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Postmortem/Last Offices Nursing Care Effectiveness as Perceived by US Licensed Funeral Directors
  1. Mikel W Dr Hand
  1. Dr Mikel W Hand, Assistant Professor of Nursing, College of Nursing and Health Professions, University of Southern Indiana, Evansville. Email: mwhand{at}usi.edu

Abstract

Background: The provision of appropriate physical postmortem nursing care, or last offices, is important for all deceased people, particularly if further preparation is required by the funeral director for the purpose of open-casket viewing. However, the effectiveness of nursing practices in this regard has been the subject of minimal empirical research.

Purpose and objectives: The purpose of this study was to explore postmortem/last offices nursing care effectiveness from the perspective of the licensed funeral director. The objectives were to describe the phenomenon of postmortem/last offices nursing care effectiveness, explore perceptions concerning how care procedures may aid or hinder the process of producing a desired cosmetic result with further preparation and gain insight into recommendations concerning care.

Methods: A survey adopting qualitative methodology with open-ended questions was used for this study. A convenience sample of 20 licensed funeral directors from a single mid-western state in the US completed a web-based questionnaire. Data analysis involved reading each of the responses several times, initial coding, reviewing for similarities, clustering themes based on similarity, review, and final theme labelling.

Results: The funeral directors provided observations, opinions and recommendations concerning effectiveness in relation to: body positioning; the use of ligatures and ties to secure extremities: removal or leaving in place of intravenous catheters and lines and surgical tubes and drains; removal or retention in the mouth of dentures and partial plates; cleansing of the body; and identification and shrouding of the body.

Conclusions: The findings suggest that postmortem/last offices nursing care practices need to be considered carefully and be based on individual assessment. The participants’ general consensus regarding physical aspects of postmortem/last offices nursing care were largely in agreement with the nursing care practices that they typically observe. However, there were discrepancies that require further investigation.

Conflicts of interest: none

Acknowledgements: The author wishes to acknowledge the Indiana Funeral Directors Association for its invaluable assistance with contacting study participants

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Care after death is a multidisciplinary activity that begins at death but continues through to burial and cremation (American Association of Critical-Care, 2003; National End of Life Care Programme and National Nurse Consultant Group (Palliative Care), 2011). Death is a significant life event for those who are bereaved. Family/ friends are left with not only grief and loss, but also the task of completing arrangements for the funeral or memorial service and decisions relating to burying, entombing or cremating the body of their deceased loved one (Worden, 1991; Speck, 1992; Davies, 2002; Kwan, 2002; National Funeral Directors Association, 2013).

Regardless of which option is chosen, an important decision that families have to make as part of the process is whether to include a public or private viewing of the deceased person. This option can be included regardless of whether or not cremation has been selected (National Funeral Directors Association, 2013).

Within the US, casketing (enclosing in a coffin) and burial continues to be the predominant method of disposition of human remains (National Funeral Directors Association, 2013). According to 2012 statistics from the National Funeral Directors Association (2013), this method of disposition accounts for 56.8% of all final dispositions in the US. The percentage within the state where this study was conducted is markedly higher at 69.7%. In the UK, the percentage for casketing and burial is substantially less, with cremation accounting for 74% of all final dispositions (The Cremation Society of Great Britain, 2012). Within the US, embalming, combined with cosmetics and other body preparation, is commonly used to prepare the decedent for open-casket viewing. Although this does occur in the UK, no public or organisational data are collected concerning the practice and, as such, the frequency to which embalming with open-casket viewing occurs is unknown (Ian Granger, British Institute of Embalmers, personal communication, 19 August 2013).

Death frequently occurs in many acute care hospitals in both the US and other countries (Flory et al, 2004; Gomes and Higginson, 2008). In the majority of these cases, the decedent will receive some form of physical nursing care after death. This is traditionally referred to as ‘postmortem’ nursing care in the US (Smith-Stoner and Hand, 2012) and ‘last offices’ in the UK (Dougherty and Lister, 2008; Albarran and Hills, 2009; The Hillingdon Hospital NHS Trust, 2009; East Cheshire NHS Trust, 2013). However, the latest national guidelines in the UK recommend that instead of ‘last offices’ the term ‘care after death’ should be used to reflect the range of different nursing responsibilities involved when a patient dies (National End of Life Care Programme and National Nurse Consultant Group (Palliative Care), 2011) (Table 1).

