Determining that Someone is Dead

Deaths should always be determined by a doctor. In cases of expected death, the clinical examination may be delegated to a nurse, if a doctor has delegated responsibility by filling out a form for "determining expected death". The nurse listens with a stethoscope for heart sounds and shines a flashlight in the deceased's eyes to assure that the deceased is dead. In cases of unexpected death, the doctor must come out for an assessment. It is also part of this to decide whether the police should be contacted.

If the identity of the deceased is known, the body should be provided with an identity band. The band is attached around the deceased's hand or ankle. If the deceased has a pacemaker, this should be noted on the death certificate, name card, and transport certificate. The same applies if there is a risk of infection.

Caring for the Relatives

For the relatives of the deceased, how they are cared for can be important. If possible, relatives should be informed that death is imminent, so that those who wish to have the opportunity to come and say goodbye. There are many traditions and cultural aspects to dealing with death in health care. We need to take these into account. In order to do this, we need to know what the family wishes in the individual case.

Losing a close relative often leads to a crisis reaction. It might also be worth blogging about the crisis reactions that relatives can go through in the event of a death. The four phases of a crisis are the shock phase, the reaction phase, the processing phase, and the reorientation phase. People react differently depending on how far they have come in the crisis. Healthcare professionals sometimes face strong emotional reactions from relatives in connection with the death.

Even an expected death can be emotional and sometimes overwhelming for the mourners. It can be about guilt, anger, bitterness, and/or denial. It is important to act dignified towards both the mourners and the deceased. The deceased should be cared for in as dignified and natural a way as possible. Adapt the care to the wishes of the deceased and the relatives. Always offer the relatives to be present when preparing the deceased.

Procedures

Many nursing homes have a white box or otherwise gathered materials and information on how the deceased should be cared for at the residence. In the Care Handbook, there is a list of measures to take in connection with a death. It might be good to check that the procedures are in line with the Care Handbook. It might also be good to go through the procedures before you face your first death at the residence so you feel more secure when it happens.

Healthcare staff also have and should have feelings. If someone has cared for a resident for many years and they pass away, there is usually grief to deal with. This requires that employees and colleagues actually take care of themselves and each other in order to be able to connect with and see new people who come to receive care.

Reflection questions - death
Care staff:
- Do you have good procedures for caring for a deceased resident?
- Are all colleagues familiar with the procedures?

Manager, nurse, occupational therapist and physiotherapist:
- Do you have good procedures at the residence for information to those who live in the same unit?
- Is there a note of which relatives want to be called at night?
- Are the on-call nurses informed about how you want the care of the deceased to take place?

Residents and relatives:
- Do you have traditions or wishes in your family that the nursing home needs to be aware of?

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day