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National guidance on last offices would prevent family distress


Although nurses commonly deal with death, no standardised training in last offices is available. Jo Wilson and colleagues explain why nationally endorsed guidance is urgently needed


Jo Wilson is Macmillan consultant nurse practitioner, Heatherwood and Wexham Park Hospitals Foundation Trust; Jane Thompson-Hill is Macmillan consultant nurse, University Hospital of North Staffordshire Trust; on behalf of the National Nurse Consultants Group (Palliative Care); with Dawn Chaplin, head of bereavement services, Heart of England Foundation Trust.


There are several controversies over best practice in performing last offices. These include whether intravenous lines should be left in situ, something over which coroners do not agree and is a potential source of family distress (Frost et al, 2010).

There appears to be no consensus on whether bodies should be packed to prevent leakage, or on the use of body bags for all patients. There may also be problems maintaining the dignity of the deceased because of a lack of appropriate equipment, such as that for bariatric patients.

The need for national policy has been recognised by others (NHS Employers, 2005).

The practice of caring for deceased patients on their pathway from death to burial is governed by many professional groups apart from nursing, such as: the Association of Anatomical Pathology Technology; the Royal College of Pathologists; coroners; the National Association of Funeral Directors; and the National Society of Allied and Independent Funeral Directors. These groups have opinions about the preparation of the body, which can differ from what is considered to be best nursing practice (Dougherty and Lister, 2008).

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Last offices present a unique challenge for nurses as they are the only professionals who care for people both in the period leading up to death and immediately afterwards. This final act of care for patients and their families may involve a wide range of emotions that affect nurses.

Nurses need to be aware of religious and cultural rituals and to understand their relevance. However, the lack of standardised training in last offices means that practice has been handed down and may include rituals that are not specific to the procedure or the patient.

Care of deceased patients and their families is complex and multifaceted. Nurses need empathetic communication skills, and may need to inform families in cases where death is expected as well as when it is sudden.

Although death is common in health settings, training in communication skills to support staff in caring for families is not. Nurses also need to know about the legal framework around death and which deaths require coronial involvement.

The National Nurse Consultants Group (Palliative Care) is working with the Department of Health and the National End of Life Care programme to produce nursing guidance for last offices that reaches consensus with all stakeholders and is nationally endorsed. This should ensure that nurses can care for deceased people in a way that honours their personhood, respects their religious and spiritual needs and supports their families.

We aim to provide guidance that all professions can agree as best practice and which recognises the challenges of different care settings. It will set out the principles and rationale for care, and address the training nurses need to perform last offices.

It is essential that nurses can deliver dignified, respectful and appropriate care at this time of transition from life to death.



Readers' comments (3)

  • Care of patients who have died on the ward and care of their families was something that I was taught in my training admittedly in the early 1970s.
    We were taught about respect (not that we needed to learn it as it was inbred in nurses in those days)
    When my Father died in hospital I was devastated to find that he had not had basic care such as closing his mouth and for my children to see their Grandfather & first death in this way made things very difficult for them.
    It is likely that my father died during the night and no one noticed hence rigor mortice had commenced.
    I will never recover from my feelings about lack of basic care and considering that I was always so respectful of others it makes me very sad for the future of nursing.

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  • it is respect and dignity that every one should follow and the golden rule is to bath the individual after death and dress in some appropiate clothes. I work in palliative care and this is done to remain each individual has a dignified ending of he r she's life.

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  • I forgot to mention an individuals dentures should be positioned correctly and the mouth closed if possible.

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