CNA & post mortem care - mandatory?

[aerocats]

Hello all,

So, as an introduction & my FIRST FORUM :)) here on allnurses.com, I'm an aspiring nurse; it's a career change for me at 30 years of age. I'm thinking it's prudent to begin working as a CNA before I get into nursing school.

Here is my MAJOR concern: I can't do post mortem care. Before you tell me that likely somebody will be doing that to me someday & we all deserve it, I'd like to say that I don't doubt you & although it's a dirty job in some opinions, somebody's gotta do it. Care of deceased individuals would scare the living daylights outta me, depress me, and god only knows what else.

What I'm asking is - is it possible to have work as a CNA & never do post mortem care? I'm assuming that if this is a possibility, then likely I'll be working in a hospital, not a nursing home?

I regret that I'm not one of those people that can look beyond death to just do the job. Sadly, that's not something I can get beyond, regardless if the job required it, that's why I'm asking you all.

Please advise.

Thank you!!

[Pauligirl]

Since my previous post to this thread there have been a few more deaths on my hospital unit during my shift.

If the family is coming to the hospital to view the deceased we "tidy" the patient up. Remove IV's, tubes (GI tube), probably keep the foley in place until we take the body to the morgue. Quick wash up of the face, peri-anal area, change brief if one was worn. Put clean gown on, clean top sheet, arrange the deceased in a restful looking position.

After the deceased's family leaves we remove all clothing from the body, then tag and bag. No clothing, no jewelery, nothing on the body. Thorough washing is not part of the routine.

One of the nurse aides' (that I mentioned in my previous post) that ignore's her responsibility when a patient she's assigned to dies had a recent death. Her and I were working on the same hall. Before her patient passed I noticed that the patient was tossing, turning, and trying to sit up in bed. He had thrown off all the sheets, blankets, and his gown was off. All of this was noticed just from walking by the room. Since it was still visiting hours and many families were around visiting other patients I decided to go in and take a look. This was not a nice sight to see and maybe the patient needed something.

I covered the patient up, told him it's chilly without clothes and blanket. Asked him if he needed anything but he didn't respond. His eyes were kind of bugged out and he had that "death rattle" in his throat. A few minutes after I covered him up respiratory therapy was in the room giving him a breathing treatment. About a half hour later his RN walked by the room and mentioned "I think that patient has passed". No rush since he was a DNR. Sure enough he had passed. His eyes were still bugged out and his mouth was wide open with black coated tongue obvious. The poor man was not a pretty sight!

When I told the nurse aide who was assigned to him that her patient had passed she said "Oh No!" and continued to do her charting. So I decided to help out and asked his nurse if family was coming. She said "yes but he needs to be tied before rigamortis sets in, tie his jaw shut , we'll just have to be sure to undo it before the family arrives in about an hour":uhoh3:

I don't have any experience with tieing deceased patients! Nor do I have any knowledge about it! So I went back to the deceased's assigned nurse aide (who was still sitting at the pc doing her charting) and told her that her nurse wants the patient tied up! And told her she had better hurry before rigamortis sets in!

The look on that nurse aide's face was priceless! She truly had the look of horror! Serves her right, since she has a habit of skirting her responsibilites! She got another aide to help her with preparing the body and I guess they had a heck of a time trying to get the deceased's jaw to close. They never did find any rope and the man's jaw never did get closed. And the assigned aide managed to dump the remainder of her responsibilities onto the aide that assisted her. Since it was after hours the other aide met the family in the lobby, etc...

I'm wondering about this tieing of the body. The RN mentioned tieing the jaw shut, arms down, etc... I really don't recall. Does anyone have experience with this? Know anything about tieing the deceased???

[rn2bnwi, BSN, RN]

i think you might change your mind. its one thing to think about it but its another when your in the process. not quite as 'significant' as your probably making it. but if you REALLY can't do it this might be a big problem if you loose someone in clinicals . i can't imagine a instructor passing someone who can't do this.

i just reread about your dad. i think eventually your own experience will give you strength an edge. i know that some of my health trials with my child have been an asset to me . GOOD luck!

