Honoring the Personhood of Brain-Dead Patients: A Delicate Approach

A dandelion alone in a field suggests the fragility of life. Photo by RIDVAN AYRIK/ Pexels

In the past month, we had a couple of patients in our pediatric ICU who had suffered tragic neurological injuries and were declared medically brain-dead. In the state of California as in most states, a pronouncement of brain death is equal to a legal pronouncement of death, and the medical team then possesses legal permission to remove mechanical support from the physical body that has remained under intensive care.

In both of these cases in our ICU, the parents struggled to accept the terminal implications of brain death and pushed back to varying degrees for more time to see if their children might still somehow find a way to recover. In these types of cases, the actual moment-by-moment practice of bedside nursing care becomes complicated. How do we honor the personhood of the patient as we provide intensive care for the body prior to removing mechanical support, and at the same time gently help the parents accept that their child has medically died?

The potential for misunderstanding nursing care

The interactions nurses have with family members as we care for their brain-dead child present many opportunities […]

2023-06-21T13:06:54-04:00June 21st, 2023|end of life, Ethics, family experience, Nursing|1 Comment
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An ICU Nurse Reflects on ‘Returning Home from COVID Island’

“It’s hard to remember my job before all this began,” writes critical care nurse Deirdre McNally in this month’s Reflections essay, “Returning Home from COVID Island.” As the pandemic abates, she finds herself searching for a coherent narrative to understand what she’s experienced. But it’s not so simple. Memories of patients, moments, stray images from many months before slip unbidden into her head.

The difficulty of making sense of the past two years.

What does it mean to ‘make meaning’ from such an all-consuming experience? Maybe the answer will come with time. For now, she suggests, there are too many events, too many emotions and impressions to really absorb as things slowly resume a semblance of greater normalcy:

“For many health care providers,” she writes, “I think this is a protective mechanism meant to shield us from experiences too difficult to absorb.”

[…]

2022-03-17T11:47:07-04:00March 17th, 2022|COVID-19, Nursing, nursing career, nursing stories|0 Comments
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A Moment of Mindfulness: A Nurse’s Mosaic to Remember Patients

A Moment of Mindfulness © 2018 by Tilda Shalof

Noted author Tilda Shalof spent 28 years as an ICU nurse at Toronto General Hospital in Toronto. Over the years, she collected the discarded plastic medical packaging—including medicine caps, tube connectors, and vial lids, all of it sterile. At the suggestion of friend and artist Vanessa Herman-Landau, they used the plastic pieces to create this 4 ft. by 9 ft. mural, which is featured on AJN‘s May issue Art of Nursing page (click through to the PDF version for the best image).

[…]

2018-05-11T08:40:36-04:00May 11th, 2018|Nursing, Patients|0 Comments
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The Patient With No Name: When Nursing Illuminates Literature

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May issue of AJN. She doesn’t usually write about books in her posts, so we hope you enjoy this change of pace.

I didn’t know much about The English Patient when I picked it up recently at a library book sale—I only dimly recalled that the novel had been made into a movie I’d never seen. Since it was published by Michael Ondaatje in 1993, I can hardly blame a lack of time for my lapse. Yet I found myself glad I hadn’t read it until now, as my own nursing experiences suffused my reading of it, leaving me more deeply moved than I might have been otherwise.

The novel is set in the final days of World War II, in a bombed Italian villa that had served as a war hospital. As the story opens, the makeshift hospital has been recently evacuated, with patients and medical staff relocating to Pisa. One nurse remains, though—a young Canadian named Hana. Described as “shell-shocked” due to her experiences during the war, she refuses to leave the damaged hospital or a nameless English patient, who she insists is too fragile to be moved.

Other characters come […]

2016-11-21T13:08:53-05:00November 16th, 2012|nursing perspective, patient experience, Patients|4 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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