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for instance, and in this case it should be at the discretion of those caring for the patient and the nurse-in-charge (local policy might also specify). Certain religious artefacts must never be removed from the patient, even after death, for example, the five Ks in Sikhism (Kesh – uncut hair, Kangha – the wooden comb which fixes uncut hair into a bun, Kara – an iron, steel or gold bracelet worn on the right wrist, Kirpan – a symbolic sword worn under clothing in a cloth sheath or as a brooch or pendant, and Kach – undergarments) (Neuberger 2004).

Table 2.3 lists the cultural and religious factors to be considered at Last Offices but these are only guidelines: individual requirements may vary even amongst members of the same faith. Families may require all, part or none of these actions to be carried out. They are adapted from Green and Green (2006), Neuberger (2004), Pattison (2008a, b) and Speck 1992.

Varying degrees of adherence and orthodoxy exist within all the world’s faiths. The given religion of a patient may occasionally be offered to indicate an association with particular cultural and national roots, rather than to indicate a significant degree of adherence to the tenets of a particular faith. If in doubt, consult the family members concerned.

Regardless of the faith that the patient’s record states they hold, wishes for Last Offices may differ from the conventions of their stated faith. Sensitive discussion is needed by nurses to establish what is wanted at this time. If patients are of a faith not listed in Table 2.3 or hold no religious beliefs, ask the relatives to outline the patient’s previously expressed wishes, if any, or establish the family’s wishes. Furthermore, the patient may be non-denominational and/or the family members may be multi-denominational so all possibilities must be taken into account.

Additional considerations

It is important to inform other patients, particularly if the person has died in an area where other people are present (such as a bay or open ward) and might know the patient. Senior staff should offer guidance in the event of uncertainty about how to deal with the situation.

Finally, Last Offices should be carried out within 2–4 hours of death. This is because rigor mortis can occur relatively soon after death, and this time is shortened in warmer environments (Berry and Griffie 2001).

Procedure guideline 2.2 Last Offices

Essential equipment

Disposable plastic apron

Disposable plastic gloves

Bowl of warm water, soap, patient’s own toilet articles. Disposable wash cloths and two towels

Disposable razor or patient’s own electric razor, comb and equipment for nail care

Equipment for mouth care including equipment for cleaning dentures

Identification labels × 2

Documents required by law and by organization/insitution policy, for example Notification of Death cards

Shroud or patient’s personal clothing: night-dress, pyjamas, clothes previously requested by patient, or clothes which comply with deceased patient/family/cultural wishes

Body bag if required (if there is actual or potential leakage of bodily fluids and/or if there is infectious disease). Labels for the patient’s body defining the nature of the infection/disease (HSAC 2003)

Gauze, tape, dressings and bandages if wounds, puncture sites or intravenous/arterial devices

Valuables/property book

Plastic bags for clinical and domestic (household) waste

Laundry skip and appropriate bags for soiled linen

Clean bedlinen

Record books for property and valuables

Bags for the patient’s personal possessions

Disposable or washable receptacle for collecting urine, if appropriate

Sharps bin, if appropriate

Optional equipment

Caps/spigots for urinary catheters (if catheters are to be left in situ)

Goggles

Full gowns

3M masks (if highly infectious) (HSAC 2003)

Petroleum jelly

Suction equipment and absorbent pads (where there is the potential for leakage)

Card or envelope to offer lock of hair, as appropriate

Preprocedure

Action Rationale

1 Apply gloves and apron, gowns/masks/goggles if the patient is infectious.