Care of Dying Client

1. 1. UNIT-XV: Care of Terminally ill patient SHRI VINOBA BHAVE COLLEGE OF NURSINGH,
SILVASSA 1 Mrs. P. Vadivukkarasi Ramanadin, Professor, Dept. Of OBG (N), Shri Vinoba Bhave
College of Nursing, Shri Vinoba Bhave Civil Hospital, Silvassa, DNH.
2. 2. • Concepts of Loss, Grief, grieving process • Signs of clinical death • Care of dying patient; •
special considerations • -Advance directives: • euthanasia will dying declaration , organ donation
etc • Medico-legal issues • Care of dead body: • Equipment, procedure and care of unit • Autopsy o
Embalming 2SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA
3. 3. Loss is an inevitable part of life 3SHRI VINOBA BHAVE COLLEGE OF NURSINGH,
SILVASSA People can experience the loss of body image, a significant other, a sense of well-
being, a job, personal possessions, or beliefs. Illness and hospitalization often produce losses. 
Loss is an actual or potential situation in which something that is valued is changed or no longer
available. 
4. 4. Situational loss. For example, a person in an automobile accident sustains an injury with
physical changes that make it impossible to return to work or school, leading to loss of function,
income, life goals, and self-esteem. 4SHRI VINOBA BHAVE COLLEGE OF NURSINGH,
SILVASSA Unwanted, or unexpected loss. Some losses seem unnecessary and are not part of
expected.  A maturational loss is a form of necessary loss and includes all normally expected life
changes across the life span. A mother feels loss when her child leaves home for the first day of
school.  Necessary loss, which is a part of life. They learn to expect that most necessary losses
are eventually replaced by something different or better. 
5. 5. A perceived loss is uniquely defined by the person experiencing the loss and is less obvious to
other people. For example, some people perceive rejection by a friend to be a loss, which creates
a loss of confidence or changes their status in a group. How an individual interprets the meaning of
the perceived loss affects the intensity of the grief response. 5SHRI VINOBA BHAVE COLLEGE
OF NURSINGH, SILVASSA An actual loss occurs when a person can no longer feel, hear, see,
or know a person or object. Examples include the loss of a body part, death of a family member, or
loss of a job. Lost valued objects include those that wear out or are misplaced, stolen, or ruined by
disaster. A child grieves the loss of a favorite toy washed away in a flood. 
6. 6. Predictable losses, like those due to terminal illness, sometimes allow more time to prepare for
the loss. However, they create two layers of grief: the grief related to the anticipation of the loss
and the grief related to the loss itself 6SHRI VINOBA BHAVE COLLEGE OF NURSINGH,
SILVASSA Sudden or shocking losses due to events like crimes, accidents, or suicide can be
traumatic. There is no way to prepare. They can challenge your sense of security and confidence
in the predictability of life. You may experience symptoms such as sleep disturbance, nightmares,
distressing thoughts, depressed mood, social isolation, or severe anxiety.  Sudden versus
Predictable Loss 
7. 7. Pattern of physical and emotional responses to bereavement may vary 7SHRI VINOBA BHAVE
COLLEGE OF NURSINGH, SILVASSA Individual experiences of grief vary and are influenced by
the nature of the loss.  The reasons for grief are many, such as the loss of a loved one, the loss
of health, or the letting go of a long-held dream. Dealing with a significant loss can be one of the
most difficult times in a person's life.  Grief is a natural part of the healing process. Grief is a
strong, sometimes overwhelming emotion for people. 
8. 8. Grief is the emotional response to a loss, manifested in ways unique to an indivi It is the
subjective response experienced by the surviving loved ones. 8SHRI VINOBA BHAVE COLLEGE
OF NURSINGH, SILVASSA Bereavement A common depressed reaction to the death of a loved
one Encompasses both grief and mourning and includes the emotional responses and outward
behaviors of a person experiencing loss (AACN, 2008).  Mourning: Coping with grief involves a
period of mourning, the outward, social expressions of grief and the behavior associated with loss.
