Special care is needed when the patient is deceased. If the patient death occurs in a hospital or medical facility, the assigned nurse is responsible for notifying the attending provider and the hospice involved in the patient’s care. When the patient is pronounced dead by a registered nurse, she is in charge of several postmortem tasks, like documentation, caring for the body, and support to the grieving family. Because these tasks can be emotionally draining, the nurse must pay attention to caring for herself.
Postmortem care, which may be provided in the decease’s home or a health care facility, entails caring for the deceased patient with cultural sensitivity and per the patient’s religious or cultural beliefs. As society becomes more culturally diverse, healthcare team members should be familiar with the ethics of death and dying and sensitive to the cultural practices of patients and family members.
Providing family time to rituals and mourning practices gives them a sense of control in the face of death. However, individual differences exist among cultural and religious groups. Therefore, the family’s specific needs must be considered when performing postmortem care.
Physical changes after death
Many physical changes occur after death, including loss of skin elasticity and change in body temperature (algor mortis), purple discoloration of the skin (livor mortis), and stiffening of the body (rigor mortis). Therefore, postmortem care should be provided as soon as possible to avoid tissue damage or disfigurement. To avoid livor mortis of the face, the head of the bed should be raised and a clean pillow placed under the authority. Individuals who want to grieve and view the patient should be given a peaceful presentation of the patient by a healthcare team member.
Care of the Body
The nurse will prepare the body per hospital or facility protocols during the postmortem period. When providing postmortem care, wear gloves and take standard precautions. The following steps are part of postmortem care. Remember to gather any necessary supplies before beginning. The body should be treated with dignity and respect by the nurse at all times.
- Arrange the body in a supine position with anatomical alignment. If your eyes and mouth are open, close them.
- Remove any clothing, jewelry, or personal items and place them in a bag for family pick-up.
- Give the body a bed bath with a basin pan filled with water and soap. If necessary, comb your hair.
- Remove any medical devices, such as venous access lines, catheters, or other tubing.
- For possible fluid leakage, a diaper or absorbent underpad can be used.
- Dress the body in a clean gown or family-provided clothing.
- Ascertain proper patient identification and place a toe tag on the patient.
- If family members will be visiting, change all bed linens and cover the patient with a sheet (only to the shoulders).
- Once prepared, place the patient in a body bag for stretcher transport to the morgue or direct pick-up by a funeral home.
- If necessary, gauze can be used loosely to secure the wrists together.
It is important to note that if a death occurs due to suicide, homicide, accident, or other unknown cause, an autopsy may be recommended. If an autopsy is ordered, the body should be cared for as described above, with all medical equipment remaining in place.
` When a death occurs, the nurse supports the family. Do not use euphemisms like “passed on” to describe death. It is preferable to use concrete, factual language. When communicating with family, it is acceptable to use the words death, died, and deceased to ensure understanding. Helping the family through the grieving process can promote healthy coping and healing.
Encourage the family to say their final goodbyes with religious rituals and in a culturally acceptable manner. Compassionate care gives family members a meaningful experience during the early stages of grief.
- Provide soft lighting and seating for the entire family.
- Place a chair by the bedside for a family member who may pass out.
- Make tissues and water available to the family.
- Give the patient’s family time alone with the body.
· Don’t rush through the grieving process.
· Do not force family members to view the body.
· Remain available to meet needs and answer questions.
Documentation continues even after the patient has died. Therefore, the nurse must ensure that the following information is accurately documented in the patient’s chart:
- Date and time of death
- Description of any resuscitative measures used (if any)
- Name of the professional certifying the death
- Any special preparation of the body for autopsy or organ and tissue donation
- First-person consent, Donate Life Registry, advance directive, or living will, if applicable.
- Name of the person who requested organ and tissue donation, if applicable.
- Name of organ donation agency representative, if contacted.
- Name of mortuary
- Names of family members consulted at the time of death and their relationships to the deceased.
- Actions were taken to secure valuables, personal belongings, and the name of the individual who received them.
- Time the body was transported and its destination.
- Location of body identification tags
- Unexpected outcomes and related intervention