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Find and read a procedure for the care of a body after death (sometimes called last offices). This must be from a reliable source.
Barbara Carper incorporates four different principles together to determine the best knowledge for a nurse when caring for a body after death. (Excelsior College, 2019)
When performing last offices nurses need to ensure they are aware of the local guidelines, policies and procedures such as infection control and moving and handling and this is to ensure they provide compassionate care (Clover, Dave West and Clover, 2018). The NMC states that everyone should be treat equal to prevent any discrimination and ensuring care to a high standard (NMC.org.uk, 2019). Curtains should be drawn around the deceased patient for respect and dignity; the doctor on shift should then be informed about the patient (NHS,2018). A death certificate should be offered which includes the details of the patient and the cause of death (Department of health,2007). After confirmation, the patients next of kin should be notified and given the time to see their loved ones within the bereavement suite whilst all the paperwork is finalised (NHS,2018).
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Before carrying out last offices nurses should ensure that they wear the correct Personal Protective Equipment (PPE) and use effective hand hygiene techniques for infection control (NHS,2018). They should then lie the patient on their back unless they are unable to due to medical reasons (Loveday et al,2014). Slight pressure should then be applied to the eyes to close them and then to the bladder whilst rolling the patient gently to help prevent any leakages (Green and Green 2006). Finally, nurses should perform personal care including removal of any catheters or cannulas, washing the patient and dressing them. (Marie Curie, 2019). Once the nurses have finished, they should dispose of all PPE correctly to reduce any cross-contamination (RCN, 2005).
When looking at the ethical requirements, a wide range of morals, questions and decisions are taking into consideration. Nurses need to be aware of sensitivity of moral values to the patient and their families which occur daily, especially for religious and cultural reasons which should always be respected. When proceeding with last offices nurses need to ensure that the patient’s body is treated with respect, and that the procedure is carried out with regards for the wishes expressed by the patient before their death, and the wishes of the family following death (Nmc.org.uk, 2019). Religious and cultural needs are very important, before and after death. Nurses should be aware of any consequences and challenges that they may face whilst dealing with lost affairs, main point of contact and DNR’s if they have one in place. (Study.com, 2019)
Also whilst looking at the ethical requirements there are ethical principle’s nurses need to ensure that they are aware of. Beneficence and non-maleficence and autonomy and justice are the main ones where challenges may arise. Nurses could come across some challenges alongside the ‘harm/do good’ and this is where nurses are thinking of the long term effects rather than short term. (Study.com, 2019)
Personal knowledge plays a large part when performing last offices due to having to be self-understanding and self-aware. (Work.chron.com, 2019) Carper also states that nurses should put themselves in the patient’s shoes so they will be more sensitive and aware of how to address things mentally, physically and emotionally (Work.chron.com, 2019). This will enable nurses to be able to empathise with the loved ones of the deceased patient and remain professional by being able to control their own emotions and being able to reflect using different tools such as GIBBS reflective model (Brookes.ac.uk, 2019). A therapeutic touch also has a positive effect on nurses and those around them because this allows patients to be able to relax and get themselves into the best state of mind for self healing (Taking Charge of Your Health & Wellbeing, 2019).
Whilst being able to reflect nurses can also build a nurse to patient relationship, nurses also build up relationships with the patients loved ones, this enables nurses to gain more knowledge and understanding about the patient and allows nurses to communicate effectively (Teófilo TJS, 2019). Nurses must ensure that they are taking a holistic approach to each individual and treat everyone as an individual and this will help deliver compassionate care to a high standard and in a way that is non-judgement (Procter, Wallbank and Dhaliwal, 2019).
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Nurses must also take into account individual’s beliefs, preferences and choices made by the patient and family; family members can contribute to these but if the patient is capable of speaking and making decisions for themselves then they overpower them. (Stmichaelshospice.org.uk, 2019).
When looking at the artistry, nurses need to ensure that they are following the correct policies and procedures and ensuring that they undertake any appropriate support that has been offered to them to ensure that they are coping well and maintaining their professionalism. (Nmc.org.uk, 2018).
When looking at Carpers way of knowing (1978) at the section about aesthetic knowledge they look at the manual and technical around death and dying (fawcett et al (2001:116)). At the end of life nurses need to ensure that they respect the patient and their families (Marie Curie, 2019). Nurses can do this by talking to the patient when providing personal care as if they were still alive, ensuring that they were being informed about what they were going to do and why; they should also inform patients families about what is going on and where possible allow them to have an input as some loved ones may find it comforting to help out when carrying out last offices or it may be religious or cultural requirements and if this is the case then going the extra mile by allowing them to do so will appreciated (Marie Curie, 2019).
Communication is a key skill that is required throughout last offices to ensure loved ones are aware of what needs done and why and to also offer support throughout the grieving process (Marie Curie, 2019). Going the extra mile may also include doing something that the patient enjoyed or wished, for example they might of requested for music on in the background while family were there, then nurses could ensure this happened and this would be respecting their wishes. Nurses should then wash the patient including mouth and teeth/dentures if they have any, unless requested not to for religious or cultural reasons (Cooke, 2000).
Barbara Carper combines all four principles to enable a nurse to provide compassionate care to a high standard and on a holistic approach. Nurses should always reflect on themselves to ensure that they are giving the best care possible and ensuring that their experiences only get better with patients.
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