Table 1

Main aims of postmortem/last offices nursing care

It is common institutional practice for postmortem/last offices care to be performed by nurses, without the participation of family/loved ones (Kwan, 2002). However, in hospices, it is considered best practice to invite relatives to participate if they wish (Kwan, 2002) and, in some cultures, care of the deceased person is the sole preserve of close relatives (Nyatanga and de Vocht, 2009).

Carrying out postmortem/last offices nursing care often has symbolic significance for nurses. It is the final caring act that nurses carry out for patients. It helps nurses achieve a sense of closure on the death of a person for whom they have cared and is a final demonstration of respectful and sensitive care (Speck, 1992; Maus-Bielders, 1995; Kwan, 2002; Pattison, 2008a; National End of Life Care Programme and National Nurse Consultant Group (Palliative Care), 2011). Undertaking last offices also gives the bereaved family/loved ones, as well as other patients on the ward, the message that caring continues after death (Speck, 1992).

With regard to preparing the body of the deceased person for viewing, it is always aimed to present the deceased person in a way that suggests he/she is no longer suffering and is at peace, thereby leaving the relatives/loved ones with a positive impression of the patient (McNamara et al, 1994; Nyatanga and de Vocht, 2009). The practice of viewing people after death has an important role in the bereavement process as it enables bereaved people to face the reality of death and pay their last respects to their deceased loved one and provides an opportunity for the expression of grief (Worden, 1991; Maus-Bielders, 1995; Weber et al, 1998; Kwan, 2002). Therefore, the practices of nurses, mortuary attendants and funeral directors in terms of maintaining optimum cosmetic appearances of deceased people have a crucial role in the bereavement process (Kwan, 2002).

The policies and procedures pertaining to how postmortem/last offices nursing care is delivered vary by institution (Smith-Stoner and Hand, 2012). There is a significant volume of available literature addressing end-of-life care preferences (e.g. Smith-Stoner, 2007, 2011; Matsui and Braun, 2009; Gheorghe et al, 2011; Wicher and Meeker, 2012). However, despite the fact that caring for a deceased person’s body is an important role for the majority of nurses working in hospitals and other institutional settings, minimal research has been carried out relating to best nursing practice in this regard (Cooke, 2000; Smith-Stoner and Hand, 2012). Consequently, there is a lack of scholarly evidence addressing physical postmortem/last offices nursing care that either supports or refutes the effectiveness of specific nursing interventions and care procedures. Institutional policies and guidelines have frequently been based on traditional practices as well as information from nursing procedure books (Wolf, 1988; Cooke, 2000; Quested and Rudge, 2001, 2003; Pattison, 2008a; Smith-Stoner and Hand, 2012). Therefore, further inquiry is needed to build on the existing literature related to postmortem/last offices care in order to inform and improve nursing practice (Smith-Stoner and Hand, 2012).

The provision of appropriate physical postmortem/last offices nursing care is important for all deceased individuals, but particularly for decedents who will undergo further preparation for the purpose of an open-casket viewing. After death in a hospital, licensed funeral directors are frequently the next provider in the continuum of care. Consequently, they have the potential to provide invaluable insight into the effectiveness of physical postmortem/last offices care that nurses provide to deceased individuals and how this contributes to a desired cosmetic result with further preparation of the body. This study, therefore, aimed to gain increased knowledge pertaining to what licensed funeral directors perceive regarding the effectiveness of the physical care practices of nurses.

For the purpose of this study, effectiveness refers to the ability of physical postmortem/last offices nursing care to aid in producing a desired cosmetic result with further body preparation, including but not limited to embalming and the application of cosmetics (Mayer, 2012). It is important to note that the evaluation of effectiveness in this study is based on the expert opinions and perceptions of the participating funeral directors.

