Care of the deceased person

Providing personal care to the deceased patient, formerly called ‘last offices’ after the religious and military origins of nursing (Delacour, 1991), has been referred to as ‘care after death’ for several years (Wilson, 2022). Last offices involved the physical care of the body in preparation for transfer to the mortuary or funeral directors, whereas the term care after death encompasses the holistic care of not just the deceased patient, but also their family, significant others and health professionals (Wilson, 2022).

The Nursing and Midwifery Council (2018a) supports the holistic approach to caring for deceased patients, stipulating that duty of care should include care of the deceased and bereaved while respecting cultural requirements and protocols. The family and carers of the person who has died should feel that the body has been cared for in a dignified and culturally sensitive manner (National Institute for Health and Care Excellence (NICE), 2021). Caring

Cultural considerations

When carrying out the procedure nurses need to be aware of the religious and cultural observations and preferences of the patient and family. Wherever possible, nurses should have discussed any religious spiritual or cultural preferences with the patient and family prior to death or be aware of any advance statements where the patient may have made their wishes and preferences clear (Samanta and Samanta, 2010; Wilson, 2022; Gold Standards Framework, 2018). Nurses should ensure that they adopt a sensitive, caring and compassionate approach, ensuring that the family and significant others have time to be with the patient, assist in performing the personal care and can carry out any cultural, religious or spiritual rituals. It is advised that local trust policies are referred to ensure that religious needs are met, and if in doubt, nurses should liaise with representatives from the patients' faith or family members.

Legal implications

It

Preparation

It is imperative that all appropriate equipment is gathered (Box 2), and the surroundings prepared to create a safe working environment. The dignity and privacy of the patient should be respected, curtains/blinds should be drawn, and doors shut. If the deceased patient is in a bay, the other patients will need to be informed as a courtesy and to offer appropriate support. Ideally, two people should carry out the procedure (Box 3), in part this is to ensure the health and safety of the staff in relation to the moving and handling requirements of the deceased patient. If the patient is on a pressure-relieving mattress, this may be left on while performing personal care, in order to comply with moving and handling protocols (Dougherty and Lister, 2015).

Box 2. Equipment

• Disposable aprons and gloves
• Bowl of warm water
• Patient's own toiletries
• Towel x 2
• Patient's own razor/disposable razor (if

Box 3. The care after death procedure

1. Lay the patient on their back, with their limbs as straight as possible
2. Ensure that the patient's eyes are closed. Apply light pressure to the eyes for 30 seconds or use lightly moistened gauze or cotton wool to maintain the position
3. All drains, cannula and catheters, should be removed and disposed of according to local infection control policy, and gauze dressings applied over the entry sites. However, if there is to be a post-mortem examination, all drains and cannulas must be left in situ and local policies adhered to
4. Cover any wounds with a clean dressing, and leave stitches and clips intact
5. The patient's bladder can be drained by applying gentle pressure over the lower abdomen. Occasionally, there may be leakage from orifices. Suction can be used to clear fluids from the oral cavity, and incontinence pads used to contain leakage from the

Summary

Care after death not only incorporates the personal care of the deceased, but also takes into consideration the cultural, religious and spiritual needs of the patient and family while being mindful of the legal requirements and adhering to local policies and guidelines. It is therefore imperative that the nurse carrying out this procedure is not only equipped with the necessary skills, knowledge and experience, but also performs this duty of care with sensitivity, empathy and compassion, while preserving the patient's dignity.

References

Croxon L, Deravin L, Anderson J. Dealing with end of life - New graduated nurse experiences. J Clin Nurs. 2018; 27(1-2):337–344. https://doi.org/10.1111/jocn.13907 

Delacour S. The construction of nursing: ideology, discourse and representation. In: Gray GPratt R (eds). Towards a discipline of nursing. Melbourne: Churchill Livingstone; 1991:pp 413–433 

Dougherty L, Lister S. The Royal Marsden Manual of Clinical Nursing Procedures. Professional edition. (9th edn). Chichester: Wiley-Blackwell; 2015 

Gold Standards Framework. Advance care planning. 2018. https://goldstandardsframework.org.uk/advance-care-planninghttps://bit.ly/2lsAQhn (accessed 25 November 2022) 

Gov.uk. When a death is reported to a coroner. 2019. https://www.gov.uk/after-a-death/when-a-death-is-reported-to-a-coroner (accessed 25 November 2022)

Green J, Green M. Dealing with death: a handbook of practice, procedures and law. London: Jessica Kingsley Publishers; 2006 

Health and Safety Executive. Managing infection risks when handling the deceased. Health and safety guidance HSG283. https://www.hse.gov.uk/pubns/priced/hsg283.pdf (accessed 25 November 2022) 

Henoch I, Melin-Johansson C, Bergh I et al