Post-Mortem care, PLEASE realize it is a human being.

Nurses General Nursing

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I have been in the healthcare field for a very long time. I've been a nurse 3.4 of that time, and am in school to advance my degree. I have a hx of LTC (when I was a CNA) and hospice care as both a visiting nurse and a continuous care coordinator. So, I have dealt with a LOT of death, and post-mortem care.

I was absolutely horrified the other day. During clinicals I was pulled, along with a noob student, to do post-mortem care. The only "learning experience" for me was it was an ICU patient, and she had just about every line you could have. So, I got to see new lines, how they were inserted, and what they were for.

Of course we had to remove all the lines, and continue with care (clean, change the bed, dress pt) to get her ready for her family. The funeral home said it would be 2.5 hours till they'd get there (so we were NOT under a time constraint).

So, the ICU nurse began removing lines. When we started helping, she kept saying, "hurry up, you can remove it faster, you don't have to worry about going to slow, she isn't going to feel it." My noob removed the IV from the CL and it started bleeding. She had informed the nurse she had never saw, let alone work with a CL. The nurse said just d/c the IV. Well, my fellow student D/C'd them at the hub, not at the connection... so the nurse slowed for a moment to ream her for a second (then realized she did not help with it by explaining what to do).

Anyhow a (VERY) long story short... I had to stand back. I was taken aback by the lack of respect and dignity this woman was being treated with. When the nurse removed the pasty that kept the ET tube in with such force it snapped the woman's head. She removed a dressing, and skin came with it - she just shrugged and moved on.

If you have worked in a field where you see dead bodies so much that they are nothing short of a piece of meat then MOVE ON! If that were my mother in that bed and I would know how she was treated, I would probably have met that nurse in the parking lot. I spoke to the nurse AND HER MANAGER after we were done. I was appalled. No, it was worse than appalling... I can't find the right word. I was so shaken that I cried when we left the floor.

This person is a HUMAN BEING who was alive just 30 minutes ago. This is someone's mother, father, sister, brother, son, daughter. Sure, they don't "feel it" but neither does someone in a coma. So, how does that nurse treat her other patients who can't feel?

When I do post-mortem care, I still take time to warm the water. I remove a band aid like I do from a live person, I don't just rip it off. Heck, I still talk to the person. Just because that person just breathed their last breath doesn't turn them into a slab of ham to throw around, rip things off of, and treat disrespectfully. Death, and the after care is part of our job, too. It isn't the time to take out our frustrations. Please, think of what the family would think if they were watching how you are taking care of their family member.

There should still be dignity with death. Please, remember this... It isn't that hard or time consuming to be respectful to someone who just breathed their last. If nothing else, just remember it is part of our job.

(And, someone may say about the funeral home - IDC how or what happens at the funeral home (well, I do, but I don't have to see it), they deal JUST WITH dead bodies. They didn't just get done caring for this person trying to save her life. They do not go to school to LEARN caring behaviors. It is NOT the same thing).

Of course we had to remove all the lines, and continue with care (clean, change the bed, dress pt) to get her ready for her family. The funeral home said it would be 2.5 hours till they'd get there (so we were NOT under a time constraint).

even though you believed there was no time constraint, i'd find it equally as credible that an icu bed needed to be opened up, which would necessitate a concern for time.

i have done hundreds of post mortems, and have pulled dozens of central lines on the deceased.

pulling lines on the deceased, isn't even remotely comparable to pulling lines on alive and kicking pts.

plus. there are disease processes that result in friable, thin skin...

diseases that cause so much increased pressure that often results in abrupt bleeds...

so much we nurses just aren't familiar with, in their respective specialties.

the reasons why this would happen, could go on and on...

and not only because this icu nurses was way too aggressive and inconsiderate.

i'd really love to hear from icu nurses, and their input.

op, it 'sounds' like you had some concerns with the demeanor of this nurse, and perhaps, may be reacting emotionally?

after all, it really is a sensitive and emotional issue.

death affects ea and everyone of us differently.

there are those who purposely detach themselves in order to avoid a breakdown.

that doesn't mean they're being inconsiderate.

finally, i too, have observed (too) many 'abuses' of how a corpse has been treated, and boy, did i step in and speak up, and report them.

and if anyone knows me, i'm a nurse who doesn't hastily and automatically support nurses randomly.

i've seen (too) many 'abuses' during postmortem care, and have taken over care, talked with involved people afterwards, then reported.

anyways and fwiw, i too, speak to and reassure my (deceased) pts...

but that doesn't mean i'd expect all to.

just as i don't expect all to treat the deceased person in baby steps.