Purpose and objectives

The purpose of this research study was to explore postmortem/last offices nursing care effectiveness from the perspective of the US licensed funeral director. Specific objectives were to (1) describe the phenomenon of postmortem care effectiveness as perceived by licensed funeral directors (2) explore how physical care procedures aid or hinder the process of producing a desired cosmetic result with further preparation, and (3) gain insight into alternative practices that benefit the process of producing a better cosmetic result.

Methods

A survey adopting qualitative methodology, using structured, open-ended questions, was used for this study (Burns and Grove, 2009; Polit and Beck, 2012). This method was felt to be appropriate for this particular study because it allows for robust, focused description of typical observations concerning physical postmortem/last offices nursing care and the provision of expert opinion concerning the effectiveness of these practices. The questions were structured to allow opportunity for participants to provide alternative recommendations if the participant perceived a particular practice to be ineffective.

Approval to conduct the research was secured from the University of Southern Indiana Institutional Review Board for the Protection of Human Subjects of Research.

Participants

All of the participants were licensed funeral directors, legally qualified to embalm and prepare deceased human remains from a single mid-western state in the US. It is important to note that the profession of funeral director is legally regulated, requiring both education and licensure to practice in this particular state and 48 others. All other non-licensed funeral support personnel were excluded from participation in the study.

Sampling and inclusion criteria

Convenience sampling was used (Burns and Grove, 2009). All members of the state Funeral Directors Association were eligible to participate in the study. Eligibility for membership in the Association is contingent on the member holding an active license in the state as a funeral director. It is important to note that individuals licensed as funeral directors in this particular state must also be qualified to embalm human remains.

Data collection

An email notification regarding the study was sent to the state Funeral Directors Association to forward to its members. The notification contained a detailed announcement describing the study and a link to the web-based informed consent and questionnaire. Participants were advised how to access the link and complete the questionnaire. The questionnaire was formulated and delivered using SNAP survey software (SNAP Surveys, 2013). This particular software delivers online surveys and questionnaires and allows for submission of responses anonymously, thus protecting the anonymity of participants completing the questionnaire.

The questionnaire comprised five demographic questions and 20 open-ended questions pertaining to physical postmortem/last offices care. The demographic questions identified the type of firm in which the funeral director practised (single or multiple location), years in practice, level of education, years of experience in practice, and the number of cases prepared by the firm each month. The questions addressing postmortem/last offices nursing care that were included in the questionnaire focused on the following areas:

  1. Most frequent position the body is placed at the time received by the funeral director

  2. The use of ligatures and ties to secure extremities

  3. Removal or leaving in place of intravenous catheters and lines

  4. Removal or leaving in place of surgical tubes and drains

  5. Removal or retention in mouth of dentures and partial plates

  6. Cleansing of the body

  7. Identification and shrouding of the body.

For each of the above areas, the participant was asked what was typically observed in practice, whether this aids or hinders a desired cosmetic result with further body preparation, and if the funeral director might have specific recommendations as an alternative to what is typically observed.

Analysis

The data-analysis framework for this study was developed for use in previous research and was adapted for this study (Stoner et al, 2010; Smith-Stoner and Hand, 2012). Each of the questionnaire responses was thoroughly reviewed by the researcher several times. The responses were then initially coded to identify initial themes, which were reviewed for similarity and categorically clustered based on similarity of meaning. The clusters and responses were then reviewed again twice by the researcher in order to eliminate duplication and determine final theme labelling. Questions were accepted and reviewed until there was significant repetition in responses and no new revelations from the information.

Results

The results are reported in relation to the areas that the questions focused upon and the themes and exemplars arising in each specific area. Where qualitative comments are provided, the participant number for the individual funeral director (FD) is used.

Respondents

A total of 20 licensed funeral directors, who were members of the state Funeral Directors Association, chose to participate in the study and completed the web-based open questionnaire. All of the participants practised in family-owned firms. Three practised in a single location with the remainder practising in multi-location establishments. The duration of experience as a licensed funeral director ranged from less than 5 years to greater than 21 years (Table 2).

