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Whilst on a placement in a nursing home I was asked by my mentor to help to provide care after death for Mary (pseudonym). Mary was 87 and had been diagnosed with a stroke 3 days before. She had been a resident of the home for 2 years with multiple pathologies including congestive cardiac failure and diabetes type II.

She had been unconscious since the stroke and her daughters had been visiting regularly. Mary’s daughters had been with her when she died and were now in the visitors’ room having a cup of tea.

My mentor said she would lead as I had not been involved in care after death before. We washed Mary and put her in a clean nightgown. All the time we were doing this my mentor spoke to Mary and I found myself doing this.

After we had finished we asked the daughters if they would like to sit with Mary which they did, The one daughter said,
“It is lovely to see mum looking so peaceful and she would have been happy that you used her creams and deodorant”.

Reflecting on this scenario, what makes this practice safe, evidence based and professionally and ethically sound?

What policies, political agendas and literature support this practice?

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This practice was safe in a number of ways...

When the mentor asked the student to help provide care after death, the mentor offered to lead. The student admitted that she had not been involved in care after death before, therefore safe practice was promoted as the student worked within the limits of her competence. The registered nurse with the experience led the procedure and did not leave the student to the action alone.

- The NMC Code (2015) was adhered to;

"You work within the limits of your competence" (Preserve safety introduction)

13.3 - "Ask for help from a suitably qualified and experienced healthcare professional to carry out any action or procedure that is beyond the limits of your competence"

The student had assistance from her mentor as she was not competent herself to carry out the after death care.

Leaving the mentor, the professional nurse, and and their student to handle the care after death is also safe practice. The safety of Mary and her daughters was preserved, as the professional who was trained and experienced lead the care. Both the student nurse and daughters are untrained and inexperienced with care after death, so practice could be considered as unsafe if either were left to lead the care.

There were measures taken to reduce the likelihood of mistakes from taking place, which is also promoting safe practice.

The mentor and the student nurse cared for Mary over a period of time. Prior to Mary's passing, she had suffered from a stroke, therefore manual handling would have been prevalent in supporting Mary and to benefit her care.

Manual handling is essential in healthcare, as it promotes a safe working environment for members of staff by reducing the risk of an injury occurring. Members of staff are required to take part in regular manual handling training. Manual handling is suggested to be a core competency in the care of patients.

1. "Carry out all personal care of the body after death in accordance with safe manual handling guidance. It is best practice to do this with two people, one of whom needs to be a registered nurse or a suitably trained person."

Point 43 from Wilson (2011)

2. It is best practice for two people to wash the body as it may feel much heavier after death has occurred. - Marie Curie (2017)

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This practice was professionally sound in a number of ways...

The student remained objective and maintained clear and professional boundaries  with Mary and her daughters.

Integrity and honesty was maintained in this scenario. The student did not treat Mary or the daughters in a dishonest or immoral way. The student and the mentor treated Mary fairly and with compassion, and they never lied to the daughters or left them out. There was no treatment of discrimination, harassment or bullying whatsoever.

Promoting professionalism and trust is one standard within the NMC's Code. The other three standards include prioritising people, practising effectively and preserving safety. The student and the mentor adhered to all four standards, which is also maintaining the profession and repuation of a nurse.

Keeping to British laws also maintains professionalism. It could be said that the student and mentor were maintaining Mary's Human Rights, by giving her the freedom of choice that she was and still is entitled to, by using her own washing products.

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Put any references here as I need to create a slide of them at the end:

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Put any references here as I need to create a slide of them at the end:

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Nursing and Midwifery Council (2015) The code: Professional standards of practice and behaviour for nurses and midwives. London: NMC.

NHS Employers (2015) Manual Handling [online] http://www.nhsemployers.org/~/media/Employers/Publications/Manual%20handling.pdf (accessed 10 September 2018)

Document - National End of Life Care Programme. Improving end of life care. NHS

http://www.hse.gov.uk/msd/backpain/employers/mhor.htm

https://www.mariecurie.org.uk/professionals/palliative-care-knowledge-zone/final-days/care-after-death

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Public & patient involvement can be done by....

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Public & patient involvement can be done by....

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Patient Feedback/surveys
Making decisions
Autonomy
Activities
Advocacy
Participation
Engagement
Partnership (MDT) collaboration

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This practice was ethically sound in a number of ways...

1. The use of speech

The use of speech allowed for mary’s integrity to be maintained and to still be treated like a human being. It also allowed for structure during the wash as it meant that mary would still have been treated like any other patient, meaning nothing would be missed or forgotten. It is also important for the student and mentor as it doesn’t remind them that they are washing a deceased person and that it is no different from washing other patients

2. Dignity and privacy

Dignity and privacy was maintained as they didn’t allow anyone else to be present while washing mary as it was important to remember that she still has rights even when a patient has passed. (Human Rights act – Right to privacy). In accordance to… the mentor and student are still expected to uphold these principles for the patient. Dignity and privacy was also maintained as Mary was given a pseudonym, and her real name was not used.

This scenario is also preserving dignity as Mary has been cared for following her death with a nurse of experience. Also dignity is preserved as Mary was washed and re-dressed in a separate room from patients and her family members, reducing the level of anxiety on other service users, promoting safety.

3. The use of her creams and deodorants and placed into a clean nightgown.

Wilson (2011) says to "clean and dress the deceased person appropriately (use of shrouds is common practice in many acute hospitals) before they go to the mortuary".

This allows for the viewing of the patient to be more pleasant for the family and Mary's dignity preserved. The use of creams and deodorant makes it more personal for the family.

4.  The idea of being at peace after death