Most mourning rituals are culturally influenced, learned behaviors. A reaction activated by a person
to assist in overcoming a great personal loss It is the behavioral process through which grief is
eventually resolved or altered; it is often influenced by culture, spiritual beliefs, and dual and
based on personal experiences, cultural expectations, and spiritual beliefs (Walter and McCoyd,
2009)
9. 9. Anticipatory Grief. A person experiences anticipatory grief, The unconscious process of
disengaging or “letting go” before the actual loss or death occurs, especially in situations of
prolonged or predicted loss (Simon, 2008). When grief extends over a long period of time, people
absorb loss gradually and begin to prepare for its inevitability. They experience intense responses
to grief (e.g., shock, denial, and tearfulness) before the actual death occurs and often feel relief
when it finally happens. 9SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA Normal
 Grief. Normal (uncomplicated) grief is a common, universal reaction characterized by complex
emotional, cognitive, social, physical, behavioral, and spiritual responses to loss and death. 
10. 10. complicated grief a person has a prolonged or significantly difficult time moving forward after a
loss. He or she experiences a chronic and disruptive yearning for the deceased; has trouble
accepting the death and trusting others; and/or feels excessively bitter, emotionally numb, or
anxious about the future. 10SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA
Ambiguous Loss. Sometimes people experience losses that are marked by uncertainty.
Ambiguous loss, a type of disenfranchised grief, occurs when the lost person is physically present
but not psychologically available, as in cases of severe dementia or severe brain injury. 
Disenfranchised Grief. People experience disenfranchised grief, also Known as marginal or
unsupported grief, when their relationship to the deceased person is not socially sanctioned,
cannot be openly shared, or seems of lesser significance. The person’s loss and grief do not meet
the norms of grief acknowledged by his or her culture. 
11. 11. Masked Grief: Sometimes a grieving person behaves in ways that interfere with normal
functioning but is unaware that he is in grief 11SHRI VINOBA BHAVE COLLEGE OF NURSINGH,
SILVASSA Delayed Grief: A person’s grief response is unusually delayed or postponed, often
because the loss is so overwhelming that the person must avoid the full realization of the loss. A
delayed grief response is frequently triggered by a second loss, sometimes seemingly not as
significant as the first loss.  Exaggerated Grief: A person with an exaggerated grief response
often exhibits self-destructive or maladaptive behavior, obsessions, or psychiatric disorders.
Suicide is a risk for these people. 
12. 12. The age of the bereaved. 12SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA
The religious beliefs  The personality of the bereaved.  Whether the death is expected or
unexpected. 
13. 13. Acceptance Denial : It is a normal reaction to rationalize overwhelming emotions. It is a
defense mechanism that buffers the immediate shock. It is a conscious or unconscious refusal to
accept facts, information, reality, etc. 13SHRI VINOBA BHAVE COLLEGE OF NURSINGH,
SILVASSA Depression  Bargaining  Anger  Denial According to Kübler-Ross’s there are five
stages of normal grief that were first proposed by Elisabeth Kübler-Ross
14. 14. Bargaining: The third stage involves the hope that the individual can somehow undo or avoid a
cause of grief. The normal reaction to feelings of helplessness and vulnerability is often a need to
regain control. This is a weaker line of defense to protect us from the painful reality. 14SHRI
VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA Anger: Anger can manifest in different
ways. People dealing with emotional upset can be angry with themselves, and/or with others,
especially those close to them. 
15. 15. Acceptance: In this last stage, individuals begin to come to terms with their mortality or
inevitable future, or that of a loved one, or other tragic event. This stage varies according to the
person's situation. This phase is marked by withdrawal and calm. This is not a period of happiness
and must be distinguished from depression. 15SHRI VINOBA BHAVE COLLEGE OF NURSINGH,
SILVASSA Depression: During the fourth stage, the grieving person begins to understand the
certainty of death. It's natural to feel sadness and regret, fear, uncertainty, etc. It shows that the
person has at least begun to accept the reality. 
