Nurse training ignores emotional impact of last offices, say academics

18 May 2010 | By Ben Clover

Academics have criticised the level of support student nurses get in the care of the dead, after Nursing Times revealed evidence suggesting over half of deceased hospital patients are not properly treated.

Principal teaching fellow at Warwick Medical School Jan Cooper said there was “very, very little attention given to the emotional impact” of last offices on new nurses who might never have seen a dead body before.

She has researched how student nurses are taught to deal with deceased patients and told Nursing Times students were uneasy with the way training in last offices tended to focus only on the practical procedures and ignored emotional issues.

“What my research found is that students didn’t like that; they really hated the de-personalisation; covering the head, taking off the ring and the wrapping up, the packaging, of the body,” Ms Cooper said.

“It’s very difficult because through last offices the patient is transformed from someone they cared for and knew to a corpse.”

Last week Nursing Times revealed hospital audits had found last offices procedures had not been carried out correctly in more than half of deaths.

Head of nursing at the University of Birmingham Professor Collette Clifford told Nursing Times staff could be unrealistic about how much exposure to last offices a new nurse will have had in their training.

Portsmouth Hospitals NHS Trust’s induction programme for all new nurses covers last offices and means no newly qualified nurse is left to perform them without a senior colleague present.

Divisional senior nurse in medicine for older people Gill Gould said the main emotional problem nurses wanted addressed was the attitude of some porters.

She said: “Nurses were very distressed when they had cared for someone for a period of weeks and then the porters would come in and the patient was treated as if they didn’t exist.”

It is down to individual NHS employers to make sure their student nurses are trained in last offices as there is no national specification and universities set their own curriculums.

Council of Deans of Health director of policy Matthew Hamilton told Nursing Times: “Whilst not all pre-registration programmes will feature explicit modules on the last offices, theoretical and practical elements of this fundamental part of care will feature in many universities syllabi to enable them to practise with compassion, dignity and respect.”

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Readers' comments (11)

Anonymous | 18-May-2010 8:14 am
newly QUALIFIED nurses need senior supervision for last offices??? I was doing this unsupervised as a first year student! Yes it's sad but a part fo the job. We will be supervising nurses to drive to work next!!!
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Anonymous | 18-May-2010 10:54 am
I also did this unsupervised as a first year student nurse but that doesn't make it right. Even though it was a long time ago I have never forgotten the experience - I had never seen a dead person before and it did have an impact. Hopefully all student nurses have the opportunity to to perform last offices in their training but if not what is wrong with a new nurse haveing a more experienced nurse support them the first time they have to perform this? Not only does it show compassion for our nurses but also ensures that a more experienced nurse makes sure the new and less experienced nurse shows compassion for the deceased on that occasion and hopefully in the future.
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Anonymous | 18-May-2010 3:29 pm
I have been a nurse for over 35 years, I can still remember the name of the first patient I carried out the last office procedure on as a student nurse, this is because the qualified nurse I was working with told me that it was my fault the patient had died as I had given him a vitimin K injection just prior to his death, she made inappropriate remarks through-out the task even singing a hit of the time "when I'm dead and gone" when I objected to her behaviour she just laughed at me!
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Matthew Lloyd | 18-May-2010 6:07 pm
Unfortunately I had to do my first last offices as a HCA before I even did my nurse training. I did this alongside a very experienced HCA who was very supportive. However, once I started my nurse training, the level of support I received during last offices varied from placement to placement, often being left to carry out last offices with a HCA whom had not dealt with a dead body before.
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Anonymous | 18-May-2010 11:10 pm
I did this one or two times as a student nurse with a senior nurse or senior HCA. If it was not for those people I would have no clue what to do. Even as a qualified nurse I have little experience of this and would greatly accept the help of somebody more experienced. It doesn't matter how qualified a person is they should still receive the support and help from somebody.
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Anonymous | 19-May-2010 5:37 am
Part of the job or not, if we feel we need supervision by someone for any part of our job then we are entitled to ask for it.......this is why mistakes happen as people believe things should be done alone and never get offered or ask for help.
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Anonymous | 19-May-2010 11:24 am
Support, hello... what name so my darlings'. My first experience as a student was caring for a dying patient who later passed during which I was told get on with it. When this patient had passed I became so emotional, no nursing staff had the common courtesy to console me. So support in the NHS I don't think so. If you ask me it's just so sad how there is a lack of moral, respect, and discrimination with in the profession, sorry.
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Anonymous | 19-May-2010 11:34 am
SUPERVISION - are you kidding me. The transition period from student nurse to newly qualified nurse is a real joke it is so poor. All the preceptor does is just take the extra cash but in terms of working with the newly qualified nurse it just doesn't happen, you are on your own mate. Basically you got a pin, which make you accountable so you get on with it. For these reasons many newly qualified nurses leave the profession to persue other profession, many gain the experience and migrate to other countries where the benefits are greater.
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Anonymous | 23-May-2010 8:09 am
It would seem that there are many issues surrounding Last offices. Simply not having the skills taught in the first place is a lame excuse in my humble opinion. If you nurse the living with the ethos of respect and the aim to maintain their dignity and self respect then surely it isn't rocket science to continue to respect and maintain the dignity of those who pass away! To be fair nursing isn't always going to result in partients going home healthy and this is a fact that even student nurses must acknowledge early on in their training. This is somewhat of an issue for me at the moment, and do forgive my rant. My father passed away in hospital 3 weeks ago. I went to the hospital promptly after receiving the dreaded call to find my Dad looking like he had been dragged through a hedge backwards with his mouth open wide. All his belongings where stuffed into bags with no care at all. Now I know you may say there are many factors that could have contributed to this i.e no staff, busy etc BUT it takes but a second to make somebody look tidy and even less to close their mouth. That image created by a careless moment could have a lasting psychological effect on a more sensitive individual. I am a midwife and sadly we have to perform last offices too, however I am pleased to say I treat the babies with the uttermost respect. This is a very important time for the loved one's family and their transition to the grieving process, maybe this is overlooked when it clearly shouldn't be? I personally think a workbook or PBL isn't assisting the next generation of nurse one little bit nor is just simply avoiding facing this task when training when the student could utilise the skills of their experienced colleagues to teach them a skill that enhance their practise.
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Joanna May | 25-May-2010 11:08 am
It very much depends which type of wards you have been allocated to as to whether you will experience this in your training. I am in my final placement as a student and it is only this week I have had my first experience of caring for a patient before and after their death. Previously I have helped with last offices but not with a patient I had been nursing and it does make a difference to the emotional impact on you.
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Anonymous | 27-May-2010 7:23 pm
As a student nurse I cannot express how wonderful our teaching on this subject was. Last offices were taught and discussed practically and we learnt how to do the task properly. However the module leaders also approached the subject very compassionately and sensitively. I think that everyone in my cohort would agree that we were prepared in the most supportive way possible! When I saw my first death on my first placement, aged just 18, I was shocked but I couldnt have been better prepared for it!
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