Friday, August 27, 2004

Nursing Instructions: Preparing the Body for a Viewing

If a patient dies in the hospital when the family is not present, it is standard protocol to arrange the body as attractively as possible before the family arrives to say their farewells. This is not the same as care for a mortuary by a funeral director nor preparation of the body for transport to the morgue. This stage of post-mortem is focused on family comfort.

1. Close the eyes

On the hospital ward, we do not have access to the technologies that funeral directors use but we do our best. However, sometimes the eyes will not stay closed.

2. Insert Dentures

If the patient wore dentures, it is best (easiest) to place them into the deceased's mouth before rigor mortis sets. With lots of muscle power, the dentures may be inserted later (it required two people the one time I had to do this - one person holding the mouth open while the other inserted the dentures). Inserting the dentures usually makes the patient appear more "normal." However, frequently the jaw is slack and thus the dentures fall out of place and appear instead quite "abnormal." [Note: Before going to the morgue, gauze may be wrapped around the head - from the top of the head and under the chin - in order to keep the mouth shut prior to rigor mortis.]

3. Cleanse body

Standard protocol requires cleansing the entire body prior to sending it to the morgue. For the purposes of family visits, pay special attention to the face and hands. Take the time to remove crusts of secretions from the eyes, nose and mouth.

4. Comb hair

Purely for aesthetic reasons. Need I say more? The comb may need to be wet down in order to flatten rebel hairs. I often warm the water, despite realizing that the patient can no longer register the temperature post-mortum. However, little details like that may help you maintain professional composure and a sense of respect for the deceased.

5. Positioning

The bed should be adjusted so that it is entirely flat and the arms placed straight at the sides. Straighten the linens and then pull the arms out so they are laying outside of the blanket, straight at each side of the body. Hands should be accessible for family members to reach out and touch. Drop all of the side rails. We are no longer worried that the patient will fall out of the bed. Dead bodies don't generally try to get up by themselves. Removing the bed rails makes the deceased more approachable (plus it's easier to get the linens to appear straight and not bunched up).

6. Lines (IV, catheters, etc)

If the deceased is going to undergo an autopsy, all lines must remain in place. Otherwise, they may be removed before or after family viewing. Minimizing lines is ideal, however keep in mind that an old IV site may continuousy bleed even post-mortem. Seeing a growing blood stain on the sheet will be just a little distracting to the family. And you are to remove any tape on the body and cover wounds with gauze and kerlex to avoid placing tape on any skin. So pressure to minimize bleeding may be more difficult to achieve without the use of tape. Urinary catheters, IV tubing and IV bags hanging from the IV pole may be disposed of prior to the viewing.

7. Environment

Arrange chairs around the room to accommodate for multiple visitors. Place at least one or two boxes of tissues throughout the room. Remove any extra linens, medical supplies, or trash; and generally tidy the room. Dim the lights if possible. Turn on some quiet, soothing music if available.

If the family is present at the time of death, I generally delay post-mortem care for at least a half-hour. I then ask the family if they would like to participate in cleaning the body. In some cultures, this is very meaningful. If the family is not interested, I wait until their visit is complete before initiating post-mortem care so as not to create any unnecessary noise and distraction as they begin to face their grief.

I have casually studied nursing aids as they've helped me in post-mortum care. The varying attitudes and energies can reveal a lot about your co-workers. Some joke inappropriately. Some say quiet solemn prayers as they run the wash cloth over the deceased's arms. The unprofessional laughter is clearly a sign of discomfort. However sometimes severe solemnity can feel equally as disconcerting. My goal in conducting post-mortem care is to feel at peace within myself and show respect for the deceased.

Anyone have any other suggestions for post-mortem care? I welcome your input.


Jennynyc said...

When people then see their deceased loved one (after preparations), do they stay long? Do they pray? Are they much aware of you? Does anyone not want to see their deceased loved one alive? I will check back for your answer. Also, how do you cope with handling dead bodies? How do you cope with viewing the sadness and other emotions of family members looking at their friend or family member who is now dead? Sorry so many questions.

Nurse Mia said...

Great questions! Not all families come to see the body at the hospital, as most have arrangements that include a viewing at a mortuary. The next of kin whom we have informed of the death have nearly always been in the hospital to visit while the patient was still alive. I've met two patients who requested limiting visitors while still alive, but when the family was informed of the death, they brought large crowds - up to 30 or 40 people each. Most often there are only three or four mourners at the bedside. The average time the family stays is about an hour. Some stay less and as I mentioned in a previous post, one family spent the night. Some family's pray. We always offer a visit from the hospital chaplain. One husband asked me to stay in the room with him after his wife died. He didn't want to be alone. Once his daughters and the chaplain arrived to pray however, I made as discrete an exit as possible. Families are always aware when I walk back into the room and look expectantly at me, though I strive to be as unobtrusive as possible.

As for my own coping, I'd like to give those questions some more thought and will create a new posting on the subject. Thanks for your thought-provoking questions!

Jennynyc said...


john godfrey said...

hi nicelly said i am in uk and seen nurses rushing in to do post mortem care my daughter is a nurse at a different hospital , i would rather her prepare my body than a stranger , also do they send the body to the mortuary in just a sheet wrap ?