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

Specialties Neuro

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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.

Specializes in Author/Business Coach.

I speak to all my patients regardless of brain death or not. It just seems so cold and unlike me not to. I don't like treating people like a slab of meat. This person was once alive a mother, daughter, father, son....They deserve respect in life and death. What harm may arise? None.

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Specializes in Critical Care, Pulmonary Educator.

NurseCutie, I agree, I talk to all - I don't believe in any way that they will hear me, but it's a way of cleaning out all the debris in your head before you move on to the next poor guy. I do, however, make it a point to not talk to my brain dead patient in front of family, especially if they are having a hard time realizing the person is really dead. Like in the case of a family who is resistant to removing life support once brain death has been confirmed. I feel like if I talk to that patient, it will just reinforce to the family that the patient is NOT dead!

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Specializes in Author/Business Coach.

I understand what you are saying about not talking to them around families who are in denial about brain death. That would confuse them even more. I always talk to my families too. I ask them if there is anything I can get for them and explain the whole process. Even though I may not speak to the pt in the families presence I still give the body the upmost respect, considering they were once a living, breathing person.

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Specializes in Critical Care, Pulmonary Educator.

Absolutely, they are the ones we are caring for, rather than the patient once brain death has been established.

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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..

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Specializes in Critical Care, Pulmonary Educator.

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.

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Specializes in Critical Care, Pulmonary Educator.

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!

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Specializes in Medical.
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.

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Specializes in Critical Care, Pulmonary Educator.

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!

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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.

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Specializes in ER/Critical Care.

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.

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i always talk to my brain dead pts., especially when family is present. just a show of respect.:nurse:

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