Table 2

Practice, experience and monthly case volume of participants (n=20)

Body positioning

The themes concerning body positioning addressed three specific areas: the level of the head; centring the head; and placement of the hands. Each of these was noted to have specific implications concerning the outcome of further body preparation.

The most frequent position that participants reported receiving a decedent was with the head elevated. It was consistently stated that positioning the deceased with the head elevated is the optimal position, as it prevents pooling of the blood in the face, neck and ears, which can lead to staining: ‘Depending on how long the deceased has remained in the flat position, it can cause staining in the neck and ears’ (FD 14).

Therefore, elevating the head was identified as the position that aided the process of producing a desired cosmetic result with further preparation on the part of the funeral director. A few participants, however, noted that it was common for them to receive decedents whose head had been lying flat, which hindered the process of preparation because of staining. Recommended means to accomplish elevation of the head was the use of a pillow or a disposable styrofoam head block. The required degree of elevation was not included in any of the exemplars.

An additional area of concern related to head positioning, as identified by participants, was the need to centre and support the head and prevent it from leaning to one side. The problem of developing rigor mortis in the neck and shoulders was considered a significant issue due to it impeding the ability of the funeral director to correct the position of the head at a later time during preparation.

Hand placement was perceived by participants as another significant area of body placement. Although there was not a specific question addressing hand placement, it was reported as an important positioning concern. The problem of being able to correct hand placement at a later stage in the process was noted by participants.

The recurring recommendation reported by participants was elevating the hands on the abdomen as opposed to positioning the hands flat by the side of the body, which results in oedema. Placing the hands on the abdomen allows for elevation and will likely not require modification during the later preparation stages.

Use of ligatures and ties

Use of ligatures and ties to secure extremities, although not frequently used, still occurs. The responses concerning this item were limited. Only two individuals responded to this particular item, with conflicting opinions concerning the benefit of this practice. One participant reported that ligatures are at times tied too tight, e.g. when binding wrists together or to keep the mouth closed. Such practice has the potential to leave marks on the body that are visible after embalming and cannot be removed: ‘Sometimes a thin gauze material is used to bind wrists together and to close the mouth. This is not recommended because of the deep marks left on face and wrists’ (FD 15).

However, no alternative recommendation emerged from the participant responses.

Intravenous catheters and lines

Participants had observed the practice of both leaving in and removing intravenous catheters and lines. The recommendations concerning intravenous catheter removal were mixed. One participant was in favour of removal because of concerns of potential damage to the body during the removal process at a later stage. However, there were multiple responses in favour of leaving intravenous catheters and lines in place: ‘...prefer left in until after embalming has taken place. It keeps things more clean and prevents unwanted portals of exit’ (FD 7).

The key rationale identified in the exemplars for leaving the devices in place until after embalming occurs was that removal can create holes in the vascular system, which hinder distribution of formaldehyde and create unwanted portals of exit for the embalming fluid. Therefore, the general consensus among participants was to leave intravenous catheters and lines in place unless they are in a position to disfigure the body.

Surgical drains and tubes

With regard to surgical drains and tubes, the most frequent practice observed by participants was for them to be left intact. However, the majority of respondents recommended removal of the tubes and drains as they can leave disfiguring marks/impressions on the skin of the deceased person. This is of particular concern if they have been inserted near a viewing area such as the face: ‘In areas that would be viewable, removing the tubes aids in not leaving noticeable marks/impressions on the skin’ (FD 14).

Areas that will not be viewed were of less concern as the funeral director will let the fluid drain for as long as possible before cauterizing the tissue. Although the majority of respondents recommended removal of surgical tubes and drains, particularly if they are near areas of the body that will be uncovered for viewing such as the face, two participants mentioned that retaining them might prevent problems associated with leakage.

Dentures and partial plates

The majority of participants reported they typically observe that dentures are removed. Responses concerning whether removal aids or hinders producing a desired cosmetic result were similar in number. However, the availability of dentures was identified as a consistent concern throughout the exemplars. Participants reported that dentures need to be available before the beginning of the embalming process if they are to be used in setting features but that frequently they arrive afterwards, making them of no use: ‘The dentures typically show up the next day with the family...too late to be in place for embalming. We then place them under the pillow in the casket’ (FD 17).

