Specialized Nursing Care

Subtopic:

Last Office

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Last offices (also known as post-mortem care or care of the deceased) is the care given to a deceased person to ensure a clean body and maintain dignity, respect, and prepare the body according to cultural, religious, and legal requirements.

Aims:

  • To prepare the deceased for mortuary or a funeral home or morgue (a place where dead bodies are kept pending identification, autopsy or burial.
  • To minimize any risk of cross infection to relatives, health care workers or persons who may need to handle the deceased.

Requirements:

Trolley (Top Shelf):

  • Two jugs of warm and cold water Small tray with:
  • Soap in a dish
  • Nail brush
  • Vaseline or lubricant
  • Comb
  • Nail cutter
  • Pair of scissors 2 Receivers (kidney dishes) Dissecting forceps (or artery forceps) – often for packing orifices Mortuary labels with tapes (at least 3 – wrist, toe, and shroud) A roll of toilet paper (or cotton wool) Brown cotton wool in a bowl (for packing orifices) – Note: Brown cotton wool is less common now; plain cotton wool or gauze is typically used. Dressing pack (or sterile pack with swabs) Flannels (or washcloths) Antiseptic lotion Jik (or other disinfectant for surfaces/equipment)

Trolley (Bottom Shelf):

  • Plastic apron
  • 2 pairs of clean sheets (one for the bed, one for the shroud)
  • Dressing mackintosh and sheets
  • A pair of mortuary sheets (or shroud/body bag)
  • Strapping and sticking plaster (adhesive tape/bandage)
  • Notification of death forms
  • Bottle of antiseptic lotion (for washing body)
  • 2 buckets (one containing disinfectant solution for contaminated items) Bedside:
  • Hand washing equipment (access to sink, soap, water, towel)
  • Screens (for privacy)
  • Bucket for wastes (clinical and general)
  • Dirty linen container

Deceased Burial Clothes:

  • Clean sheets
  • Dressing clothes as preferred by family/culture (e.g., Men – underwear, trousers, shirt, coat, tie; Traditional wear according to culture or religion).
  • Diapers/pads (if needed)

Procedure (Preliminary Steps & First Phase):

Key Points  (Adult Last Offices):

  • Maintain a calm, quiet, and respectful atmosphere throughout the procedure.
  • Always handle the deceased body gently and with dignity.
  • Be sensitive to the cultural and religious beliefs of the patient and family regarding death and body preparation. Consult with the family or spiritual advisors if unsure.
  • If the death is a medico-legal case, follow specific protocols regarding removal of tubes, handling of clothing, and notification of authorities.
  • Ensure proper identification of the body with labels before transfer to the mortuary.
  • Wash hands thoroughly before and after the procedure.
  • Terminal disinfection of the patient’s unit is essential.

LAST OFFICE IN PERINATAL DEATH

Objectives:

  • Define the term perinatal mortality.
  • Display the ability to break news of death and counsel the parents of a deceased baby.
  • Identify the requirements for carrying out last office to a deceased new born baby.
  • Prepare the requirements for carrying out last office to a deceased new born baby.
  • Perform last office of the deceased new born baby.

Definition:

Perinatal mortality is the death of a baby in the first 28 days of life, including stillbirths (death before birth after 28 weeks gestation).

Requirements (Perinatal Death):

Additional requirements to adult last office requirements:

  • Baby clothes (as provided by parents/family)
  • Diapers (or pads)
  • Small artery forceps (for packing orifices)
  • Small blanket or receiving cloth (for wrapping the baby)
  • Mortuary label (specifically for stillbirths/neonates)

.

Procedure (Last Office in Perinatal Death):

Key Points (Perinatal Death):

  • Be exceptionally sensitive, supportive, and compassionate when caring for parents experiencing perinatal loss.
  • Allow parents adequate time to see and hold their baby if they wish. This is a vital part of the grieving process.
  • Provide privacy for the family. Ideally, the last offices for a perinatal death should be performed in a separate room, not in the main ward where other mothers with babies are present.
  • Ensure the environment is quiet and conducive to grieving.
  • Handle the baby gently and with the utmost respect throughout the procedure.
  • Follow hospital policy and cultural/religious practices regarding the disposition of the body.
  • Minimize psychological trauma for the mother and family.
  • Ensure appropriate follow-up support is offered to the parents.
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