Post Mortem Nursing Care Effectiveness as Perceived by U.S. Hospital Staff Nurses

Purpose: The purpose of this study was to explore postmortem nursing care from the perspective of the hospital staff nurse. The objectives were to describe phenomenon of postmortem nursing care from the perspective of the hospital staff nurse, explore perceptions concerning how the care provided either helps or hinders the achievement of a desired cosmetic result of the deceased with further body preparation, and to gain insight into common nursing care practices and recommendations concerning the improvement of care.

Methods: Approval to conduct the study was obtained from the Institutional Review Board of the University of Southern Indiana.  A qualitative survey method using open ended questions was used for the study.  A convenience sample of 34 members of a state nursing association in the USA who self-identified as hospital staff nurses participated in the study. Each participant completed an anonymous web based questionnaire that included four demographic questions and twenty five open ended items concerning post mortem care practices used by nurses, perceptions of whether that care practice aids or hinders a desired cosmetic result with further body preparation, and alternative care recommendations to aid in the preparation process. Questions were focused  to address practices concerning body positioning, use of ligatures to secure extremities, intravenous catheters and lines, surgical tubes and drains, dentures and partial plates, cleansing of the body, identification, shrouding and exposure prevention.  In order to analyze the data, the researcher reviewed each questionnaire several times. The responses were then initially coded to identify broad themes. The broad themes were then reviewed for similarity of meaning and categorically clustered. The clusters were then reviewed again twice by the researcher in order to determine final theme labeling. Questions were accepted and reviewed until there were significant repetitions in responses and no new revelations of information.

Results: The results are reported based on the focus of the questions and the accompanying exemplars.   The majority of participants reported a flat position as the most frequent body placement used for postmortem care and that this position aids in producing a desired cosmetic result. However the exemplars concerning alternative recommendations for body placement contain substantial insights including elevation of the head to prevent swelling drainage, and the presentation of a natural appearance.  Questions concerning the use of ligatures and ties to secure extremities produce a very limited response inadequate to determine a perception for or against use. A single exemplar indicated rare use of these in current practice. The majority of participants reported that they typically remove intravenous catheters and lines and that doing so aids in producing a desired cosmetic result. Exemplars support this perception addressing concerns such as normal appearance, creating a less disturbing environment, and comfort for family. Recommendations from exemplars include consideration of the setting and legal requirements that may require retention. Responses concerning tubes and surgical drains mirror those regarding intravenous catheters and lines. Exemplars supporting removal include family consolation by removal, and ease in viewing. A majority of participants reported leaving dentures and partial plates in the mouth of the decedent. Rationale in the exemplars included leaving in place for mouth positioning, loss prevention, and leaving in place for hospital viewing. Typical body cleansing practices reported by participants varied greatly and included cleaning head to toe, use of warm water and soap, inclusion of oil or perfume, and basic removal of soiling. Participants identified the toe and wrist band as the most frequent locations to place identification tags and that these provide safe and adequate identification of the deceased. Exemplars did not include alterative locations for placement, but rather emphasis on confirmation of identification, verification that identification tags in all locations match, and to never assume that one tag is correct. Typical wrapping and shrouding procedures reported by participants varied and included use of a plastic shroud, wrapping in bed sheets, body bags with a zipper, blankets for infants, and no longer wrapping bodies as a practice. Exemplars did not include alternative recommendations for shrouding, but rather additional suggestions such as the use of a covered gurney, closing the curtain and the door, and providing privacy for removal.  This study had limitations included limited geography, convenience sampling, lack of maximum variation in participants, and focused nature of the questions.  Data were collected in a single mid-western state with limited variation in population demographics and burial practices. A convenience sample was used and no method to incorporate diversity among participants was incorporated. It is unknown if this may have contributed to minimal diversity in responses. The web based questionnaire allowed for anonymity of participants, but it also prevented any follow up inquiry. The focused nature of the questions directed the responses in a relevant manner. However, this may have hindered the participant from sharing additional sights pertaining to postmortem nursing care that were not included in the preset questions.

Conclusion: The practices, observations, and recommendations reported by participants are based on their nursing practice, observations, and experience with the provision of postmortem nursing care.  The perceptions and recommendations shared by participants demonstrate a commitment to comforting the surviving family by attempting to make the appearance of the deceased as normal as possible.  However, it is important to note that the perceptions and alternative recommendations identified here are not consistent with those reported by Licensed Funeral Directors in a study published in 2013 addressing the same areas of inquiry. There are notable differences in perceptions between nurses and Funeral Directors pertaining to commonly observed postmortem nursing care practices and their effectiveness.  These include body positioning, use of ligatures and ties, removal of IV catheters and lines, surgical drains and tubes, and placement of dentures and partials. These are worthy of consideration because Funeral Directors are the next care provider for the decedent and are the professionals  who complete the additional body preparation following post mortem nursing care. As a result, they are in an ideal position to provide valuable insight into the effectiveness of these nursing care practices.  Additional research is needed to expand on the body of knowledge concerning postmortem nursing care. Future research efforts should include secondary analysis of data from this study and the prior involving Funeral Directors in an effort to develop a more in depth and coherent understanding of the perceived effectiveness of these practices, examine and scrutinize alternative recommendations, and to potentially generate further research questions.