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).

Specializes in Certified Med/Surg tele, and other stuff.

I warm the water too. I know they can't feel the difference but I know. Maybe the warm water is more comforting to me. I feel like I'm getting them cleaner? I don't know..:confused:

Why would a nurse not pull the curtain? Who wants to walk by and see a dead body? I always pull the curtain out of respect for the deceased and family.

Don't talk to the deceased though, but if the family is in the room I ask them questions about the patient, ie..where they grew up, how many siblings did they have? Many times, they start telling funny stories and it lightens the mood just a bit.

Did a lot of PM care as an aide in LTC.

The deceased residents were as good as my family.

Always respect.

Specializes in Peds/outpatient FP,derm,allergy/private duty.
Hold on now- you were with this patient and this nurse for hours doing complex procedures, trying to keep her alive for hours before she died, and had no issue with the nursing care. That nurse may well have been rough, and inappropriate after death, but apparently she was respectful and caring to the living. She might have messed up on postmortem care, or maybe you were feeling extra emotional. I say cut her some slack. Cut her a lot of slack if she did supported the family too, after the death. Nurses are not bulletproof.

As none of us were there, just reading the words without the emotional/spiritual impact the scene must have had . . .I'm inclined to this viewpoint as well. The issue of dignity, death and dying is so unique to each person that it would take quite a bit for me to label it abusive, keeping in mind that we are in no way talking about what we do when a family member is present. I remember when my mom passed away a year ago, I was sitting with her holding her hand and the housekeeping lady snapped a plastic bag - well I almost hit the roof -- to me it sounded like she had dropped a box of steel pans on a hard surface it was so disturbing to me. Then she smiled at me. She was just doing her job.

. . .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."

Is there any possibility she was being efficient and trying to get your classmate over any "purpose hesitation" or discomfort about being around a deceased person for the first time? I'm imagining she might not have known your history with hospice or maybe having done the procedures with other students she needed to take the more business-like approach. Honestly, I don't think (sans knowing the tone and expression she used) what she said was out of line.

Not being that nurse I don't think I'd want to decide if she had plenty of time to complete her task even if the funeral home was not scheduled to arrive for 2.5 hours. At least she stopped long enough to explain the procedure to your classmate who had never d/ced a central line. Unfortunately, there are many who would not have or told her to get out and she would do it herself.

When I was in clinical I saw the most horrific tracheostomy done on a supposedly comatose man in ICU and a glass thermometer placed in his rectum with nobody holding it and naked except for a wet washcloth tossed over his genitalia. It was so bad our entire class needed an extensive debriefing. They suggested we misinterpreted the whole thing. All these years later I can say we did not misinterpret anything - indeed the behavior was appalling no matter how many niceties they use to paper it over.

I am just mentioning that as food for thought. I am not trying to challenge your account.

What did the nurse say to you when you confronted her with the behavior you'd witnessed?

Specializes in ICU, Telemetry.

I started off in a hospital that had a lot of bad doctors, so I saw a lot of dead bodies. I'll never forget we had two pass away within 30 minutes -- one a code, one not, but both needed to be cleaned up for the families. One was so edematous (must have been in complete renal failure, it's been too long for me to remember now) that when the pt's primary nurse was cutting off the sutures to the central line, she accidentally nipped the patient's skin. I thought she was going to have to go home, she came completely apart, started crying, apologizing to the patient, etc. Finally, I grabbed her hand and said, "Honey, she died 20 minutes ago, you didn't hurt her." She had to leave the room while we finished. And despite everything we did, the patient's skin came off where she'd had the IV dressings and central line dressing. Her skin sloughed off when we turned her, she was just coming apart. Had someone seen that, they'd have thought we were being horrible.

Another nurse just couldn't do postmortem care, couldn't. Well, I thought that was kinda mean to the rest of us that she'd leave us to deal with the various niceties like never ending rivers of stool coming out of a dead GI bleeder, packing towels into foot sized sacral decubes just so we could get the patient over to the transporter without leaving a bloody trail, etc. Turned out she'd lost her parents in a MVA as a child, and she could do anything to anyone to keep them alive, but once they weren't alive, she couldn't deal with it. I always wondered if she'd seen them die or been trapped in the car with their dead bodies.

