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Practice comment

Nurses need national guidance to standardise last offices care  


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.


Readers' comments (3)

  • I certainly do not think there is a lack of respect. Everyone has their own belief systems, and their own rituals. I have seen for example Nurses open the window directly after a death as a tradition to let the soul out, others do not know what that means. There may also be a lack of knowledge in the finer details of the patients own belief systems/religions, etc. But we cannot be expected to be experts in philosophy and religion too, as long as we know the basics and involve the family if there are any as much as they wish to be involved, we just do our best to treat those who die with dignity and respect. And the guidance issue is difficult, I mean how exactly do you guide on something with is so individual, so personal and so unique to each patient and Nurse? Perhaps the forthcoming guidance on legal/coroner issues could be more useful, as these can often be the source of confusion, but anything else it may be difficult to offer guidance on.

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  • the above article by mike is so true. i dont think there is any lack of respect in any waybut purely lack of knowledge. someof the day to day nursing practices are purely tradition which nurses pass on from one decade to the next. sometimes its 'you do it this way' rather than policy says ... New nurses will be shown a certain way and practices continue forever.

    on a second note i feel like pulling my hair out when people keep talking about consistent preparation for nurses/ students. may be the authors will respond for once. i qualified abt 30months ago and the nursing syllabus is very different from one university to the next. in Yorkshire where i trained there are many universities each doing their own thing, but once qualified you could be working in a different trust from where you did placements, but close by. in that case its not always as easy to prepare anyone. i will also add that for instance some hospitals will wash with water during last offices but my trust stopped using water unless necessary eg heavily soiled [you get the picture].

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  • I would hope that there is not a lack of respect from the nurses performing the last offices. In my many years as a nurse I have performed last offices on numerous occasions, with adults and baby's, and I can honestly say that not once did I ever loose respect for the job I was doing. As nurses we care for people both sick and alive and also for those unfortunate to die in our care, we should strive to achieve the best for everyone. Time MUST be made available to nurses to perform last offices and they should not be disturbed whicls doing it. However, it is fundemental that nurses are taught last offices and to be aware of the the rituals surrounding different religions after someone dies. This is the last caring act that you as a nurse can perform for the person your cared for, it should be carried out with pride, dignity and with the utmost respect for the person who has died.

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