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As with a holistic approach to nursing, we require all four ways of knowing to provide the best care to a patient after death. The four fundamental patterns of knowing have been identified by Carper as the science of nursing, the art of nursing, personal knowledge of nursing and the ethics in nursing.
Carper (1978) defines the Science of nursing as knowledge that is systematically organized into general laws and theories for the purposes of describing, explaining, and predicting phenomena of special concern to the discipline of nursing. (Chinn & Kramer, 2015).
The scientific procedure of care after death involves so many aspects including; informing relatives, religious and cultural beliefs, personal care, positioning of the body, infection control, legal aspects, time of death, removing medical instruments, and using appropriate personal protective equipment. https://journals.rcni.com/nursing-standard/how-to-care-for-a-patient-after-death-in-hospital-ns.30.33.36.s43 accessed 10.01.18
Evidence Based Practice (EBP) is important in providing the most effective care and Haradon 2006 states that the use of EBP guidelines has been proven to improve patient outcomes. Encouraging best practice regarding infection control (Brooker, Chris, et al p513), which is just as important after death as before. Health and Safety Executive have issued guidelines on the handling of bodies with infections and if not followed there is a high risk of transmitting these infections (Dougherty pg361)
There are many reasons to carry out care after death such as infection control and positioning the body before rigor mortis, allowing the mortuary to manage the body correctly, however it is also a continuation of respect and to preserve dignity, and the condition of the deceased (Wilson 2012).
The NMC code, NICE guidelines and Trust Policies protect and care for both patient and the person caring for the patient after death. They are there to ensure best practice is followed as you only have one chance to get it right.
Ethical knowing helps one develop our own moral code; our sense of knowing what is right and wrong. For nurses, our personal ethics is based on our obligation to protect and respect human life. Our deliberate personal actions are guided by ethical knowing (https://www.excelsior.edu/article/nursing-the-ways-of-knowing/) Accessed 08.01.19.
Beauchamp and Childress (1994) identified the four ethical principles underpinning healthcare practice; respect for non-maleficence, beneficence, autonomy and justice. Registered and Student nurses have a legal duty of care to do the patient no harm, to promote the well-being of the patient, respect peoples wish and treat all individuals fairly (Hall & Richie 2013).
In relation to care after death the principles that prevail are autonomy and justice, even more so than when the patient was alive as they no longer have a voice for themselves. As mentioned earlier it is important to respect any religious and cultural obligations or beliefs and treat all individuals fairly, not discriminating on the grounds of race, gender or religion. (Hall & Richie 2013).
Personal Knowledge (299)
Paraphrasing; “A key purpose of personal knowledge is to provide framework for individuals to manage, integrate and enrich information. Doing so will empower everyone to apply their own personal knowledge in an effective and evolving manner” (Martin 2008).
As a nurse you require a deep personal knowledge, both practically and professionally, of how to care for a patient after death in order to respond in an effective and emotionally appropriate manner. Without the correct procedures, professional attitude and ability one cannot carry out a nurse’s duties nor empathically connect and assist the patient’s family.
To be an effective nurse is to be an artful nurse. Imagine nursing as more than a set of tasks and instead as a way of seeing, feeling, and knowing. Henry, D. (2018)
To care for a patient after death is more than just following the steps in the correct order, even though this is very important in its self. Carper states that we are led to believe that the only valid and reliable knowledge is empirical, nonetheless nursing is in part an art, expressed through a nurse’s creativity and style in designing and providing nursing that is effective and satisfying. The art of nursing encompasses many of the 6 c’s of nursing, to show compassion to the relatives is an expression of empathy as Carper states that it is the capacity for participating in experiencing another’s feelings and is an important mode in the esthetical pattern of knowing. One gains knowledge of another person’s singular, particular, felt experience through empathetic acquaintance. (Carper 1978 pg25-27)
It is an extremely important and honoured procedure for a nurse to undertake, the nurse should show the same level of person-centred care to the patient after death as if they were still alive. This precious moment of a person dying can have lasting effects on relatives, health care providers and non-clinical staff who have been close to the patient. Therefore, the art of nursing is so important as it allows the nurse to express creativity and provide nursing that is effective and satisfying. A nurse can show this by personalising the care after death, if the patient had a faith having a bible, book or religious effect in the room, playing music or singing hymns might help the relatives feel at peace. Being mindful of what was important to the patient and the relatives can really make the difference in the person-centred care that a nurse provides after death.