Some people deal with a surplus of emotions and compassion by trying to act like they don't have them, especially if they have an audience. When I work with a nurse that I think is a complete "B" I remember the scene in M*A*S*H where the dog that HotLips has been looking after gets run over. Hawkeye finds her crying, and she's like "we see so much death, why am I crying over a dog?" Maybe that nurse was being such a "B" because she was about to start crying over the dog, and couldn't, especially with students present. So she tried to get it done and over with as fast as she could.

Everyone gets a chance to mourn -- everyone but us. And sometimes it's just too much, and bad stuff happens. Compassion fatigue, grief, anger, frustration, they are all real, and they all happen. People think I'm nuts because I'll talk to the dead patient just like I do when they're alive -- I'm not doing it for the dead patient, I'm doing it for ME. I do it for ME because if I start thinking about how this person will never water her flowers again, never thought when she put on those house slippers on the counter that she was putting on shoes for the last time, when I look at the wedding band she probably hasn't had off in 30 years, and notice a bandaid over a bug bite, and think about how she had no idea she was 24 hours away from dying from a MI when she put on the bandaid, all while I'm listening to her husband and children crying....and I don't get to cry, I don't get to mourn, I don't get to think about how I'm going to handle it when it's my turn with my parents, I've got to DO.

So, yeah, maybe the nurse was just a "B" -- and maybe she was shedding tears inside that you never saw.

nerdtonurse?

Her skin sloughed off when we turned her, she was just coming apart. Had someone seen that, they'd have thought we were being horrible.

never ending rivers of stool coming out of a dead GI bleeder, packing towels into foot sized sacral decubes

Oh, Lord, yes...

Have experienced that.

I never thought of it, but it must look barbaric to someone who doesn't know-- even though we are doing our best to be respectful.

Good point.

I warm the water too. I know they can't feel the difference but I know. Maybe the warm water is more comforting to me. I feel like I'm getting them cleaner? I don't know..:confused:

Why would a nurse not pull the curtain? Who wants to walk by and see a dead body? I always pull the curtain out of respect for the deceased and family.

Don't talk to the deceased though, but if the family is in the room I ask them questions about the patient, ie..where they grew up, how many siblings did they have? Many times, they start telling funny stories and it lightens the mood just a bit.

I never do the speaking unless it is in private rooms and that is to comfort myself mostly...Not in the crazy super loud, "your still alive" way but if I bump their arm or do something clumsy I might throw out a whisper of "I'm sorry".

Dealing with families I guess must be more gauged by a case by case basis...Personally I could only find that sort of conversation okay with people who have an elderly family member die rather than a sudden death. I had a really horrible experience in a hospital when my 18 year old sister committed suicide and my mother and I went to see her. I KNOW that the nurse had the best intentions at heart but it was just not the best time to be telling us what a beautiful girl my sister was, asking us what University she was at, and how sad it was that she killed herself. It just made it so much worse...After that experience I always tried to allow the family to start the direction of a conversation by asking an open ended question of some kind or even took the topic off of the situation and directed it onto something else like the purse they are carrying or something. It helps them fly away from that moment for a second...they will sit in the death for so long after a little break sometime helps.

Everyone gets a chance to mourn -- everyone but us. And sometimes it's just too much, and bad stuff happens. Compassion fatigue, grief, anger, frustration, they are all real, and they all happen. People think I'm nuts because I'll talk to the dead patient just like I do when they're alive -- I'm not doing it for the dead patient, I'm doing it for ME. I do it for ME because if I start thinking about how this person will never water her flowers again, never thought when she put on those house slippers on the counter that she was putting on shoes for the last time, when I look at the wedding band she probably hasn't had off in 30 years, and notice a bandaid over a bug bite, and think about how she had no idea she was 24 hours away from dying from a MI when she put on the bandaid, all while I'm listening to her husband and children crying....and I don't get to cry, I don't get to mourn, I don't get to think about how I'm going to handle it when it's my turn with my parents, I've got to DO.

So, yeah, maybe the nurse was just a "B" -- and maybe she was shedding tears inside that you never saw.

