News — Process variations related to brain death have far-reaching implications beyond delaying an official declaration of death, including added stress for the patient鈥檚 family, missed opportunities for organ donation and increased costs of care, according to an article in the December issue of Critical Care Nurse ().
鈥溾�� urges clear standards and uniform protocols be developed for declaring a patient brain dead. It concludes that aggressive surveillance, patient advocacy and collaboration during all phases of care following severe brain injury are imperative 鈥� and as a primary provider of bedside care, nurses are well positioned as key team members to lead this charge.
The article also calls for timely and optimal clinical assessment, potentially identifying treatment opportunities before a brain injury progresses to a terminal stage. It advocates for consistent standards for determining brain death to facilitate protocol implementation, including uniform intervals for examinations necessary for determination of death due to neurological criteria.
Author Richard B. Arbour, RN, MSN, CCRN, CNRN, CCNS, reviews clinical factors related to brain injury, identifies and illustrates criteria for determining brain death and details confounding factors in brain death. He also discusses the role of bedside nurses and advanced practice nurses in caring for critically ill patients with a life-threatening brain injury.
鈥淏edside nurses are best positioned to recognize even subtle neurological changes after brain injury,鈥� he said. 鈥淭hese subtle changes can identify treatment opportunities to promote the primary goal of patient recovery well before consideration of a brain death protocol.
鈥淔rontline clinicians are also trained to recognize a patient鈥檚 worsening neurological status and initiate formal, collaborative neurological evaluation for brain death, as clinically appropriate, and remain involved during a brain death protocol,鈥� Arbour said.
After a patient is declared brain dead, it is the nurse鈥檚 role to continue to provide optimal family communications, including addressing potential organ donation.
Arbour has more than 30 years of clinical experience in the care of critically ill patients with a focus on neuroscience critical care, organ donation/transplantation and end-of-life issues. He is widely published and recognized nationally and internationally for his expertise in end-of-life care, neuroscience critical care, organ donation and care of the organ transplant patient in both pre- and post-operative phases. He is currently a liver transplant coordinator at Thomas Jefferson University Hospital in Philadelphia.
As the American Association of Critical-Care Nurses鈥� bimonthly clinical practice journal for high acuity, progressive and critical care nurses, CCN is a trusted source for information related to the bedside care of critically and acutely ill patients.
Access the article abstract and full-text PDF by visiting the CCN website at .
About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in high acuity, progressive and critical care settings. CCN enjoys a circulation of more than 100,000 and can be accessed at .
b>About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, Calif., the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN joins together the interests of more than 500,000 acute and critical care nurses and claims more than 235 chapters worldwide. The organization鈥檚 vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. ; ;
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