16. 16. Cognitions (Thought Patterns) • Disbelief • Confusion or memory problems • Problems with
decision making • Inability to concentrate • Feeling the presence of the deceased 16SHRI VINOBA
BHAVE COLLEGE OF NURSINGH, SILVASSA Feelings • Sorrow • Fear • Anger • Guilt or self-
reproach • Anxiety • Loneliness • Fatigue • Helplessness/hopelessness • Yearning 
17. 17. Behaviors • Crying and frequent sighing • Distancing from people • Absentmindedness •
Dreams of the deceased • Keeping the deceased’s room intact • Loss of interest in regular life
events • Wearing objects that belonged to the deceased 17SHRI VINOBA BHAVE COLLEGE OF
NURSINGH, SILVASSA Physical Sensations • Headaches • Nausea and appetite disturbances •
Tightness in the chest and throat • Insomnia • Oversensitivity to noise • Sense of depersonalization
(“Nothing seems real”) • Feeling short of breath, choking sensation • Muscle weakness • Lack of
energy • Dry mouth 
18. 18. Frequent, intense, or prolonged exposure to grief and loss places nurses at risk for developing
compassion fatigue. Compassion fatigue, described as physical, emotional, and spiritual
exhaustion resulting from seeing patients suffer, leads to a decreased capacity to show
compassion or empathize with suffering people 18SHRI VINOBA BHAVE COLLEGE OF
NURSINGH, SILVASSA
19. 19. Hospice Care. Hospice care is a philosophy and a model for the care of terminally ill patients
and their families. Hospice is not a place but rather a patient- and family-centered approach to
care. It gives priority to managing a patient’s pain and other symptoms; comfort; quality of life; and
attention to physical, psychological, social, and spiritual needs and resources. Patients accepted
 into a hospice program usually have less than 6 to 12 months to live. Hospice services are
available in home, hospital, extended care, or nursing home settings. 19SHRI VINOBA BHAVE
COLLEGE OF NURSINGH, SILVASSA Palliative Care: in Acute and Restorative Settings.
Interventions for people who face chronic life-threatening illnesses or who are at the end of life
need palliative care. Palliative care focuses on the prevention, relief, reduction, or soothing of
symptoms of disease or disorders throughout the entire course of an illness, including care of the
dying and bereavement follow-up for the family. The primary goal of palliative care is to help
patients and families achieve the best possible quality of life. Although it is especially important in
advanced or chronic illness, it is appropriate for patients of any age, with any diagnosis, at any
time, or in any setting. 
20. 20. Rigor mortis: Stiffing of the body after death. The arms Absence of all refluxes.  Pupil
becoming fixed and not reacting to light  Absence of pulse, heart beat and respirations  
Measurable brain activity stops within 20 to 40 seconds.  At the onset of clinical death,
consciousness is lost within several seconds.  Clinical death is the medical term for cessation of
blood circulation and breathing, the two necessary criteria to sustain life.[1] It occurs when
the heartstops beating in a regular rhythm, a condition calledcardiac arrest.  & legs cannot be
bent or straightened while rigor mortis is present unless the tendons are torn 20SHRI VINOBA
BHAVE COLLEGE OF NURSINGH, SILVASSA
21. 21. “DEATH RATTLE”-A rattling sound heard in throat caused by secretions that the patient
cannot cough longer. 21SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA
Hiccoughs, Nausea, Vomiting, abdominal distensions are seen. the patient feels the inability to
swallow.  Usually the pulsations are seen even after the patient has stopped breathing 
Circulatory changes cause alterations in the temperature, pulse and respirations. Radial pulse
gradually fails  Respiration becomes irregular, rapid and shallow breath or very slow  Sign of
approaching death 
22. 22. CHANGES IN SIGHT, SPEECH, AND HEARING.- Sight gradually fail. The pupil’s fails to
react to light. Eyes are sunken and half closed. 22SHRI VINOBA BHAVE COLLEGE OF
NURSINGH, SILVASSA -Reflexes and pain are gradually lost. Patient may be restless due to
lack of oxygen  The skin may become pale, cool and sweats lot (cold sweats).Ears and nose are
cold to touch. 
