● Notation of the absence of pulses, respirations, and pupil responses ● Those present in the room and response during the pronouncement of death ● Any communication provided to staff or others during the assessment, such as releasing the body to a funeral home or the nurse notifying the patient’s attending family, pastoral care, social worker, donor services, and coroner Additionally, a patient must be pronounced dead for organ and tissue donation to take place and many jurisdictions, along with the 1986 Omnibus Budget Reconciliation Act (OBRA,) require that a patient’s survivors be made aware of the option of organ and tissue donation upon death (Elsevier Clinical Skills, 2020). Clinical Skills, 2020). Cultural and religious beliefs can dictate how the body will be handled after death and should be discussed as part of the patient’s plan of care before death (Table 3; Pyrek, 2017). It is important to remember that cultural practices may vary, and clinicians should ask the patient and family about religion and beliefs. Universal precautions along with any other infection control procedures must be maintained for infection prevention and to limit bloodborne pathogen exposures (Pyrek, 2017).
Upon the pronouncement of death, the patient must first be correctly identified by two patient identifiers and per facility policy. The person verifying the death notes the general appearance of the body, notes the unresponsiveness to verbal or tactile stimuli, and listens for the absence of apical and carotid pulses and breath sounds (usually for one full minute). The time at which the assessment was completed must be recorded—this is the official time of death. The physical examination, time of death, and family response are then documented in the medical record and may include the following. Postmortem Care After the pronouncement of death, postmortem care can begin. Postmortem care, which can be provided in the home and in healthcare facilities, involves “caring for a deceased patient’s body with sensitivity and in a manner that is consistent with the patient’s religious or cultural beliefs” (Elsevier Clinical Skills, 2020). Typically performed by nursing staff, postmortem care should be done as soon as possible to prevent tissue damage or disfigurement and should provide a peaceful and respectful presentation of the patient for family and other visitors (Elsevier ● The pronouncer’s name and license number ● A brief description of events preceding death ● The primary hospice diagnosis
Table 3. Religious and Cultural Considerations in Care of the Body near and after Death Faith/Religion Cultural Considerations Buddhism ● Provide a quiet place for death and maintain strict silence after death ● Incense may be requested to use ● When the person has died, cover the body with a cotton sheet
● Leave the deceased’s mouth and eyes open ● Autopsy and organ donation are permitted
Christianity
● Varying practices at time of death; there are not prescribed rituals for body preparation ● Bible texts may be read near or at the time of death; Protestants receive the sacraments of Holy Communion or sometimes baptism ● Roman Catholics often request sacraments of Penance, Anointing of the Sick, and Holy Communion at the end of life ● In most cases, autopsy and organ donation are permissible ● Prefer to die at home or in a quiet setting, and family members prefer to wash the body after death ● Because of a belief in reincarnation, efforts are made to resolve relationships before death ● The head of a person nearing death should face the east with a lamp placed near the head if possible ● If the dying person is unable to chant mantras, a family member can chant them into the right ear ● Passages from Bhagavad Gita are recited ● Hindus prefer cremation of the body
Hinduism
Islam
● A Muslim reader recites verses from the Qur’an when the person is near death ● Family members usually prepare the body, and non-Muslims should not touch it ● The person’s eyes should be closed after death and the arms and legs straightened ● Autopsy or organ donation is generally not permissible, except as required by law
Judaism
● Confessional, blessings, and readings from the Torah are traditional ● Sometimes a family member will close the person’s eyes and remain with the body until burial, which takes place within 24 hours, but not on the Sabbath ● Organ donation prohibitions may exist in Orthodox Judaism, but not for all Jews ● Autopsies may be considered if organs are not removed
(Perry et al., 2018) If an autopsy is required, IV lines, tubes, and catheters (capped or clamped) should be kept in place rather than removed, unless facility policy states otherwise (Elsevier Clinical Skills, 2020). These can be removed if no autopsy is required and as facility policy allows (Elsevier Clinical Skills, 2020). Supporting Families Coping with Dying One way clinical staff can provide psychological support to families and caregivers following the death of a patient is allowing them to provide postmortem care for the deceased family member if they choose. They can comb their loved one’s
Postmortem care also includes giving the patient’s clothing and jewelry to the family. If the family is not present, personal belongings should be bagged and labeled and may be stored or given to the funeral director for later retrieval by the family (Elsevier Clinical Skills, 2020). The body is then left on the bed for the funeral director or before transportation to the morgue (Elsevier Clinical Skills, 2020). hair, wash their hands and face, stroke their head, apply lotions to the arms, wash the entire body, and/or dress their loved one in fresh pajamas or clothing before the body is sent to the morgue or funeral home (Elsevier Clinical Skills, 2020).
EliteLearning.com/Psychology
Book Code: PYFL4024
Page 250
Powered by FlippingBook