Nurses have been criticised for neglect in last offices care. But this is due to lack of guidance rather than lack of respect, say Jo Wilson and colleagues
A recent article in Nursing Times claimed that “in more than half of hospital deaths, nurses neglect to follow procedure” related to last offices (West et al, 2010).
We support the view that the care of deceased patients and their families is indeed a crucial aspect of nursing care and is the final part of the pathway of care for dying patients, as documented in the end of life care strategy (Department of Health, 2008).
The care of deceased patients presents nurses with a unique challenge. They are the only profession to care for people both in the period leading up to death and immediately afterwards. Last offices mark the care transition between life and death. The processes that are integral to this make it explicit that patients are now dead; something that transforms an apparently simple procedure into a complex social and professional act, which is potentially emotionally difficult.
The National Nurse Consultants in Palliative Care Group challenges the word “neglect” used in the news article. We acknowledge the fact that the audits showing lack of consistency in practice (cited in West et al, 2010) can be replicated in other acute trusts. However, we propose that any inconsistencies in practice are due to lack of clear, nationally negotiated, multiprofessional guidance rather than lack of respect or neglect of care by nursing staff.
The practice of caring for deceased patients on their pathway from death to burial is governed by many professional groups apart from nursing: the Association of Anatomical Pathology Technology; Royal College of Pathologists; coroners; National Association of Funeral Directors; and National Society of Allied and Independent Funeral Directors to name but a few. These groups have opinions about the preparation of the body following death, and these can differ from what is considered to be best nursing practice (Dougherty and Lister, 2008). There are currently several controversies raised by these differences of opinion, such as whether intravenous lines should be left in situ or removed, something for which there is no agreement between coroners, and recently recognised by Frost et al (2010) as a potential source of family distress.
The National Nurse Consultants Group (Palliative Care) is working to produce nursing guidance for last offices that reaches consensus with all stakeholders and is nationally endorsed, so that nurses can provide care to deceased people in a way that honours their personhood and is respectful of their religious and spiritual needs, and enables care of their families. We acknowledge the fact that changes in the coronial process may positively influence this work. In addition this guidance will enable consistent educational preparation of nurses, in their pre-registration programme and once in professional practice.
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.
Department of Health (2008) End of Life Care Strategy - Promoting High Quality Care for All Adults at the End of Life. London: DH.
Frost PJ et al (2010) Managing sudden death in hospital. British Medical Journal; 340: 1024-1028.
Dougherty L, Lister S (2008) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Oxford: Wiley-Blackwell.
West D et al (2010) Last offices neglected in over half of hospital deaths. Nursing Times; 106: 18, 1.