Medical practice, procedure manuals and the standardisation of hospital death

Managing Bodies, Managing Persons: Postmortem Care and the Role of the Nurse

This paper addresses how interactions between UK palliative care nursing staff and the bodies of the deceased they care for function as a mechanism to help them make sense of death in line with their work as carers. Through an analysis of postmortem care rituals, I will argue that nurses play an integral role in the 'making of the dead', and look at how this functions in relation to their role as carers of bodies in line with associated states of personal wellbeing. Further to this, there is an argument to be made for the recognition of the nurse's place in biomedical models as managers of the transient body; as the constructors of the well, sick, living and dead body.

Last offices: nurses' experiences of the process and their views about involving significant others

BACKGROUND

Last offices are the procedures carried out shortly after a person dies. The National End of Life Care Programme UK guidelines recognise the potential impact of last offices on nurses and advocate the involvement of significant others, but offer no guidance on how to facilitate this.

AIM

To explore nurses' experiences of carrying out last offices, in hospice inpatient and community settings, and their views on involving the person's significant others in the process.

METHODS

Semi-structured interviews with 10 nurses/health-care assistants (held in June to August 2012). Interviews were analysed using interpretative, thematic analysis.

RESULTS

Four main themes emerged from the data. Last offices were described as: a range of care activities, a learning and coping challenge, a time of transition, and a demonstration of respect and support.

CONCLUSION

Last offices are a range of care activities, shaped by the environment, time and help available. Further research into the potential benefits and harms of involving significant others is required.

Relatives' participation at the time of death: standardisation in pre and post-mortem care in a palliative medical unit

PURPOSE

The aim of this study was to illuminate the development of standardisation of relatives' participation at the time of death in the Palliative Medical Unit and to explore if the implementation of standardisation brought palliative care more in line with its ideology.

METHODS

A registration form was developed and utilized by the Palliative Medical Unit nurse in charge of the patient and family to register to what extent relatives participated at the time of death. The study consists of two data sets named evaluation 1 and 2. Evaluation 1 includes data collected during the period 01.11.1995-31.12.1999, representing 73% of all deaths (N = 244). Evaluation 2 includes data collected during the period 01.01.2003-31.12.2009, representing 71% of all deaths (N = 400). The data was analysed in SPSS, covering primarily the frequency of participation and correlation between evaluation 1 and evaluation 2.

RESULTS

Relatives are more often present at the moment of death, while nurses are less present at this moment. Additionally, Palliative Medical Unit nurses use more time to inform and discuss relatives' participation in pre and post-mortem care, as well as making agreements with relatives after death occurs.

CONCLUSION

Important premises for successful standardisation are fostering Palliative Medical Unit nurses' knowledge about various aspects of pre and post-mortem care through regular evaluation and an educational programme providing staff with necessary time, awareness and skills. In addition nurses also require sufficient amount of time in the clinic.

Music during after-death care: a focus group study

BACKGROUND

The intensive care unit (ICU) is not only a place to recover from injuries incurred during accidents and from serious illness. For many patients, it is also a place where they might die. Nursing care does not stop when a patient dies; rather, it continues with the care of the deceased and with family support. The aims of this study were (1) to explore the experiences and attitudes of nurses towards the use of ambient music in the ICU during after-death care and (2) to describe the feedback nurses received from relatives when music was used during the viewing.

METHOD

A qualitative design employing focus group interviews was used. Three focus group interviews with 15 nurses were conducted. All the interviews were audiotaped, transcribed verbatim and analysed using qualitative content analysis.

FINDINGS

Six main categories of attitudes emerged from the analysis: (1) different attitudes among nurses towards the use of music; (2) music affects the atmosphere; (3) music affects emotions; (4) use of music was situational; (5) special choice of music and (6) positive feedback from the bereaved.

CONCLUSION

This study demonstrates that music might be helpful for nurses during after-death care as well as for the care of the relatives.

RELEVANCE TO CLINICAL PRACTICE

Including ambient music in an after-death care programme can help nurses show respect for the deceased as the body is being prepared. Music played during the viewing may be a way of helping relatives in their time of grieving. It may ease the situation by making that event special and memorable. However, standardizing this intervention does not seem appropriate. Rather, the individual nurse and the family must decide whether music is to be used in a particular situation.

Negotiating leave-taking events in the palliative medicine unit

In this article I explore the importance staff and relatives give to patients' social identity at the time of dying, death, and leave-taking in a palliative medical unit in Norway. I employ Timmermans' concept of death brokering and show how various patient identities are used to broker and negotiate the timing, content, and form of leave-taking events. In their end-of-life care, nurses strive to accommodate relatives and support them in their grief process. Making patient identities relevant illustrates the close relationships between maintenance of the integrity of the material body and maintenance of the integrity of the social person; this practice aligns biomedical and physical identities with biographical and personal identities. Maintenance of patients' social identity is not a uniform process. Throughout postmortem care, nurses and relatives oscillate between poles of nearness to and distance from the deceased, who paradoxically can be experienced as both socially alive and socially dead.

Enacting death in the intensive care unit: medical technology and the multiple ontologies of death

This article explores various ways health personnel enact death in connection with mechanical ventilation treatment withdrawal in the intensive care unit (ICU) at Trondheim University Hospital. The main focus is on sedated terminal patients who undergo mechanical ventilator treatment withdrawal and relatives’ presence at this time. Mol’s (2002) praxiographic orientation of the actor-network approach is followed while exploring this medical practice. Utilizing this interdisciplinary science and technology studies approach this article describes what Timmermans and Berg (2003) have called ‘ technology-in-practice’. Thus the main focus of the analysis is on medical interventions, and enactments of death within medical practice. The article argues against a ‘social essentialist’ approach to medical technology, which views technology as a passive force empowered by social relations. It explores how various enactments of death are intrinsically linked with and shaped by the use of medical technology within clinical practice. A praxiographic inquiry into how death is enacted carefully takes notice of how medical practice and techniques make death audible, tangible, visible, knowable and real. Mol’s praxiographic approach also enables a description of how the multiple enactments of death connect within end-of-life care through various forms of coordination. This article is based on interviews with 28 nurses and two physicians in a Norwegian intensive care unit.