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faith, there may be differences in the way each person practises. It is, as always, vital that assumptions are not made on the basis of a previously disclosed religious preference – for example, not all Catholic believers will want to be given the sacrament of the sick. Each patient and their relatives should have the opportunity to express their needs and nurses should ensure that, wherever possible, these are met. Further information about religious/cultural perspectives and practices is given in Table 2.3.

Table 2.3 Cultural and religious factors to be considered at Last Offices

Postprocedural considerations

Nursing care does not end when the death of the patient occurs. Last Offices should be performed with as much attention to detail and respect for the individual as any other procedure.

Last Offices

Definitions

The term ‘Last Offices’ is historically related to the Latin officium, meaning service or duty. It is used to refer to the final act performed on a person’s body. Last Offices, sometimes referred to as ‘laying out’, is the term for the nursing care given to a deceased patient which demonstrates continued respect for the patient as an individual (NMC 2008). Nursing care continues even after death. Last Offices includes health, safety and legal requirements, making the person’s body safe to handle, respecting religious, cultural and spiritual requirements, and making the person who has died as pleasant as possible for others to see.

Patients, even though they have died, are still referred to as patients or people throughout this section.

Related theory

After-death care is the final act a nurse will carry out for the patient and remains associated with ritual (Pattison 2008b). Nursing care for a patient who has died has historical roots dating back to the 19th century (Wolf 1988). However, contemporary nursing has moved away from the ritualistic practices of cleansing, plugging, packing and tying the patient’s orifices to prevent the leakage of body fluids to encompass much more than simply dealing with a dead body (Pattison 2008b, Pearce 1963). Consideration now has to be given to legal issues surrounding death, the removal (or non-removal) of equipment, washing and grooming, and ensuring correct identification of the patient (Costello 2004). The End-of-Life Care Strategy (DH 2008) emphasizes care after a patient has died, and in particular it points to the value of integrated care pathways in managing administrative and psychosocial care. This corresponds to ‘good death’ theory where being treated with dignity is an underlying premise (Kehl 2006, Smith 2000), and good death encompasses all stages of dying and death (Pattison 2008b). This principle, therefore, continues after death.

Carrying out such an intimate act, that in many cultures would be carried out only by certain family or community members, requires careful consideration by nurses and adequate preparation of procedures that include family members where possible. Since 60.6% of all men and women who die in England and Wales will die in an institution (hospice, hospital, care home) (ONS 2009), it is predominantly nurses who will have to carry out after-death care, prior to patients being moved to mortuaries or funeral homes. Quested and Rudge (2001) suggested that this aspect of care is largely invisible to other healthcare workers.

Death threatens the orderly continuation of social life, according to Seale (1998). Last Offices can mark the social transition of the person as well as the biological death of the patient, and begins the process of handing over care to the family and funeral director. Last Offices can be considered as an important act in the rite of passage in moving the deceased person into the world of the dead (Van Gennep 1972) and is a procedure that people in all cultures recognize.

Evidence-based approaches

Rationale

Last Offices has its foundation in traditional cultures and is a nursing routine which does not have a large amount of research-based evidence (Cooke 2000). The administration of Last Offices can