Definition
Care of body in 30-45 minutes following the declaration of death by a physician.
Purposes
- To maintain normal body alignment before rigor mortis sets in.
- To reduce mental distress of family.
- To facilitate transportation to mortuary/residence.
Articles
- Long artery clamp.
- Bandage.
- Absorbent and nonabsorbent cotton.
- Hospital gown or patient’s clothes.
- Mackintosh.
- Mortuary cards in transparent plastic cover.
- Valuables envelope.
- Shroud/body bag/sheet.
- Clean gloves.
- Articles for cleaning or bathing the body
Procedure
| NURSING ACTIONS | RATIONALE | |
| 1. | Before procedure Assess for the presence of family or significant others and whether they have been informed of the patient’s death. Ask if they wish to view the body, observe their response, and offer them the opportunity to ask questions. | It is the physician’s responsibility to notify the family of patient’s death. Nurses provide emotional support and prepare body for viewing. |
| 2. | Assess patient’s religious and cultural practices. Determine if family wishes to have a minister or priest at the bedside. | Specific religions dictate ceremonies at time of death. |
| 3. | Determine, if patient was on isolation precautions for an infectious disease. | Precautions must be taken to prevent the spread of infection to other. |
| 4. | During procedure Wash hands. | Reduces transmission of microorganisms. |
| 5. | Don gloves and gown or protective devices as applicable. | Body secretions may harbor infectious microorganisms. |
| 6. | Close room door or draw bedside curtains. | Provides privacy for the deceased and family. |
| 7. | Identify the body according to agency policy. | Ensures proper name use in labeling. |
| 8. | Position the body in supine with arms at side, palms down, or arms across the abdomen. Do not place hands one on top of the other because bottom hand will become discolored. | Body appears in natural position. |
| 9. | Place small pillow or folded towel under the head or elevate head of bed 10-15°. | Prevents pooling of blood in the face and subsequent discoloration. |
| 10. | Gently place fingers over the closed eyelids for a few seconds. | Holds eyelids in place to create a natural appearance. |
| 11. | Insert dentures into mouth (if applicable). If mouth fails to close, place a rolled towel under the chin. | It is difficult to insert dentures after rigor mortis occurs. Dentures maintain normal facial expression. |
| 12. | Remove all bottles, bags, or receptacles from urinary catheters, nasogastric tubes, IV lines, or drainage tubes. | In case when autopsy is needed, these need to be preserved. |
| 13. | For tubes remaining in the body, either remove clamp or cut within one inch of the skin and tape in place. | Hospital policy dictates tube care. Specific guidelines apply if an autopsy is to be performed. |
| 14. | Remove soiled dressing and replace with clean gauze dressings. | Controls odor caused by microorganisms. |
| 15. | Wash body parts soiled with blood, urine, feces, or other drainage and put clean gown on. | Prepares body for viewing and reduces odors. |
| 16. | Apply jaw bandage (four-tailed bandage). | Keeps the mouth closed. |
| 17. | Plug body orifices, such as nose, mouth, vagina, and rectum with absorbent cotton followed by nonabsorbent cotton (ears to be plugged only if there is cerebrospinal fluid leakage). Nose to be packed in such a way that cotton is not visible. | Relaxation of sphincter muscles after death may cause release of urine, feces, and body fluids. |
| 18. | Close eyes by keeping wet cotton balls on eyelids. | Eyelids remain closed with wet cotton on them. |
| 19. | Fold hands as in praying position and tie thumbs together. | |
| 20. | Straighten legs, bring feet together, and tie big toes. | |
| 21. | Complete mortuary card and place in plastic cover and tie to the big toes together. | Use ball point pen to avoid ink from spreading. |
| 22. | Place an absorbent pad under the patient’s buttocks. | Relaxation of sphincter muscles after death may cause release of urine or feces. |
| 23. | Brush and comb patient’s hair. Remove any clips, hairpins or rubber bands. | During viewing, the patient should appear well groomed. Objects, such as pins can damage or discolor the face and scalp. |
| 24. | Remove all jewelry. Exception: family may request wedding band be left in place. Place a small strip of tape around finger over the ring. | Prevents loss of valuables. |
| 25. | Account for all valuables remaining in the patient’s room and label each item. Prepare a “valuables list” to inventory all items. Return valuables to immediate family members when they arrive or store in locked container/cupboard. | Nurse is responsible for safe keeping of personal valuables, such as jewellery, wallet, eyeglasses, or religious medals. |
| 26. | Place patients clothing and shoes in a labelled bag and return to family members. | Keeps items safely secured. |
| 27. | Complete identification tags and attach one to the patient’s ankle. The remaining tag should be saved in order to attach to the outside of the sheet/shroud after the body is covered. | |
| 28. | If the family requests viewing, place a sheet or light blanket over the body with only the head and upper shoulders exposed. Provide soft lighting and offer chairs to the family. | Maintains dignity and respect for the patient and family and prevents exposure of body parts. |
| 29. | After the family has left, remove all linen and the patient’s gown, then place body in body bag or apply the shroud. Be sure that the shroud completely encircles all body parts. | Prevents injury to skin and extremities and avoids unnecessary exposure of body parts. |
| 30. | Secure shroud with tape wrapped over the shoulders, waist, and legs. | Keeps shroud secure and protects body during transfer. |
| 31. | Attach second completed label to outside of the body bag or shroud. | Ensures proper identification of the body. |
| 32. | If patient had a transmissible infection, special labelling may be used. | Protects healthcare workers who transport and store the body. |
| 33. | Arrange for transportation of the body to the morgue or mortuary. | The body should be cooled in the morgue to prevent further tissue damage. |
| 34. | Carefully transfer the body to a stretcher keeping the body aligned. Cover with a clean sheet. | Carefully transfer the body to a stretcher keeping the body aligned. Prevents damage to body tissues. A false bottom stretcher makes it appear there is no body lying on stretcher. |
| 35. | Close other patients room doors and arrange to transport the body. | Appearance of a body can upsets to other patients. |
| 36. | After procedure Remove remaining items and linen from the patient’s room, wash hands. | Prevents transfer of microorganisms. |
| 37. | Record date and time of death, time physician was notified, name of physician announcing death, disposition of valuables and belongings, care delivered to family, consent form signed by family, disposition of the body, and information provided to family members. | Ensures that patient’s death is recorded accurately and legally. |
| 38. | Document any marks, bruises or wounds on body before death or those observed during care of the body. | Reduces risk of liability for creating such marks in the care of the body after death or transport to the morgue. Certain markings can identify the body if identification tags are lost or destroyed. |
| 39. | Document any infectious process that the patient had when death occurred and document the procedure used to identify the risk on body bag. | Reduces liability for inadvertent contamination by persons handling the body after transfer from the division or agency. |
Releasing Body
- Check all the documents, such as:
- Copies of death certificate
- Autopsy permit if needed
- Entries in mortuary register
- Authorization paper to take body to destination
- Handover the body to relatives after the bill has been settled and the body dressed in own clothes.
- Assist for transporting body into conveyance from mortuary.
- Replace articles brought back from mortuary after adequate disinfection.
- Document in nurse’s record, the date and time of release of the body.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
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