[Muttlover]

Hi, I'm a new CNA and haven't had to deal with post mortem care yet. But, I fully expect to and I can't promise myself that I won't be scared at the time. But like many people above said, I, too learned that it is the final act of life. When a baby is born, it is such a wonderful, intimate moment. I kind of look at it that way, too. It's a very intimate, final moment in the person's life. They should be treated with dignity and respect. I remember when my mom passed away (in a hospital) after being in a coma for 2 weeks. Talk about horrendous times in your life -- I wish I could thank the person/people that took care of her post mortem needs. Needless to say, I didn't think of it at the time, but I kind of look at it like giving back to someone's else's family in their time of need.

[kangamangus]

As we are told in our classes.....unless you work in maternity/ pediatrics you are practicing geriatrics....most hospital admits today are an aging population.... if you are young and fairly healthy then the insurance agencies want you in and out...chances are pretty good that you will encounter post mortem care unless you work as a CNA in labor and delivery.....and it's really only going to get worse...the baby boomers are going to be coming more and more into the healthcare needs society.....and we may end up not having enough nurses to care for this aging population...but I digress.....you should think about what really bothers you about post mortem care..maybe even volunteer through a hospice agency so you can see what the whole process is...

[1badnurse]

I dont want to sound harsh, but I have to agree with my collegues who say this may not be for you. We all have certain fears when starting anything new, and will death is not something we may want to deal with, it is and always will be part of the job. Anyone working in the medica field has to deal with death in some form. If you dont feel you can overcome your fear/issue, maybe consider another position in the medical field. Dealing with issues like death is part of what makes aides and nurses such angels, not everyone is equipped for this.

[rn2bnwi, BSN, RN]

I have NEVER seen a body tied. that is kind of bizarre? we did tape a patients eyes shut who died with her eyes open . She had young children and we were concerned that it might be too much to see her eyes open. Their father ended up deciding that they shouldn't come see her but after a couple hours we took the tape off and her eyes were stayed closed so its a trick i will use again. for open mouths we tend to just do oral care and we put their heads up on a pillow so that its elevated but i have never had a mouth that was wide open like i imagine your describing.... The place i go to the most always sends their patients to the funeral home in a gown and they always postition their hands with flowers or a teddy bear before the family comes in.... its customary for the family and a few workers to escort the body to the funeral homes vehicle. even if family doesn't come workers who took care of them will escort them. its really kind of a beautiful 'ceremony' . My first person that died was a resident at a nursing home. He had lived there for years and i was really 'sad' at the lack of any reaction by the regular workers there. i decided it must be that you 'just get so used' to it. but when i started going to a hospice facility i was really touched by the care , compassion and dignity that gave their patients even in death. it was very monumental for me and an experience i think that will shape me later when im finally a nurse.

[StephyCNA]

Well, considering that I wanted my original major in college to be Mortuary Science, death has never been an issue for me. I decided to become an RN first before pursuing MORS.

I am currently a CNA in New York. I've been doing the job for about a month now and I had my first post mortem in the wee hours of Sunday morning. I work 3rd shift, which seems to be when many of our residents pass away. I swear some of them wait until their family leaves before they'll let go.

This was a resident that I didn't usually work with, but I liked him anyway. I sat in his room with him after his family left and stayed until he passed away. Where I work post mortem care can be appropriately done by 1 CNA in most situations, but 2 of us did it because I was hesitant to do it alone the first time.

It's really not that bad. A lot of times it is very easy to lose sight of the fact that the pt is deceased because we do the PM care very quickly, before they feel cool to the touch.

I'm sure the thought of it might freak you out. Most people in the nursing dept. feel a little nervous around death at first, but I think you'll be able to do it. While working as a CNA, just let your coworkers know that you are a little frightened at the idea of PM care. If you work with good people (and a good CNA has a GREAT sense of sympathy and understanding), they will walk you through it and stay with you until you feel comfortable!

Good luck with your new career choice! I am in college for my RN as well and decided working as a CNA would be great experience while moving up the medical ladder!

