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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Throwing a Rope Down The Hole of Despair: Early Referral to Palliative Care

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. Illustration by the author: River, Mountain, Sky – detail of Polar Bear’s Last Song. Watercolor, inkjet collage, 2016.

River, Mountain, Sky - detail of Polar Bear's Last Song. Watercolor, inkjet collage, 2016 by Julianna ParadisiNervously, I adjust the Bluetooth earpiece I’m wearing before dialing the phone number. I’ve rehearsed my greeting. On the other end, the patient answers, “Hello?”

I tell her it’s her nurse navigator and I’ve called to find out how she’s doing. Her oncologist recently informed her the cancer has returned—further treatment will only ease symptoms, not cure the cancer.

“I haven’t left the house since I got the news,” she tells me. “Sometimes I just sit on the sofa all day. I don’t know what to do.”

It’s a common response from patients in similar circumstances. The realization they will not survive can become emotionally paralyzing, rendering a person unable to find purpose or a reason to keep going. Pain, fatigue from surgery, chemotherapy, and radiation therapy, contribute to feelings of hopelessness, hampering the ability to consider their choices.

“Did your doctor mention a palliative care referral?”

Many health care […]

2016-11-21T13:01:14-05:00May 2nd, 2016|Nursing, Patients|2 Comments
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Bedpans and Learning: Nursing Basics Still Matter

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

Photo by Morrissey, via Flickr. Photo by Morrissey, via Flickr.

There I was, orienting to a busy medical ICU, perplexed over a bedpan. You’d think, since I was just graduating from nursing school, that bedpans would be my area of expertise. Critical thinking and vent strategies came easy; how could I possible admit I had no idea how to give a bedpan to a patient?

Frightening, to graduate from nursing school and a competitive externship program without this competency. Somehow, though, every unit I’d experienced offered patient care assistants, or patients who didn’t need this age-old tool. I’d certainly helped patients to the bathroom and cleaned incontinent ones. Despite the barrage of clinical learning, the basics of offering the pink plastic tool hadn’t sunk in.

Paralyzed, I stood with it in my hand, looking at my intubated, awake patient. I’d had the wherewithal to ask the family to step out, but couldn’t figure out which end went first. The horror of my preceptor finding it backwards would end me. Did the pointed end go towards the patient’s back? The larger end toward the feet for better coverage? Why couldn’t I remember?

Somehow, I managed to decide, […]

2016-11-21T13:02:43-05:00April 8th, 2015|career, narratives, Nursing, nursing perspective, patient engagement|7 Comments
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What’s Your ‘Impact Factor’ as a Nurse?

Blue Impact I, by Helico, via Flickr. Blue Impact I, by Helico, via Flickr.

I hate to admit this in public but I do enjoy a good self-help book from time to time. My latest guilty pleasure is Write It Down, Make it Happen, by Henriette Anne Klauser. The title sums up the premise of the book pretty well: if you want to make changes in your life, start writing about them and your aspirations will begin to take on a life all their own.

I haven’t actually done that yet, so I will have to keep you posted. However, what really struck me was an anecdote about a study from the 1960’s (apparently this story has gotten around quite a bit and may have become an urban legend). Scientists observing monkeys on an island off the coast of Japan noted that these monkeys were washing sand off potatoes in a stream. Little by little other monkeys adopted this same behavior. When a certain number of monkeys (a “critical mass”) was reached, primates on neighboring islands started to do it too. This is sometimes referred to as the 100th monkey theory. […]

2016-11-21T13:33:56-05:00April 23rd, 2009|Nursing|0 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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