Personal care after death refers to physical care of the patient’s body. Nurses should view care after death as a continuation of the person-centred care they provided while the patient was alive. It is important that the care which nurses provide to the patient after death conveys respect for the patient and their family and fulfils any religious or cultural obligations or beliefs (Leadership Alliance for the Care of Dying People 2014, Martin and Bristowe 2015).
In conclusion, to care for someone after death is a privilege that shouldn’t be taken lightly, there are many things to consider that integrate all four fundamental patterns of knowing which link in nicely with the 6 c’s Science & Personal Knowledge (Competency/ Commitment) Ethics (Courage, Compassion), Art (Care/Communication), they are all required to ensure patients are cared for well in life and in death.
- Brooker, Chris, et al. Alexander’s Nursing Practice E-Book: Hospital and Home – The Adult, Elsevier, 2013. ProQuest E-book Central, https://ebookcentral.proquest.com/lib/northumbria/detail.action?docID=1721915.
- Chinn, P. L., & Kramer, M. K. (2015). Knowledge development in nursing theory and process (9th ed.). St. Louis, MI: Elsevier.
- Martin S, Bristowe K (2015) Last offices: nurses’ experiences of the process and their views about involving significant others. International Journal of Palliative Nursing. 21, 4, 173-178.
- Leadership Alliance for the Care of Dying People (2014) One Chance To Get It Right: Improving People’s Experience of Care in the Last Few Days and Hours of Life.
- chance_to_get_it_right.pdf (Last accessed: January 08, 2019.)
- Henry C, Wilson J (2012) Personal care at the end of life and after death. 2012. NursingTimes.net https://search.proquest.com/docview/1011483566?accountid=12860
- Hall, Carol, and Dawn Ritchie. What Is Nursing? Third edition. Transforming Nursing Practice Series. London: SAGE/Learning Matters, 2013.p44
- Henry, D. (2018) ‘Rediscovering the Art of Nursing to Enhance Nursing Practice’, Nursing Science Quarterly, 31(1), pp. 47–54. doi: 10.1177/0894318417741117.
- Carper, B.A. (1978). Fundamental patterns of knowing in nursing. Advance Nurse Science. 17(4): pp 12 – 19.
- Greenway K, Johnson P (2016). How to care for a patient after death in the community. Nursing Standard, RCN Publishing Company Limited. https://journals.rcni.com/doi/full/10.7748/ns.30.37.34.s39
- Martin, J (2008). Personal Knowledge Management: The basis of Corporate and Institutional Knowledge Management, Spotted Cow Alberta. <http://www.spottedcowpress.ca/KnowledgeManagement/pdfs/06MartinJ.pdf>.
- Dougherty, L., & Lister, S. (2015) The Royal Marsden Manual of Clinical Nursing Procedures. West Sussex: John Wiley: pp 356 – 367.
- Hall, Carol, and Dawn Ritchie. What Is Nursing? Third edition. Transforming Nursing Practice Series. London: SAGE/Learning Matters, 2013.
- Price, Bob, and Anne Harrington. Critical Thinking and Writing for Nursing Students. Transforming Nursing Practice. Exeter: Learning Matters, 2010.
- FEE, E., PHD. and GAROFALO, MARY E,R.N., B.S.N., 2010. Florence Nightingale and the Crimean War. American Journal of Public Health, 100(9), pp. 1591.
- IZUMI, S. (., NAGAE, H., SAKURAI, C. and IMAMURA, E., 2012. Defining end-of-life care from perspectives of nursing ethics. Nursing ethics, 19(5), pp. 608-18.
- Clinical Context for Evidence-Based Nursing Practice, edited by Bridie Kent, and Brendan McCormack, John Wiley & Sons, Incorporated, 2010. ProQuest E-book Central, https://ebookcentral.proquest.com/lib/northumbria/detail.action?docID=822486.
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