Providing Postmortem Care
When a patient dies, the nurse’s responsibilities include caring for the patient’s body, caring for the family, and discharging specific legal responsibilities. The latter involve ensuring that a death certificate is issued and signed, labeling the body, and reviewing organ donation arrangements, if any. After the patient has been pronounced dead, the nurse is responsible for preparing the body. The body is placed in normal anatomic position to avoid pooling of blood, soiled dressings are replaced, and tubes are removed. In most cases, it is unnecessary to wash the body; the mortician normally attends to this. Some religions strictly forbid washing of the body, whereas in others a special person must perform it. In cultures in which the family’s washing of the deceased’s body is considered the last service a family can give a loved one, the family should be given the necessary supplies and left alone in the room with the body. If an autopsy is to be performed, any tubes that were in place should not be removed. In such cases, the nurse should follow the hospital’s policy. The nurse is legally responsible for placing identification tags on either the shroud or garment the body is clothed in and the ankle to ensure that the body can be identified even if it is separated from its shroud. The nurse also places an identification tag on the patient’s dentures or other prostheses to ensure that the mortician receives these. The importance of proper and complete identification cannot be overemphasized. The patient’s body may be placed in the hospital’s morgue refrigerator if mortuary arrangements were not made before the patient’s death. If the patient died of a communicable disease, the body may require special handling to prevent the spread of disease. Requirements for such handling are usually specified by local laws and are contingent on the disease-causing organism, mode of transmission ,and other characteristics. Most often, the family is in the emergency department waiting room when death is confirmed. They are stunned, bewildered, and numb. Do not rush them from the waiting room, rather, provide them with a private place to begin their grieving. It is appropriate for the nurse who was caregiver or who took care of the patient for a prolonged period to attend the funeral. It also is appropriate for the nurse to make a followup call to the patient’s family after the funeral or memorial service to offer both concern and care for the family’s well being. Follow-up visits are important to give support to the family. If the nurse assesses that the family is not coping well, appropriate referrals should be made. If the patient was cared for by a hospice, the family is offered grief support for up to a year following the death.