DEATH AND DYING (MIDTERM)
o Check patient documentation or enquire with the family
Dying is the process. Death is the event.
DEATH
 Is the separation of body and soul.
 Death is an active consummation, a maturing self-realization
that embodies what each person has made of himself or
herself during life (Karl Rahner, 1965)
 Inevitable and critical moment when an organism ceases to
function as a specific, unified, homeostatic system and
becomes disorganized into a mere collection of heterogenous
chemical substances
 Death is such a phenomenon; it involves awe, fear, and
mystery. For this reason, health care professionals, just as
other people, are tempted to avoid facing the evil of death.
 Studies show that too many HCPs retreat and cut themselves
off from the dying patient completely.
 Those who must deal with dying have 3 options:
1. They can ignore the dying patient and thus become
hardened and jaded.
2. They can relate to the dying patient in a sincerely personal
manner without knowing how to deal with their own
feelings, or
3. They may relate to the dying patient in a healthy way,
recognizing the psychological strain that patient and
professional undergo together.
TRUTH TELLING TO THE DYING
 “What to tell patient” Has been considered one of the more
difficult and delicate ethical question for HCPs.
 Modern communication theory has shown that successful
transmission of information from one person to another
depend on good emotional relations between the
communicators.
END OF LIFE CARE
 The goal of care for people who are dying focuses on helping
them enjoy as good a quality of life as possible. This may
include relieving suffering; helping people stay as well as they
can; and helping them achieve goals that are important to
them before they die. This care is often provided by a mix of
professionals, including those skilled in palliative care.
How to care for the deceased patient.
 Immediate care of the deceased and family
o Time with the deceased.
o If possible, a quiet and private area should use to allow the
family and/or close friends time with the deceased.
o The family should be prepared to enter the environment
where the deceased is laying.
o There MUST be a member of nursing staff present with the
family when they first see the deceased to provide
support attend to any needs at this time.
 Special rituals
o Some cultural/religious observations involve special
rituals such as washing and draping of the body.
 Valuables.
o Valuables and personal effects should be documented
and given to the nominated next of kin.
o Valuables that are on the body may be left there. Seek
guidance from the family on this.
 Social work.
o If available a social worker should be engaged early to
assist the family. The social worker is invaluable in
providing support and information to the families at
this time.
 Pastoral Care.
for the patients preferred religious denomination or
spiritual belief.
o Always ask the family what their relative would wish with
respect to pastoral care.
Care of the Cadaver Policy
 Health and Social Care Act 2008 Code of Practice for the NHS
on the prevention and control of healthcare associated
infections and related guidance, places a duty upon NHS Trusts
to have in place appropriate management systems for infection
prevention and control.
 Healthcare organizations keep patients, staff and visitors safe by
having systems to ensure that the risk of healthcare associated
infection to patients is reduced
 Opinion differs among healthcare workers on the management
of a body associated with an infection and the measures taken
or advised to control the perceived hazards and are often
insensitively applied.
 Grieving is essential for the healing process and in some
religions and cultures it may require special rituals including
washing the body and kissing.
 Relatives should be asked about their wishes before body
preparation is commenced.
 The safety of the persons who may come into contact with a
body associated with an infection must always be given high
priority and this is covered in various Acts of Parliament and by
Regulations made under these acts.
 Policy Aim
 The aim of this policy is to ensure safe and appropriate
management of cadavers by staff and to minimize risks to
individuals when handling infected cadavers.
 Policy outcome
 Staff manage care of the cadaver sensitively and safely and
advise others who may come into contact with the cadaver
of any potential risks of cross infection without breaching
confidentiality.
 The body of a person who has been suffering from certain
infectious diseases may remain infectious to those who handle it
following death.
 The risks of infection are not high and are usually prevented by
the use of standard principles of infection control which include
appropriate protective clothing and the observance regulations.
Preparing the body for the family to view.
 Also known as laying out the body or last offices.
 Should be considered as a mark of respect and an honor
bestowed upon you.
 The body should be treated with dignity and respect and staff
should attend to it accordingly.
 Standard precautions should be observed by staff involved with
close contact care of the body after death.
The following guidance is intended to help you with preparing the
body.
1. Lay the body supine and straighten their limbs (unless this is not
possible).
2. Remove any clothing from the body and pack personal
possessions.
Clothing can be packaged for return to relatives, but sensitivity
should be observed when dealing with soiled or damaged
belongings (consult with the family when possible).
3. Clean the body. Pay particular attention to the face and hands.
4. Body bag (optional)
5. Close the eyes.
6. Clean the mouth. Remove all particulate matter, suction any
secretions and perform a mouth toilet. Consider applying
Vaseline to the lips. Clean and replace dentures.
7. Try to make the patients hair tidy and in their preferred style.
8. Dress in a clean gown/ shroud.
9. Position the body.
10. Prepare the environment.
 Remove all distractions from the immediate area where the
family will view the body. Consider lowering the bed and
providing adequate chairs so family members can sit and still
easily touch the body.
 Lights can be slightly dimmed
11. After initially bringing the family to the deceased and spending
some time settling them into this experience, it may be useful to
withdraw to the background.

Transport to the mortuary.

 Prior to transporting the body to the mortuary it is enclosed inside
the body bag. Some form of mortuary tags or ID must be attached
to the body.
Special precautions (Disease)
 There are several infectious diseases that may require the use of
Personal Protective Equipment (PPE) by staff handling the body.
 If the deceased has been exposed to the following diseases extra
precautions such as double body bagging, hermetically sealing,
use of special labels and withholding viewing by family may be
required
 Anthrax, Diphtheria, Creutzfeldt-Jakob Disease (CJD), Plague, Small
Pox, Yellow Fever, Viral Haemorrhagic Fever (including: Lassa,
Marburg, Ebola, Congo Crimean Fevers)
Special Precautions (Radiation)
 If death has occurred following treatment with radioactive
substances expert guidance should be sought.
Care of yourself and your colleagues
 Do not underestimate the impact that the death of a patient may
have on yourself and those you work with (and that includes
everyone from Doctors to Cleaners).