I DID talk to my cadavers like they were alive when I worked in the morgue because I can't even BEGIN to tell you how HORRIBLE and disrespectful some of the people are who work there are to those bodies. Frankly it was just f**king sickening at times...like not caring when a body fell on the floor, or making jokes by moving them around in "comical ways". Horrible stuff it really broke my heart...it made it feel that much more necessary to treat them like people.

Honestly I think that it would be a great idea for nursing schools to require their students to do a specific amount of clinical hours before graduation devoted SPECIFICALLY to post mortum care. For some it's the most difficult part of nursing to cope with so getting a good dose of it early to learn the best ways to deal with it effectively would be amazing. I know that when I saw my first bad death on an EMT run I froze for a second and getting totally wrecked after getting a new green job would be so lame. :(

Specializes in Geriatrics.

I have a question... I'm a fairly new nurse, who did not work as an aide. I've worked a couple of years in LTC and am in the process of starting some PRN hospice agency work. I have never done post mortem care or have never seen it done. I basically know what to do, but how does one do this by themselves? I was thinking that when the time comes I would ask the facility aide on the floor to help me with the turning/brief change. Is this typically what is done? If I'm working with someone who can't turn themselves, as least partially, I will have the facility aide or nurse help me change the brief. Since I never have worked as an aide I'm very poor at changing briefs on someone who can't move, especially a large person, and it terrifies me to think that I'll toll the deceased off the bed while I'm doing PMC...

Specializes in Addiction, Psych, Geri, Hospice, MedSurg.
I have a question... I'm a fairly new nurse, who did not work as an aide. I've worked a couple of years in LTC and am in the process of starting some PRN hospice agency work. I have never done post mortem care or have never seen it done. I basically know what to do, but how does one do this by themselves? I was thinking that when the time comes I would ask the facility aide on the floor to help me with the turning/brief change. Is this typically what is done? If I'm working with someone who can't turn themselves, as least partially, I will have the facility aide or nurse help me change the brief. Since I never have worked as an aide I'm very poor at changing briefs on someone who can't move, especially a large person, and it terrifies me to think that I'll toll the deceased off the bed while I'm doing PMC...

Usually, it is best to have someone help roll, the rest is fairly easy, basically a bed bath. Your facilities will have specific protocols. If you have to turn the on your own, just have the rails up and use the sheet to turn them toward you... bend the top knee in toward you, bring their opposite arm over them, and roll. It really isn't that difficult. But, usually there will be someone to assist, at least to turn.

I have a question... I'm a fairly new nurse, who did not work as an aide. I've worked a couple of years in LTC and am in the process of starting some PRN hospice agency work. I have never done post mortem care or have never seen it done. I basically know what to do, but how does one do this by themselves? I was thinking that when the time comes I would ask the facility aide on the floor to help me with the turning/brief change. Is this typically what is done? If I'm working with someone who can't turn themselves, as least partially, I will have the facility aide or nurse help me change the brief. Since I never have worked as an aide I'm very poor at changing briefs on someone who can't move, especially a large person, and it terrifies me to think that I'll toll the deceased off the bed while I'm doing PMC...

When in doubt ask for help...You are more likely to get into SERIOUS trouble doing something your unsure of alone rather than feeling annoying and getting someone to help. Don't be so worried about "bugging" more senior nurses with questions, just be honest about your inexperience/challenges with procedures so that they know to take it a little slower when showing you how do do something and don't act ****** thinking your trying to get out of doing icky work. :)

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.

How did this conversation go? Did you have any impact on the nurse and her manager? Just curious.

Specializes in Addiction, Psych, Geri, Hospice, MedSurg.
How did this conversation go? Did you have any impact on the nurse and her manager? Just curious.

The nurse had no response. Basically rolled her eyes and walked away. I was not finger pointing, or confrontational - but I did express my concerns and observations. I also informed her I was not merely a "student" but have been a nurse for over 12 years.

The manager said it would be addressed. I was there only for clinicals, so I have no way of knowing if anything will be done.

But, the next day, the manager pulled me in her office and thanked me for speaking up. She alluded to this nurse having previous complaints about the same thing, and even being rough with other (live but comatose) patients. I had to put my complaint in writing at that point.

I know we all handle things differently. I understand there *IS* a difference between a live vs. dead human being. I still think our professionalism carries through post mortem care and we should not denigrate the body further.

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