Post mortem care

marachne · Feb 11, 2009

What I find interesting is the assumption of embalming and, I assume open caskets? Maybe it's just my cultural perspective, but I find them very foreign. (I'm Jewish). Just saying, that not everyone goes that route. As a matter of fact, two people I follow on twitter, @CemeterySpot and @RivetedRosie are involved with alternative approaches to funeral arrangements.

rnboysmom · Feb 11, 2009

Mike

True, true. I am from the midwest and from an area with a strong German Catholic heritage. In my years as a hospice nurse, I can think of maybe one time that a family initially objected, then changed their mind and actually insisted on picking out the clothing that the deceased would leave the house with even though they did not wish to have anything to do with the bathing. It is about 1/2 and 1/2 on the family's wish to participate with the post mortem care in this area, but almost 100% wish to have it done. Some areas with strong presence of sub-cultures may be different though.

deecee474 · Feb 11, 2009

In my hospice experience... not home health.

RochesterRN-BSN, BSN, RN · Feb 11, 2009

I have never heard of a RN or CNA, or anyone doing postmotem care....except a Mortician. A dead human body has to be treated in a certain way. This is what Morticians learn in Mortuary College. Changing a person's clothes after death, washing the body, closing the eyes and mouth are a Mortician's job....not a Nurse!
If you pull too hard on an eyelid and break the skin it will leak for hours after the body is embalmed. A scratch to an arm after death will also leak after embalming. All sorts of dammage that can be done by a well meaning Nurse. Any dammage to the skin after death will be a problem after embalming. Running a brush through someone's hair will leave marks on the scalp....many problems will occur during and after embalming if the body was not cared for by someone who is trained to take care of the dead. Washing, drying, moving arms and legs, closing eyes and mouth are all things that will dammage the tissues.
The correct thing to do is to cover the body with a sheet and call the Funeral Home or the Coroner. You should never fuss with a Coroners Case because you'll destroy evidence.
Nurses care for the sick and dying......Morticians care for the dead!

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I don't know where you have worked that this is not the job of the nurses........As I think you can see here on this thread that this is common practice. Like another poster mentioned.......When I worked on a medical floor we always did this....usually a nurse and one or two of the techs would help. To take out any lines, drains, etc. Wash up and put on a clean gown and groom........most of the time when I did this I found that very soon after the death everything relaxes and any stool and urine in the body drains out........I can remember turning a patient to clean stool and getting them all clean and when turned again...more cam out and this would continue several times!!! Even in a person that wasn't incontinent......so we always cleaned up as musch as possible and put on a breif.......like I said clean gowns and groomed while the family had stepped out or before they got to the hospital if it occured while they weren't there......then they smell and look clean and peaceful for the family who will want to come and say their last goodbyes.......This is the job of the nurses........the only time you can't pull lines, drains, etc. is in an autopsy case--unexpected deaths of a young person generally, criminal cases......you can check your states policy--they require that these things be left but you can still at least clean up stool, put on a clean gown, groom.

That should be a part of every nursing program as far as I know--

rnboysmom · Feb 11, 2009

BTW, in this area (midwest) several of our local morticians have requested (at inservices) that (if we think about it) not to pull midlines or PICC's as they are easy routes for embalming. As we meet a lot of the same folks from the funeral homes that do pick-up of the deceased, (and if you do a lot of on-call, you meet a lot of morticians in the middle of the noc!) we try to build relationships. We have several of our local funeral homes that, when the family has no special charity to leave donations to, kindly suggest that our hospice has a foundation to assist those with financial hardships. We have noticed a sharp increase in our donations to our foundation with the forming of these relationships. Also, at our hospice, it is an unwritten understanding that we stay with the deceased until the funeral home has arrived. At three in the morning you do a lot of on call, you also know that there is no hurry on the part of the funeral home to pick up the deceased. Forming these relationships and having the patient ready, clean and presentable not only makes the family content, but it has formed wonderful relationships with our funeral homes--we actually receive referrrals from our morticians wanting us to take care of their loved ones because of our post mortem care of the deceased. Which also goes to show....you are forming relationships with every single thing you do within your company!!!

