The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [64]
Many parts of this nursing procedure are based on general principles of infection prevention and control, and safe working. Furthermore, there is a cultural requirement to continue with the practice of Last Offices, as ‘rituals serve to express symbolic meanings important to groups of people functioning within a subculture’ (Wolf 1988, p.59). This is particularly important with something as profound as death. Rituals have a role in providing comfort and structure at a traumatic time, which Neuberger (2004) suggests can be valuable for families. Nurses approaching this act of care with compassion might enable families to see that their family member was respected and cared for, even after death. Nurses demonstrate the respect they have for a person who has died and the family, who may now ‘own’ the body, through rituals associated with Last Offices (Pattison 2008b).
Contemporary nursing practice and education increasingly shy away from ritualistic practices as they are considered irrational and unscientific (Philpin 2002) but Last Offices remains a notable exception. However, this is not to say that nurses carrying out Last Offices do it ‘without thinking about it in a problem-solving way’ (Walsh and Ford 1989, p.9) or in a way that does not recognize the individual needs of deceased patients and their carers. Instead, they are carried out with insight into the meanings attached to the accomplishment of this aspect of nursing care (Philpin 2002).
This aspect of care is usually carried out on the ward. In institutions without mortuary technicians, nurses may also rarely be called on to aid a family to view a patient who has died in the hours after death in the mortuary (Figure 2.4) or in a ‘chapel of rest’ (Figure 2.5).
Figure 2.4 Mortuary.
Figure 2.5 Chapel of rest.
There is no national guidance for how to prepare patients who have died for the mortuary or funeral home. Patients Who Die in Hospital (DH 1997) and What to Do After a Death (DWP 2006) deal with death in hospital and focus on procedures around the legalities of organizing funerals. Specific guidance might potentially disallow individual variation and personalization of after-death care in respect to patient wishes, cultures and religions. There is, however, national guidance on infection prevention and control in relation to people who have died. Care of the patient who has died must take into account health and safety guidelines to ensure families, healthcare workers, mortuary staff and undertakers are not put at risk (HSAC 2003). This chapter incorporates this guidance into broader national guidance where appropriate. It aims to ensure that patients who have died are treated with respect and dignity even after death, that legalities are adhered to, and that appropriate infection prevention and control measures are taken.
Indications
When a patient’s death has been verified and documented.
For adult patients who have died in hospital or in a hospice.
Contraindications
When to consult for further guidance before undertaking procedure:
if a patient who has died is indicated for a postmortem
if a patient who has died is a candidate for organ donation.
Legal and professional issues
In administering Last Offices, nurses need to know the legal requirements for care of patients after death and it is essential that correct procedures are followed. Every effort should be made to accommodate the wishes of the patient’s relatives (Neuberger 2004). The UK is an increasingly multicultural and multifaith society which presents a challenge to nurses who need to be aware of the different religious and cultural rituals that may accompany the death of a patient. There are notable cultural variations within and between people of different faiths, ethnic backgrounds and national origins. This can affect approaches to death and dying