[StephyCNA]

Thorough washing is not part of the routine.

Really? At my nursing home we give a full bed bath for PM care.

My resident died with his mouth open as well, but I have never heard of tying the patient's jaw or anything like that. I'm in NY state and we never learned about that in CNA classes and I've never heard of it being done, at least by CNA's.

[KimberlyRN89, BSN, RN]

Really? At my nursing home we give a full bed bath for PM care.

My resident died with his mouth open as well, but I have never heard of tying the patient's jaw or anything like that. I'm in NY state and we never learned about that in CNA classes and I've never heard of it being done, at least by CNA's.

I haven't had to perform PM care yet, but when I was doing clinicals for my CNA class we got to see a resident who had just passed away. He died with his mouth open & our instructor told us that the funeral home will tie something around their head to keep their mouth closed.

[CrunchyMama, ASN, RN]

As a CNA I never really had a problem with death. Then when my mom passed away unexpectedly and I'm the one who found her....my nursing supervisors understood when I explained to them that I couldn't do it. I couldn't have anything to do with death! Even when the funeral home would come pick them up, I couldn't even help transfer the body to their stretcher. Always had to get someone else to do it. Luckily everyone understood. I was messed up for awhile. Anyway... this was almost 10 years ago (wow) and I'm "better" now and I'm sure I can deal with it....especially after dealing with cadavers during A&P. However... I'm assuming it's something you'll have to get over. I know it sounds harsh but being a nurse, you're going to have to deal with death sooner or later....unless you stick to doctors offices.

[TampaTech]

Dont worry we all have to PM care. It isnt glamourous but like you said, "someones gotta do it". Now not to sound mean and uncaring, but unless you have some sort of documented reason as to why you cannot do post mortem care then you are just going to have to do it. Even though they have died, they are still people, and I dont know about your state laws but in florida you cannot refuse a task or assignement, and if someone wanted to be mean and hateful. Someone might beable to even get you in trouble for patient neglect. Especially as a nurse.

[PhoenixTech, LPN]

hi aerocats

no, my dear. we do pm care in the hospitals big time. my first, and i do mean very first, week as a tech i had two pts pass on and guess what....yes, i had to do it. thank god i didn't do it alone and when i found out i'd have to, i felt dread in the pit of my stomach and felt very much like you did. i didn't think i could do it either.

the first one was a code and i watched fascinated as i realized that codes last for more than 10 min. afterwards as we were performing her care, when we turned her she leaked fluid from her mouth from all the boluses they had administered during the code. her eyes were open and as we kept trying to close them they'd open back up real slowly. let me tell you, she was a messy one and when it came time for me to touch her i was screaming at the top of my lungs in my head. however, i calmly washed my side and the fact that she had just departed not more than 30min ago made it easier. her body was still warm and after awhile it felt like we were performing her care while she was asleep.

the second pt was in the room right next to hers and went two days later. i was just holding a conversation with him and just like that he was gone. this time his care wasn't done quickly after and although he wasn't a code and there wasn't any mess, he was cool to the touch. when we turned him, you could see that all the blood had pooled on his back. i think it's called lividity. needless to say that although i didn't have nightmares, it certainly took me a long time to fall and stay asleep for about a week.

i can't say that i'm completely comfortable with it but i have definately gotten better doing it. i can fall asleep with no problem and it's just become another part of the job description for me. a very intimate part no doubt, but a part just the same. you'll do it and you'll get through it. trust and believe in yourself. just have another aid help and you'll be just fine. my best wishes to you whatever you decide.:redpinkhe

pauligirl

we have a pm kit which comes with the bag and ties. we not only tie the hands and feet at my hospitat but we also tie the jaw shut. i'm not quite sure why but i can tell you that it makes it easier when we transfer them to the morgue and put them in the drawers. i can only guess that having the apendages flopping around will make transport harder. also, if the pt had a messy death as with my first pt., then having the jaw tied can prevent more fluid loss while transporting the patient. if not, we'd have to keep cleaning the pt and we'd never get it done. in this sense, it does make sense to me to tie the body.