The key recommendation concerning dentures and partial plates was, therefore, to have them available with the deceased, whether in the mouth or an accompanying container.

Cleansing of the body

The majority of participants reported that they typically receive bodies that are clean. Cleaning was noted as beneficial, although anything beyond simple bathing was identified as unnecessary. One participant made specific mention that it was the practice of funeral directors to rewash the body completely, even if the nursing staff had already carried out this activity: ‘We always completely wash the body anyway and would do so if the nursing staff did as well’ (FD 18).

Therefore, the key recommendation for cleansing of the deceased person’s body was simple bathing.

Wrapping the body and the placement of identification tags

The observed practices relating to wrapping or shrouding the body varied and included techniques such as using a body bag or sheets and blankets from the hospital bed. One participant reported that plastic sheets could be wrapped too tightly around the body, causing the nose to be bent to one side. The majority of participants reported that they considered the typical practices adequately maintained privacy issues and prevented exposure. However, participants recommended use of a body bag as a more reliable means of addressing exposure prevention. A thicker body bag was mentioned as an alternative approach in the event that the deceased had undergone autopsy: ‘If there is an autopsy or much blood flow a thicker bag would be helpful. Really have not had much of an issue with this’ (FD 18).

All of the participants reported that identification tags are placed somewhere on the body. However, the individual position varied somewhat, with the wrist, toe, and ankle being the most common. The zipper was the most commonly observed location identified for tag placement on the shroud. The majority of participants reported that tag placement on the body provides safe and adequate identification of the deceased. One significant issue noted in an exemplar is that tags that are placed on the outside shroud could easily fall off or be switched. The key recommendation concerning identification tags is that at minimum they need to be placed somewhere on the body.

Discussion

The primary purpose of this study was to examine the effectiveness of physical postmortem/last offices nursing care from the perspective of US licensed funeral directors. The opinions expressed by participants concerning various hospital nursing care practices are contingent on what they as a practitioner experience. The recommendations provided by the licensed funeral directors participating in this study demonstrate a commitment on the part of these individuals to achieve the best cosmetic outcome resulting from embalming and body preparation. The results include observations and recommendations related to positioning and preparation of the body, that may be useful in guiding postmortem/last offices nursing care practices and the development of policies related to them (Table 3).

Table 3

Recommendations for physical postmortem/last offices nursing care

Postmortem/last offices nursing care is a complex activity that requires both technical and psychosocial skills and individualised assessment of the presentation of each deceased person (Neuberger, 1994; Quested and Rudge, 2001; Hadders, 2007, 2009; Dougherty and Lister, 2008; Pattison, 2008a,b; Robinson, 2009; Smith-Stoner and Hand, 2012). Although many aspects of postmortem/last offices nursing care practices are compulsory, such as identifying the deceased person and the required practices when the death is being referred to a coroner, others may be open to individual interpretations of procedure manuals, such as positioning and best ways to retain leakage (Hadders, 2009). The quality of postmortem/last offices care has been a concern both in the US and the UK and has resulted in auditing of care practices and published analyses of policies and procedures specific to postmortem/last offices care (Allbarran and Hills, 2009; Smith-Stoner and Hand, 2012).

For example, in the UK, the National End of Life Care Programme and National Nurse Consultant Group (Palliative Care) (2011) undertook a consensus methodological approach (Jones and Hunter, 1995), involving key stakeholders (including funeral directors), to review critically a wide variety of local UK guidelines relating to last offices. Following this process, a final set of guidelines was produced based on the best available empirical evidence, the consensus of the stakeholders as well as national guidelines developed by the Royal Marsden Hospital (Dougherty and Lister, 2008). The areas where there was found to be minimal supporting evidence or consensus included containment of leakage, including the use of sheets and body bags, preparing the body, how best to maintain dignity, identification of the deceased and information required from nurses to communicate about the deceased to mortuary staff and funeral directors.

