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.
Dougherty L, Lister S (2008) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Oxford: Wiley-Blackwell.
Frost PJ et al (2010) Managing sudden death in hospital. British Medical Journal; 340: c962.
NHS Employers (2005) The Management of Health, Safety and Welfare Issues for NHS Staff. London: The NHS Confederation.