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, 2015). 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, 2015). 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), 2017). Caring for a dying patient is an integral part of nursing care and Quested and Rudge (2003) pointed out that performing last offices is the final duty of care for the patient. Although the procedure can conjure up a myriad of feelings in nurses such as fear and anxiety (Henock et al, 2017; Croxon et al, 2018), it can also have a positive effect with nurses seeing the procedure as a privilege.
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, 2015; 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. This article does not address the religious or cultural considerations, therefore, it is advisable 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 is important to ascertain whether the deceased patient requires a coroner's referral or not (see Box 1), to comply with the correct personal care, and enable the family to prepare for the possibility of a post-mortem examination (Gov.uk, 2019). Personal care on the deceased patient cannot commence until the death has been verified. If the death is unexpected, a doctor usually conducts verification of the death. If the death is expected, then depending on local trust policy, a registered nurse who has received additional training may be able to certify or verify the death (Dougherty and Lister, 2015; Royal College of Nursing (RCN), 2018; Wilson et al, 2019).
Organ and tissue donation
The patient's preferences in relation to organ and tissue donation should be recorded, ideally before death has occurred. Further advice and information regarding consent should be sought from NHS Blood & Transplant (NHSBT) specialist nurses in organ donation, who are based in acute hospital trusts, or by contacting NHSBT directly (Wilson, 2015).
Health and safety
The Health & Safety Executive (HSE) (2018) stipulates that health and safety guidelines should be taken into consideration to prevent any risk to the family, staff, mortuary staff or funeral directors. Personal protective equipment (PPE) such as aprons and gloves should always be worn, and local infection control and moving and handling guidelines should be adhered to.
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).
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.