as long as dignity is preserved (like not exposing them naked, even if alone), then i'm fine with a seemingly 'laissez-faire' attitude.

as a matter of fact, i was also totally like you, and wanted to bite anyone's head off that didn't treat them as i did.

after a rather long and difficult journey, this is how i see it now.

but definitely continue doing pm care as you believe it should be.

it is loving, sensitive, and honorable...thanks for that.

leslie

Specializes in Addiction, Psych, Geri, Hospice, MedSurg.

op, it 'sounds' like you had some concerns with the demeanor of this nurse, and perhaps, may be reacting emotionally?

after all, it really is a sensitive and emotional issue.

death affects ea and everyone of us differently.

there are those who purposely detach themselves in order to avoid a breakdown.

that doesn't mean they're being inconsiderate.

finally, i too, have observed (too) many 'abuses' of how a corpse has been treated, and boy, did i step in and speak up, and report them.

and if anyone knows me, i'm a nurse who doesn't hastily and automatically support nurses randomly.

i've seen (too) many 'abuses' during postmortem care, and have taken over care, talked with involved people afterwards, then reported.

anyways and fwiw, i too, speak to and reassure my (deceased) pts...

but that doesn't mean i'd expect all to.

leslie

I was not with the nurse prior to post-mortem care... She may have very well have been the best nurse with this woman prior to death, that doesn't mean it stops with death. If she was not in a position to continue the dignity and care then she should have allowed someone else to care for this patient.

This was not an emotional reaction on my part. As a hospice nurse I work with death, a lot. I've been with people as they've breathed their last, and I've done PM care on more than I can count. I am not uneasy around death, I see it as a passing, and usually a relief for that person (usually, definitely not always). I am uneasy around someone stripping a person's dignity and not providing respect. I would not be ok if that were a family member in that bed, or worse, me.

Let's put it this way: she was upset at me for "being in her way" as I went around and draped a towel over this women when she stripped the sheets off, and her gown, WITH THE curtain and doors open. I shut the curtain to keep this woman covered for privacy and dignity.

I had no problem with the nurse's demeanor, I had a problem with her (lack of) care or concern with PM care. She wasn't "mean" or inconsiderate to me. The only time she "over-reacted" was with my classmate, but she quickly calmed down and explained to my classmate what she had done wrong.

The ONLY issue I had was how she treated this (deceased) woman's body as she was doing PM care. She literally kept saying, you don't have to be slow, you aren't going to hurt her, she's dead. I understand PM care is different than taking care of someone living, but you can still do it where there is dignity and respect involved, and can even rush it without disrespecting... but I assure you, the only reason I was take aback is because neither was the case.

I could go into the whole story... but it would be far longer than my original post. I've been a nurse for a long time, and I am far from a spring chicken. Being judgmental? Well, if you are going about care the wrong way, yes, I am going to say something. I just have a feeling this nurse has worked around the dead so much that perchance she sees them as no longer a "human being," but simply as a "dead body."

The intent of my original post was to remind people that PM care is still CARE of a PERSON! I would like to encourage nurses to keep that in mind. I had far from enough space to get into the entire story... I highlighted only some of the particulars.

Like you, Leslie, I am one who doesn't break down easily, and hardly ever find myself in a position to have to council another nurse, let alone report them. But, this was completely and utterly inappropriate.

Specializes in Addiction, Psych, Geri, Hospice, MedSurg.

To go a little further (I realize I didn't proof read as well as I thought). The dressing she removed was attached to an area that was stitched closed. She removed it with such force the STITCHES and SKIN came with.

And, I have been a nurse for 3/4 of the time I've been in healthcare (lol).

It was not just the lines we were removing when she told us to hurry... She turned the patient, and her arm and leg fell off the bed. Her arm made a thud sound as it bounced off the side and came back with a gash on it. Yes, it really WAS that bad...

As I said, it is a (VERY) long story. I was far from emotional about the "death" or it being a "dead body," as I was from, what I would consider, abuse...

If you have worked in a field where you see dead bodies so much that they are nothing short of a piece of meat then MOVE ON! If that were my mother in that bed and I would know how she was treated, I would probably have met that nurse in the parking lot. I spoke to the nurse AND HER MANAGER after we were done. I was appalled. No, it was worse than appalling... I can't find the right word. I was so shaken that I cried when we left the floor.

Yes, I am right with you on that. :cool:

To me even if the patient is gone, I still want to treat them as if they were my loved one. I could not bear to think that they were handled so carelessly. I know people look at it differently though, it is not intentional to be goofy, it just happens like that sometimes I guess. :anbd:

I'm going to have to respectfully disagree with a few points. I realize this will probably upset some people. I'm sorry, but I feel like I have to interject my own perspective.

