Honoring the personhood of brain-dead patients: A delicate approach

Photo: RIDVAN AYRIK/Pexels

Last month, we had several patients in our pediatric ICU who suffered tragic neurological injuries and were declared brain dead. Within the state of California, as in most states, a declaration of brain death is corresponding to a legal declaration of death, and the medical team then has legal permission to remove mechanical support from the physical body while it was under intensive care.

In each of those cases in our NICU, parents struggled to just accept the last word consequences of brain death and, to various degrees, postponed the choice for an prolonged time period to see if their children could still in some way discover a option to get better. In most of these cases, the actual, momentary performance of bedside nursing care becomes complicated. How can we honor the patient’s personhood by providing intensive look after the body before removing mechanical support, while also gently helping parents accept that their child has died of medical causes?

Possible misunderstanding of nursing care

Nurses’ interactions with relations as we look after their brain-dead child create many opportunities for confusion or clarity. Nurses answer a barrage of questions from relations about what one reflex neurological twitch might mean, why we proceed to be diligent about protecting the skin if the patient is de facto gone, and why we proceed to inform the patient what we’re going to do if he or she will’t do it. longer interactions with the skin world.

Our willingness to proceed to respect the patient’s personality through a sensitive approach may unintentionally delay the hope of struggling parents that the patient stays fully present and just needs just a little more time to “get up”: “Our baby just isn’t dead. In any case, the nurse says she doesn’t want his skin to get damaged and he or she’s talking to him anyway, so why would we’d like to take out the respiration tube?”

The common human struggle to disconnect from a brain-dead patient

I feel an ethical concern about keeping this corporeal shell alive through aggressive medical interventions once the spirit has passed away. At the identical time, if I alter the best way I provide care by refraining from personal contact, I feel a way of loss about who I’m and what I value as a nurse. In this manner, I feel deeply conflicted.

Nonetheless, I’m aware that this just isn’t only my fight, but in addition that of my patient’s family. Human beings should not programmed to easily turn off their hearts when a switch is flipped or a physician’s order is issued. We value personhood and struggle with the concept of ​​disconnection from the person that was once embodied by this flesh and blood and now stays present only through mechanical support. I don’t need to be an off-the-grid nurse; how far more resistant are my patients’ parents to the concept of ​​finally separating from their beloved child?

This awareness of our common human struggle with disconnection gives me more empathy to satisfy my patients’ parents where they’re as they struggle with the consequences of brain death. This permits me to supply them with the emotional safety they should struggle, grieve, after which perhaps slowly trust what we tell them about their child’s condition.

Tailoring patient care with sensitivity to family struggles with loss

If parents remain ambivalent about brain dead status, it will be useful for me as a nurse to obviously explain the explanations for my approach to patient care. I’d say, “I would like to be gentle together with your baby’s body, and I consult with every patient I look after, whether or not they can hear us or not. But even when I do, you will need to understand that we don’t expect your child to get better or react again, and I’m very sorry for that. I imagine it is necessary to treat him with as much respect as possible while he’s in our care.

Stating this as clearly as possible will help keep all of my verbal and non-verbal communications consistent with the whole medical team as we try to assist parents understand and ultimately accept brain death. Nonetheless, in situations where parents are particularly immune to the concept of ​​brain death and the case is drawn out, causing greater moral stress for the health care team, I and other colleagues have decided to stop talking to the patient within the presence of the doctor. parents to avoid misunderstandings.

All my interactions must happen within the context of broader communication with the family, based on openness, careful listening and trust. Only then will parents have the option to view my individualized care as an expression of deep respect, slightly than as a sign that a brain-dead patient may in some way still have a likelihood of coming to life.

We cannot overemphasize the importance of the discernment, empathy and patience of the whole medical team when caring for brain-dead patients, especially bedside nurses who’re most current with the patient and family during this extremely delicate time.