With regard to the aspects of postmortem/last offices nursing care that are the subject of the current research, the guidelines mainly concur with the participants’ recommendations. However, there are discrepancies. For example, the guidelines state that the deceased person’s limbs should be straightened if possible, which contradicts the majority view of the research participants that hands should be placed on the abdomen to prevent swelling. The optimum positioning of the arms and hands is, therefore, worthy of further consideration.

In addition, the guidelines appear to advocate that, in the interests of infection control, all lines, tubes and drains should be capped, spigotted or clamped and left in place without cutting to help prevent leakage of body fluids. They also make it clear that when the coroner is involved or the death was unexpected, suspicious, sudden or occurred as a result of unknown causes, all lines, cannulae and endoctracheal tubes, urinary catheters and bags should be left in place, intravenous infusions should remain connected but clamped and the body of the deceased must not be washed or mouth care performed as this can destroy evidence. In the current study, while the majority view was that intravenous catheters and lines should be left in place, it was recommended that surgical tubes and drains should be removed if they are in a location potentially to leave disfiguring marks/ impressions on the skin of the deceased person. This was felt to be of particular concern if they had been inserted near a viewing area such as the face. It was acknowledged, though, that removing tubes and drains resulted in leakage. It should be noted, however, that the aim of the current research was specifically focused on the requirements of the funeral director with regard to the physical care of the deceased during postmortem/last offices nursing care that preserve the body in the best state for viewing, as opposed to the holistic considerations of care.

Certain aspects of postmortem/last offices nursing care can cause anxiety among nurses, especially when the nurse is newly qualified (Komaromy, 2000; Hadders, 2009; Nyatanga and de Vocht, 2009; Clover, 2010; Smith-Stoner and Hand, 2012). These include removing ornaments such as jewellery and watches, attaching identification tags and wrapping the deceased person in a shroud and then placing in a body bag, all of which can make nurses feel that they are removing the identity of the once living person (Quested and Rudge, 2003).

Hadders (2009) undertook a qualitative interview study of 28 nurses working in the intensive care unit of a 900-bedded tertiary university hospital in Norway. The aim was to explore in what manner the management and standardisation of hospital death has evolved over the last few decades and nurses’ interpretations of postmortem nursing care practices and procedures. Although acknowledging the necessity of shrouding or wrapping, the nurses found this practice difficult, particularly when the face is covered, as it symbolises the end of their relationship with that patient. As a patient would never be shrouded in life, during the act of shrouding or wrapping, the dead person finally becomes a ‘dead body’. With regard to identifying the deceased person, the nurses reported that it used to be common practice to tag the big toe. However, they considered this practice as being disrespectful to the deceased as it was perceived as being tantamount to marking the person as a package to be transported. Therefore, the tag is commonly placed on the wrist as would have occurred when the person was alive. The UK’s latest guidelines for care after death clearly state that the identification name band should be placed on the deceased person’s wrist or ankle and that toe tags should be avoided (National End of Life Care Programme and National Nurse Consultant Group (Palliative Care), 2011).

Anxiety regarding, and the variable practices associated with, postmortem/last offices nursing care are exacerbated by lack of standardised training and minimal experience relating to caring for deceased people during preregistration nursing education (Wilson et al, 2010; Smith-Stoner and Hand, 2012). Educating nurses about best practices relating to postmortem/ last offices should be an essential part of nurses’ education (National End of Life Care Programme and National Nurse Consultant Group (Palliative Care), 2011; Smith-Stoner, 2011). When developing curriculum pertaining to care after death, nursing faculties must consider not only the emotional impact of caring for deceased patients, but also physical presentation and planning, implementing and evaluating interventions that are based on the best available evidence. Such education should also include potentially negative aesthetic consequences that may result from improper care. As well as the theory, there should be an opportunity for practice, either in the clinical or skills laboratory setting (Smith-Stoner, 2009).