RochesterRN-BSN, BSN, RN · Feb 11, 2009

Interesting about the request to leave central lines...........never thought of it. Okay so I sound stupid but I never thought about how they do that..... so how in the world do you get a line into a dead person??? It's hard enough on someone who is crashing and has hardly any BP and who's arms are getting cold because of it! I have to wonder how in the world they do that. Sorry just a thought!

rnboysmom · Feb 11, 2009

That was the exact reason they requested we leave central lines, midlines and PICC's--they said it was much easier to use an existing line than to accomplish the task post mortem. I don't know about how they do all of that. Not being morbid, but I would like to watch it, maybe just once.

dlxrn · Feb 19, 2009

I always consult with the family as this is their grieving period. Some families do not want the body touched or moved and other families want that favorie shirt or outfit on the patient. It is important to obtain consent to do so. Some cultures forbid the body for being touch for 6-8hrs....

mykrosphere · Feb 20, 2009

i have never heard of NOT giving post mortem care.

dlxrn · Feb 20, 2009

And coming from a night shift Hospice triage/visit nurse with a night consisting of 3-5/deaths (on a busy night)...trying to do post-mortem care on each pt, answer the pager, and worrying about the fact that there are several others pts that had just died...unless the family asks about washing the pt..it is just not happening.

rnboysmom · Feb 20, 2009

Gee, I am sorry that you are that busy with the company you work for, but the fact that the company you work for chooses to work you like that does not excuse giving proper care to a patient or family after a death. (What would you even say to a family--sorry I can't help you but, on to the next one?) I sure hope that your spiritual team or social services team is on call to assist you during the overnoc hours as I cannot even imagine that in the 3-5 deaths a night there are no psychosocial or spiritual issues with families during the night. If the company is so big that you have 3-5 deaths a night, who is helping the families that have issues during the dying process? Three deaths a night is a wild night, 5 deaths in a night is next to impossible for even the best of hospice nurses. If your company works you like that, I am betting that it is an overall culture in your company. I cannot imagine that these families are prepared enough to not need additional support during the night. How sad, that this is allowed within this benefit. Our team would never be allowed to slight care to families during this time of need.

redheadedvixen · Feb 21, 2009

I have never heard of a RN or CNA, or anyone doing postmotem care....except a Mortician. A dead human body has to be treated in a certain way. This is what Morticians learn in Mortuary College. Changing a person's clothes after death, washing the body, closing the eyes and mouth are a Mortician's job....not a Nurse!
If you pull too hard on an eyelid and break the skin it will leak for hours after the body is embalmed. A scratch to an arm after death will also leak after embalming. All sorts of dammage that can be done by a well meaning Nurse. Any dammage to the skin after death will be a problem after embalming. Running a brush through someone's hair will leave marks on the scalp....many problems will occur during and after embalming if the body was not cared for by someone who is trained to take care of the dead. Washing, drying, moving arms and legs, closing eyes and mouth are all things that will dammage the tissues.
The correct thing to do is to cover the body with a sheet and call the Funeral Home or the Coroner. You should never fuss with a Coroners Case because you'll destroy evidence.
Nurses care for the sick and dying......Morticians care for the dead!

I was taught in nursing school that you ALWAYS clean up a body after death. How would you like to say goodbye to your loved one who is lying in a puddle of their own excrement or covered in vomit!!! I didn't know there were places that don't do this..I'm shocked! I always give the family the option to leave or stay if they feel comfortable. I don't always give a full bath if they've had one recently but I ALWAYS do peri care, wash their face and hands and comb their hair, put a fresh gown on......ALWAYS. Not only is it respectful to the patient who has just passed I also believe it shows the family that we really did care for their loved one.

Sorry about the vent but this is a pet peeve of mine, I've had problems in the past with aides who would not help clean a body, other nurses who complained about "having" to do it while washing the body. I don't care if the person is dead you don't complain about them while you are working on them. :angryfire Some people will say that it's just a body...blah, blah, blah. Yes but it is also someone mother/father, sister/brother, wife/husband. I would want my family members body taken care of respectfully and want them freshly cleaned when I come in to say my last goodbye.