23. 23. Periodic suctioning is necessary. 23SHRI VINOBA BHAVE COLLEGE OF NURSINGH,
SILVASSA Keep the room well ventilated and keep crowed away.   Elevation of the patient’s
head and shoulders may make breathing easier.  Oxygen inhalation to remove his discomfort. 
The dying person who is restless, apprehensive and short of breath may be given-   Problem
associated with breathing:   SYMPTOMATIC MANAGEMENT  Meeting the spiritual needs
according to his religious customs.   Maintenance of hope.  Maintenance of security, self
confidence and dignity.  Relief from loneliness, fear and depression.  Psychological support:
The psychological need: 
24. 24. The denture are removed and kept safely. 24SHRI VINOBA BHAVE COLLEGE OF
NURSINGH, SILVASSA Apply emollients to the dry lips.   Give frequent oral hygiene.  
That will help the patient to keep the mouth moist. If they can tolerate the oral fluids, sips of water
is given with teaspoon.  Most of them may require I.V fluids.  The patient is unable to swallow
even the sips of water poured in the mouth. Anorexia, nausea, and vomiting are commonly seen
in dying patient person  Problem associated with eating and drinking: 
25. 25. Patient should be comfortably placed and their position frequently changed in the bed. 25SHRI
VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA Frequent skin care should be given
with particular attention to the pressure point.  Problem associated with immobility:  Through
skin and Perineal care is to be given, to keep the patient clean and to prevent skin breakdown.  
Catheterization has to be done  Constipation, retention of urine and incontinence of urine and
stool are some of problem faced by the patient.  Problem associated with elimination: 
26. 26. Since the eyes are opened, protect the eyes from corneal ulceration with protective ointment.
26SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA  Speak distinctly so that
patient may understand what is done for him. Avoid whispering any think in patient room. 
Since the hearing is retained longer, speak only what is appropriate.   Since the patient loses
sight, before given any care to the patient, the nurse should touch the patient and say what she is
going to do.   Problem associated with sense organ: 
27. 27. Cleanliness of the skin, hair, mouth, and cloth has to be maintained. 27SHRI VINOBA BHAVE
COLLEGE OF NURSINGH, SILVASSA Cleanliness and appearance are important until the end.
  Problem associated with cleanliness and grooming:   Maintain calm and quit environment. 
 The visitors should be instructed not to disturbed the patient during his resting.  Patient should
 not be disturbed while sleeping.   Patient may distressing symptoms in these patients.  
Problem associated with rest and sleep: 
28. 28. Consistency: Continuing, persistent attention is highly valued by patients who often fear that
they are a burden and will be abandoned; consistent physician involvement mitigates these fears.
28SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA Cheerfulness: A gentle,
appropriate sense of humor can be palliative; a somber or anxious demeanor should be avoided. 
Cohesion: Family cohesion reassures both the patient and family.  Children: If children want to
visit the dying, it is generally advisable; they bring consolation to dying patients.  Communication:
Allow patients to speak their minds and get to know them.  Competence: Skill and knowledge can
be as reassuring as warmth and concern.  Concern: Empathy, compassion, and involvement are
essential. Cassen (1991) suggests seven essential features in the management of the dying
patient:
29. 29. Improving our understanding of pain and suffering will also improve communication and
effective interactions. 29SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA
Recognizing that a moderate level of death anxiety is acceptable.  Developing increased
resourcefulness in dealing with death related situations.  Encouraging peer groups for families
coping with bereavement.  Developing a sense of control and efficacy.  Management of the
dying patient often elicits anxiety in nursing staff. Education and role playing can improve
perspective taking and empathetic skills, respect each other’s point of view as well as appreciate
the situation of patient and their families.  Be fully prepared to accept their own counter
transferences, as doubts, guilt and damage to their narcissism are encountered.  Try to respond
appropriately to patient’s needs by listening carefully to the complaints and  Deal with mental
anguish and fear of death,  The person who deals with the dying patient must commit (Schwartz
and Karasu, 1997) to: 
30. 30. An autopsy consent may be requested  After the physician has pronounced death legally
documented the death in the medical record, care of the body is usually performed by the nurse. 