Recommendations for future research

Postmortem/last offices nursing care practices, death care practices, and final disposition preferences vary between geographic locations and institutions, both within the US and internationally. The requirements of the funeral director relating to the physical care of the deceased during postmortem/ last offices nursing care in order to preserve the body in the best state for viewing has received minimal attention in the nursing literature. Although future research may be difficult to undertake due to limited funding sources, larger-scale studies into funeral director perceptions of postmortem/ last offices nursing care effectiveness on both a national and international level is required to help inform nursing practice and knowledge in this regard (Smith-Stoner and Hand, 2012).

In particular, this study has suggested some new areas for future research:

  • ▶▶ Whether the hands should be placed on the abdomen to prevent swelling as opposed to straightening the arms

  • ▶▶ Whether or not methods to secure extremities and to facilitate mouth closure should be incorporated as part of postmortem/last offices nursing care.

Limitations

This study had several limitations, including geography and prevalence of common practice, lack of maximum variation in participants, method of response, and the closed nature of the questions used. Data collection was limited to one single mid-western state in the US. The majority of families in this state select embalming and open-casket viewing as part of the funeral arrangements for their loved one (National Funeral Directors Association, 2013). This may have contributed to similarity in participant responses. It is unknown if frequent selection of other types of arrangements such as cremation would have altered the opinions or alternative recommendations provided.

In addition, a convenience sample was used and no methods were employed to incorporate diversity in respondents. All participants practised their profession in family-owned firms and there was no effort employed to recruit participants from firms owned by corporations. It is unknown if inclusion of funeral directors practising in corporate firms would have produced different opinions than those provided by the participants.

Data were collected using a web-based open-ended questionnaire. This allowed for anonymity of participants, but prohibited the opportunity for any follow-up inquiry. It is unknown if additional information would have emerged had follow-up inquiry been possible. The closed nature of the questions elicited very specific responses concerning clearly delineated aspects of physical postmortem/last offices nursing care. The responses were relevant and specific to the questions asked. However, the themes of responses were preset and this may have potentially hindered the participant from sharing information, relevant to postmortem/last offices nursing care that was not included in the structured questions.

Conclusions

The provision of appropriate physical postmortem/last offices nursing care is important for all deceased individuals, but particularly for those who will undergo further preparation for the purpose of a public or private open-casket viewing. Viewing a loved one after death can help bereaved family members face the reality of death and can play a valuable role in the bereavement process.

Postmortem/last offices nursing care requires a range of physical, technical and psychosocial skills, including maintenance of the deceased person’s dignity, family support interventions, knowledge of the associated legal issues, hygiene and infection control practices and the religious and cultural beliefs, values and preferences of the patient and family/loved ones, as well as being able to maintain the optimum appearance of the body of the deceased person. The way in which nurses prepare the bodies of deceased patients can have an impact on the ability of funeral directors, who are frequently the next provider in the continuum of care, to achieve good cosmetic appearance for future open-casket viewing.

Despite being an essential nursing role, there is minimal empirical evidence with regard to best nursing practice and a lack of standardised training/education. It is necessary to gain increased knowledge pertaining to what licensed funeral directors perceive regarding the effectiveness of the physical nursing care provided to deceased individuals and how this contributes to a desired cosmetic result, particularly in relation to positioning. It is recommended that researchers conduct future studies to expand on the body of knowledge pertaining to postmortem/last offices nursing care.

Key Points

  • ▶▶ There is a lack of research and education relating to best practice with regard to the performance of postmortem/last offices nursing care.

  • ▶▶ Postmortem/last offices nursing care requires a range of physical, technical and psychosocial skills, including family support interventions and knowledge of the associated legal issues, hygiene and infection control practices and the religious and cultural beliefs, values and preferences of the patient and his/her family/loved ones.

  • ▶▶ The way in which nurses care for the bodies of deceased people can have an effect on the ability of the funeral director to ensure optimum cosmetic appearance for open-casket viewing.

  • ▶▶ Viewing a loved one after death can help bereaved people to pay their last respects to their loved one and face the reality of the death. It, therefore, can play a valuable role in the bereavement process.

  • ▶▶ It is necessary to gain increased knowledge pertaining to what licensed funeral directors perceive regarding the effectiveness of the physical nursing care provided to deceased individuals and how this contributes to a desired cosmetic result.

References

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