible way for that patient to 'wake up' ever again. At the point in time when their injury or whatever disease process they have caused a cessation of blood flow to the brain - that person was no more. They died right then and there. They will never be the person they were before that event happened. It is SO hard to explain that to families. Just look at how much disinformation is out there, even among us nurses!

    As for talking to the brain dead patient. I do not. It is my belief that the person, the 'soul' of that body, has already left this Earth and is not 'hanging around' in the hospital room. It is my belief that the concsious person has 'left the building' and is long gone. At that point in time, I am working on constant resucitation of a body and nothing more. I am trying to keep organs alive in the case that we have gotten consent from the family in order to harvest. I do remain professional and respectful while doing that job, but I do not speak with the dead as though they are still alive.
    Last edit by VizslaMom on Oct 12, '08
  8. by   nursecass
    The responses to this post have been very interesting.

    I am one that does talk to brain dead and occasionally post-mortem bodies. It is not at all because I don't understand that they are dead and gone, but just out of habit-I'm used to explaining what I am doing to a sedated/vented patient (and even awake and oriented patients), so I just automatically do it in the room with a bd pt. Just like I always knock before entering the room-I do it even in the rooms with bd or dead bodies. Although I have learned to beware with family present in organ donation cases so that I do not lead them to think I am talking to the person because they are alive and get everyone confused. JMO.
  9. by   oceaneyez
    i always talk to my brain dead pts., especially when family is present. just a show of respect.
  10. by   talaxandra
    If any of you who speak to the brain dead also speak to the dead, I'd love to hear your thoughts about that on the death work thread. I've started a PhD looking at why health care providers who talk to the dead do so and think your insight would be valuable, just as it was for the Masters that this thread assisted. I didn't use anything from here directly, but the vigorousness of the thread, particularly without my input, several years on is a demonstration of how significant this is for ICU nurses, even those who don't talk to their brain dead patients.
  11. by   slcpicu
    Couldn't pass on this even though it is really old. I do not talk to them, especially if it is a donor case. The family must realized that the child or adult is no longer there just because there is a body there. I believe and have been taught that this causes some misrepresentation to the family that you are speaking to a pt that is no longer alive. Clinically Brain dead=DEAD that's the time of death not when the heart actually stops.
    So, for continuation of the diagnosis the pt is no longer a pt just a donor. Once they are pronounced your attitude must change from saving to slavaging organs if donors. IF they are not donors, it is still important to change your care (ie not explaining to the dead body what your doing. not saying johnny i m going to turn you stick you or whatever) and help the family with the greiving process.
    I dont believe it is show of respect it can actually make the process of acceptance take much longer.
    From reading some more of this super long thread, it seem alot of people do this for themselves and not so much for the family or the pt.
    anyway to each their own.
    Last edit by slcpicu on Oct 20, '08
  12. by   MistyDawnRN06
    I am an ICU nurse and have been for almost 3 years. I've worked my share of brain death cases. I speak to my patients. I feel it is the respectful thing to do.

    In nursing school and during my precepting period, I was taught to always explain to my patients what I was doing and why whether they could understand me or not (out of respect for those intubated/sedated/paralyzed, etc.) It's a habit I never got out of.

    The medical profession in general has a tendency to talk over our patients or about our patients in the ICU setting instead of to our patients. (I say ICU because that is my experience - may happen elsewhere - not sure).

    I understand brain death. I understand death. But I also have respect for the body, so I talk. They are still my patient until I have discharged them to the morgue and I strive to treat patients the way that I would want to be treated.

    Although I have to say that if family is at the bedside in a brain death case, I talk to the family rather than to the patient (I make an exception) so that the family doesn't misinterpret my actions as being toward a living patient. A brain dead patient is legally dead. It seems to be a natural transition to me, not one I have to think of. If the family is not there, I talk to the patient.
  13. by   Old and New
    I'm only a nursing student, but we are taught to treat even deceased patients who are being prepared for a family viewing with dignity and respect, and to continue speaking to them and explaining to them what is being done. I think it's a way of honoring the person who was. How would you want your body to be treated? Like a slab of meat, or the body of the wonderful human you were not long ago?