CNAs, whether working in hospital or long-term care settings are called upon to assist with post-mortem care. If you’re not clear on this going in, perhaps a different career choice would be best. Just sayin’.
Yes, death gives darn near everyone the heebie-jeebies, yours truly included. Everyone’s reaction to death and corpses is individual. What can be standardized is a competent, professional response to the practical need to prepare the body for 1. family to spend time with the departed and 2. need to get things settled/cleaned/straightened before rigor sets in. We’ve certainly come a long way since the time of the Black Death.
In the hospital, the nurse may supervise this care, or it may be performed by a couple of CNAs working together. A CNA may also perform this duty solo, but usually this doesn’t occur, for the practical reasons that positioning is more safely accomplished with two or more workers, and that post-mortem care does an emotional/spiritual number on even the most grizzled, seasoned health care worker.
Sometimes, the nurse needs emotional support. He or she has supported the patient through efforts to save his/her life, then through hospice or “comfort care” and then the dying process. The nurse has to be supportive of family/loved ones as well, and their reactions to the dying process. Last but not least, the nurse is responsible for final charting, finding out which funeral service the family would like used, dealing with belongings, and supervising/performing post-mortem care according to facility policy.
So, what’s our role as the CNA in all this? There are three areas: rules of behavior/etiquette, rules of gathering supplies, and rules of post-mortem care.
1. Rules of behavior/etiquette:
- Watch your mouth! It is said that hearing is the last sense to go. So keep it proper! Plus, many hospitals only have a curtain between you and family members lingering outside the room, other staff, management, and passers-by.
- It’s not about you, it’s about the consumer! (Best business advice ever, courtesy of Joe Dirt.) Nobody wants to hear how you handled the death of someone in your family. They are having their own experience, save the stories and advice for another time and location. So STFU.
- Be discreet! If the family will be coming back into the room post-mortem to spend time with their departed loved one, put the body bag in a drawer or cupboard. Bag up extra non-needed medical wastes (catheters, lines, drips, etc.) and get’em out of the room. Lower the lights so things don’t look so stark.
- Be realistic about time frames. Post-mortem care can take 15-30 minutes to accomplish with a team of two or more, depending on how much there is to remove/clean, and how much bleeding/oozing is going on. Keep the family informed so they don’t freak out on you.
Rules of gathering supplies:
- 10 mL syringe for removing Foley cath
- 60 mL Luer-lock syringe for removing stool/fecal management system (excellent product video from Bard – select the removal procedure video)
- plenty of chux
- paper tape (less damaging to skin)
- drain sponges/gauze (needed along with tape for securing holes where lines used to be)
- surgical scissors (find in procedure cart as needed) – needed for removing sutures holding in PICC, central, art lines (these are too tight to get at with trauma shears, which have blunted leading tips)
- body bag with tags (usually 3 – for body, outside of body bag and for belongings) – to use per facility protocol (LTC – usually the funeral service brings this item)
- bags for belongings if not already taken by family – don’t forget to tag them
- clean gown
- clean bed linen
- wash cloths/towels
- EMPTY garbage cans with plenty of liners (don’t forget the biohazard bags – you’re gonna need ’em) – it just plain sucks to start post-mortem care with every waste can in the room chock-full!
- did I mention – plenty of chux? OK.
Rules of post-mortem care:
Hopefully you had a good CNA textbook that covered this topic and you read it during your CNA course. If not, might be a good idea to review it before taking a new position. I highly recommend the following article: Post-Mortem Care.
Remember to put a chux down under orifices (or is it orifi?) on the side you are rolling the body to, because drainage happens. This one piece of advice will hopefully save you a few post-mortem linen changes.
Remember, this is the patient’s (and their family’s) last experience with your facility, so make it a professional one.