When a person is dead, they are beyond all hurt or harm. The body is just a shell, what made them a person has gone on to the undiscovered country. I feel that our duty shifts from providing patient care to providing a decent last experience for the family. Their loved one just died, and my primary concern has always been to ease the marks of death's unkindness.

I never warmed the water, but I used soap to get them decently clean; never have I sent a body to the funeral home dirty. That's my respect for the person they were. But I moved fast. It's not a living being to feel pain, the spirit has fled. I don't see the point in cherishing the mortal clay. Talking to it serves no purpose. It's something to get done quickly, because there are living patients who still need care. I moved the body however I needed to in order to get the job done. Tape came off, lines came out, without any sentiment on my part. There is no dignity to defend when the person is dead, corpses don't need a loving touch. Then I made sure the bed was clean and a fresh gown covered them, placing a rolled up towel underneath the chin to prevent the gape of death. That was my respect for the family.

It's extreme to cause damage to the body, it's obvious that ripping skin is being too rough. But to react as one would in the case of a living being is also a little extreme.

I know of a woman who was in a coma and was regularly handled in a very rough manner by a certain tech who changed her linens & repositioned the patient. During one of these rough handling sessions, the woman awoke enough to plant her first firmly in the side of the tech's face! :D

Yes, but we aren't talking about a comatose person here. Of course a living person deserves careful handling and guarding of his or her dignity. We're talking about corpses.

Why would you use warm water on a dead person unless it's because it works better though I would think baby oil would work better at getting tape off of fragile skin. I don't thin you have to be extremely careful like a live person but causing new wounds is uncalled for.

Specializes in Addiction, Psych, Geri, Hospice, MedSurg.

I never warmed the water, but I used soap to get them decently clean; never have I sent a body to the funeral home dirty. That's my respect for the person they were. But I moved fast. It's not a living being to feel pain, the spirit has fled. I don't see the point in cherishing the mortal clay. Talking to it serves no purpose. It's something to get done quickly, because there are living patients who still need care. I moved the body however I needed to in order to get the job done. Tape came off, lines came out, without any sentiment on my part. There is no dignity to defend when the person is dead, corpses don't need a loving touch. Then I made sure the bed was clean and a fresh gown covered them, placing a rolled up towel underneath the chin to prevent the gape of death. That was my respect for the family.

Honestly, I don't disagree with what you said, except I believe there is still dignity to defend. As I don't want everyone to see me naked alive, I still don't want everyone seeing me naked when I am dead. I think covering a patient and providing modesty and privacy is still dignity. That is the body that spirit dwelled in for so long. I would not vandalize a house just because I no longer live there.

However, I understand that other's don't feel as ...passionate??... as I do about PM care. Sure, it IS a different touch with a deceased person as with a live. And, sometimes we, indeed, are in a time crunch. But, I know how I would want my mom/dad/brother/husband/child treated, even when their "spirit has fled." I don't think a few extra minutes to ensure no damage or harm is caused, and privacy is still intact is too much to ask. I think that is not only respect for the deceased person, but also for the family.

Warm water?? IDK, I still see the person as my patient... that is just me... Talking to them? Do you watch NCIS? I am the Ducky of PM care ;)

Also, a roll behind the neck provides a more natural look (for the family) than the chin roll! It works great!

When the next time comes, and I'm sure it will, I will experiment with that roll-behind-the-neck idea.

I can understand how you're feeling. It may be strange, but I work in a NICU and I DON'T MIND taking care of a dying baby, at times I feel like I do do a good job helping the family do whatever they may need. In the NICU we do all kinds of bearevement stuff, pictures, hand/feet molds, etc and I am fairly comfortable involving the family as much as they want to be involved. I remember when my primary baby died, her mom wanted to give her a bath, so I went in the hall and warmed some water in the sink, another nurse asked my why I was heating it up? Well, I wasn't going to give that mother COLD water to give her baby her last bath in! :madface:

I worked as an EMT for a while before I started nursing school so I have had quite a bit of "hands on" experience with the dead and those who do not act properly around them. I always found that the people with the biggest issues in regards to after death care were usually the ones who were the most uncomfortable or in fear of death. I always took the time to make it known that sometimes it's okay to be a little off about it...Death is REALLY scary and some of these people have NEVER seen it first hand until they are standing there next to the gurney. I am always very careful while working with a person's body. Just explaining what I was doing quietly, apologizing for being clumsy, that sort of thing...I don't know...it would make me feel comforted to know that someone was still treating me like a person after I had died if I was in their shoes and I feel better knowing that. Sharing my coping mechanisms and whatnot helps with getting people to slow down and think about actions a little more.

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