The Patient Has Passed But The Nurse Is Not Done

January 27th, 2012

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By , BSN, RN

Patients die. During my first clinical of my first semester of nursing school one of my patients died while I was trying to hear her "interesting" heartbeat. One of my classmates had just listened to it and had called me over. I thought something was wrong with my stethoscope. I moved it—and moved it again, and again, then said to my friend, "I don't hear it." She put her stethoscope back in her ears, moved it a couple of places, looked at me and said, "I think she's dead." WOW!

This, I was not particularly prepared for. However, I had been around dead bodies in less appealing circumstances in my journalism career and my classmate had once worked in a nursing home. We knew the patient was a "DNR," do not resuscitate. We handled it. The patient had been eating lunch when she died. My classmate took the food out of her mouth, tucked in her arms and pulled the sheet up to her chest neatly and combed her hair. She looked good. I called our clinical instructor.

Getting to the point here, some of our classmates did not handle this well, even though she wasn't their patient. Again, patients die. If you are a nursing student you best be prepared for this. It isn't easy, it can be sad but it is part of the job, part of the responsibility of being a nurse.

So, how do you care for a dead patient?

Post-mortem care is pretty much the same whether on the floor or in specialty departments like mine, the operating room. Our biggest difference is the family is, obviously, never there when the patient passes. Post-mortem care serves several purposes, including:

  • Preparing the patient for viewing by the family.
  • Ensuring proper identification of the patient prior to transport to the morgue or funeral home.
  • Providing appropriate disposition of the patient's belongings.

Seems straightforward, right? But, this is a person we are dealing with, breathing or not. Treat them with respect. I know for me, I continue to talk to my patient while providing post-mortem care. It makes me more comfortable, and it makes sure I don't start thinking of them as a diagnosis or just a body.

The process of post-mortem care is not difficult, just time consuming. Your unit or department or facility has a protocol. The instructions should be simple to follow and will look more or less like these:

  1. Gather your supplies. – The first thing you will do is collect a "morgue" or "shroud" pack. It will contain gloves, a variety of bandages and coverings, soap, and cloths to clean and a shroud. You will also need a stretcher or morgue cart.
  2. Make them look good. – Give your patient a bath. Clean away blood, cover wounds and punctures, and remove IV's and other tubes (unless patient is slated for autopsy, then they must remain in place, but clean them off as well). Remember that sphincters relax and there will likely be drainage in the groin and buttocks areas—provide some absorbent pads. If the patient wore dentures and they are available, put them in. Comb their hair.
  3. Positioning. – Move the patient to the stretcher or morgue cart, if necessary, and slightly elevate the head. Provide a clean pillow. Straighten the legs and tuck the arms at the sides and pull a clean sheet up to the chin, nice and neat. Leave the hands available for family members to reach out and touch. Make sure the eyes are closed. If not, moistened cotton balls placed on the lids for a few minutes should make that possible. Do not tape them closed. Place a small rolled towel under the chin if the mouth won't stay closed. Rigor mortis can start in as little as 10 minutes or take up to 6 hours to set in. Try to get them settled before the muscles start to stiffen.
  4. Clean the room. – Something bad, something sad just happened there. Leave as little evidence as possible. Remove soiled linens, empty the trash, remove any extraneous equipment and mop the floor if necessary. Death is traumatic, no matter how quietly the patient may have slipped away. Don't make the family climb over our tools to get to their loved ones. Finally, dim the lights, close the shades, we all look a little better out of harsh or fluorescent lighting.
  5. Give them some space. – When the family comes in try to be prepared for raw emotions. Have some tissues available on the patient's tray table. Put the trash can within reach. Offer to call the chaplain or other spiritual providers. Allow the family the time they need to say goodbye. Allow them time alone but be available to answer questions or provide support as necessary. Give the family the patient's belongings to take with them.
  6. It's time to go. – When the family is done it is time for your patient to leave. If not there already, move them to the stretcher or morgue cart. If there are dentures take them out if you can. Wrap your patient snugly in the shroud. Make absolutely sure all identifying tags are correct and in place. One tag goes on the chest, one on the big toe or ankle. Make sure the information matches. Check your paperwork and documentation one last time.

So, that's the big stuff. Here are a few little hints I've learned along the way. If you have access to French-fry lights with pink light bulbs (often used in the OR for keeping babies warm, or check the nursery) bring them in, put them in a corner facing the wall behind the patient. They give off a nice glow that makes us all look a little better. If you have left the arms and/or hands outside the sheet, for as long as possible keep them wrapped in blankets from the warmer. At the last minute you can remove them and when the family reaches out for their loved one, they are not so startlingly cold. Finally, have enough seating. Death is exhausting; make sure everyone has a place to rest.

When we started this week discussing death and dying at Notes from the Nurses' Station the first piece was titled Death and Dying Are Part of Life. Taking care of our patients sometimes means taking care of them past the point of living. It is our responsibility to see that they are respected every moment they are in our care.

2 Responses to “The Patient Has Passed But The Nurse Is Not Done”

  1. Marrice Says:

    This is a great post Jennifer!!

  2. Jennifer Olin Says:

    Thanks, Marrice…you know quite well who taught me so much of it.

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