 & If the patient had any valuables, they are handed over to the relatives 30SHRI VINOBA
BHAVE COLLEGE OF NURSINGH, SILVASSA  The family often wishes to view the body
before final preparations are made, they may be allowed.   If the patient is to be an organ donor
arrangements will be made immediately.  obtained if required.
31. 31. Make body look as natural & Patients own set of clothes. 31SHRI VINOBA BHAVE
COLLEGE OF NURSINGH, SILVASSA Thumb forceps Pair of gloves  Restraints for jaw,
hands and legs.  Sheets Perineal pads  Extra bandages and cotton swabs   Articles for
bath   ARTICLES REQUIRED Protect other patients from unpleasant sights and sounds which
could frighten them  Perform his last duty tenderly.  beautiful as possible.
32. 32. Algor mortis is the gradual decrease of the body’s temperature after death. When blood
circulation terminates and the hypothalamus ceases to function, body temperature falls about 1°C
(1.8°F) per hour until it reaches room temperature. Simultaneously, the skin loses its elasticity and
can easily be broken when removing dressings and adhesive tape. After blood circulation has
ceased, the red blood cells break down, releasing hemoglobin, which discolors the surrounding
tissues. This discoloration, referred to as livor mortis, appears in the lowermost or dependent
areas of the body. Tissues after death become soft and eventually liquefied by bacterial
fermentation. The hotter the temperature, the more rapid the change. Therefore, bodies are often
stored in cool places to delay this process. 32SHRI VINOBA BHAVE COLLEGE OF NURSINGH,
SILVASSA Rigor mortis is the stiffening of the body that occurs about 2 to 4 hours after death.
Rigor mortis starts in the involuntary muscles (heart, bladder, and so on), then progresses to the
head, neck, and trunk, and finally reaches the extremities. 
33. 33. Livor Mortis: Dependant parts of body become discolored. The patient will likely be lying on
their back, their backside being the 'dependant' body part. The discoloration is a result of blood
pooling, as the hemoglobin breaks down. 33SHRI VINOBA BHAVE COLLEGE OF NURSINGH,
SILVASSA Algor Mortis: Temperature decreases by a few degrees each hour. The skin loses its
elasticity and will tear easily.  Rigor Mortis: body becomes stiff within 4 hours after death as a
result of decreased ATP production. ATP keeps muscles soft and supple. 
34. 34. 34SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA
35. 35. Remove all tubes and other devices from the patients body. The patient looks more peaceful
Reduce the anxiety of the relatives Comfort consult close relatives before preparing the body for
removal from the ward to the mortuary where the relatives will receive the body To meet customs
and wish of the relatives in caring for the body Reduce the tension of relatives If the relatives
require, the nurse should help them to sponge the patient as necessary. brush and comb hair. To
reduce odor and for aesthetic sense for normal appearance Appearance of the body after death
 should be presentable Replace soiled dressing with cleaned ones To avoid odor For better
appearance comfort 35SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA
36. 36. Apply perineal pads and plug the rectum & Allow members of family to see the patientProvide
clean cloths(own For better appearance Take care of valuables and personal belongings by
handing over to members of family. For legal considerations vagina (in females) with cotton
balls.). To prevent soiling of bed and the patient cloth After death there may be leaking of
secretions form orifices Safety & remain in the room & remember that the body is still dear to
someone. Provide emotional support and helps grieving process by helping family to accept death
It allows them to ventilate their grief and feelings 36SHRI VINOBA BHAVE COLLEGE OF
NURSINGH, SILVASSA
37. 37. 37SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA
38. 38. If you change your mind you can change your Advance Directive to reflect this. If you have
mental capacity and can communicate your wishes then your Advance Directive will not apply.
38SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA You can use an Advance
Directive to refuse any treatment, including life-sustaining treatment such as resuscitation, artificial
nutrition and hydration, or breathing machines. An Advance Directive enables healthcare
professionals to know what your wishes are even if you cannot tell them yourself, e.g. if you had
severe dementia or were in a coma.  An Advance Directive allows you to make a refusal of
treatment in advance of a time when you can’t communicate your wishes, or don’t have the
capacity to make a decision. It only comes into effect if either of these situations occur.  A good
advance directive describes the kind of treatment the patient would want depending on the
sickness  An advance directive tells the health care team what kind of care the patient would like
to have if he is unable to make medical decisions (e.g., if in coma)  Advance Directive is a
Scottish term, but in other parts of the UK these documents are also called Advance Decisions. 
39. 39. Appoint a health care agent. The AHCD allows you to appoint a health care agent (also known
as “Durable Power of Attorney for Health Care,” “Health Care Proxy,” or “attorney-in-fact”), who will
have the legal authority to make health care An Advance Health Care Directive (AHCD) is a
generic term for a document that instructs others about your medical care should you be unable to
make decisions on your own. It only becomes effective under the circumstances delineated in the
document, and allows you to do either or both of the following:  The Advance Health Care
Directive provides a clear statement of wishes about your choice to prolong your life or to withhold
or withdraw treatment. You can also choose to request relief from pain even if doing so hastens
death. A standard advance directive form provides room to state additional wishes and directions
and allows you to leave instructions about organ donations. 39SHRI VINOBA BHAVE COLLEGE
OF NURSINGH, SILVASSA Prepare instructions for health care. The AHCD allows you to make
specific written instructions for your future health care in the event of any situation in which you
can no longer speak for yourself. Otherwise known as a “Living Will,” it outlines your wishes about
life-sustaining medical treatment if you are terminally ill or permanently unconscious, for example.
decisions for you if you are no longer able to speak for yourself. This is typically a spouse, but
can be another family member, close friend, or anyone else you feel will see that your wishes and
expectations are met. The individual named will have authority to make decisions regarding
artificial nutrition and hydration and any other measures that prolong life—or not.
40. 40. It’s almost impossible to know what a dying person’s wishes truly are unless the issues have
been discussed ahead of time. Planning ahead with an Advance Health Care Directive can give
your principal caregiver, family members, and other loved ones peace of mind when it comes to
making decisions about your future health care. It lets everyone know what is important to you,
and what is not. Talking about death with those close to us is not about being ghoulish or giving up
on life, but a way to ensure greater quality of life, even when faced with a life- limiting illness or
tragic accident. When your loved ones are clear about your preferences for treatment, they’re free
to devote their energy to care and compassion 40SHRI VINOBA BHAVE COLLEGE OF
NURSINGH, SILVASSA While most people would prefer to die in their own homes, the norm is
still for terminally-ill patients to die in the hospital, often receiving ineffective treatments that they
may not really want. Their friends and family members can become embroiled in bitter arguments
about the best way to care for the patient and consequently miss sharing the final stage of life with
their loved one. Also, the opinions and wishes of the dying person are often lost in all the chaos. 
41. 41. Euthanasia literally means “good death”. It is basically to bring about the death of a terminally
ill patient or a disabled. Generally, the word euthanasia is defined as the act or practice of
painlessly putting to death or withdrawing treatment from a person suffering an incurable
disease. [3] From the definition, one can say that euthanasia is an unethical act as much as it is a
great sin for those who strongly believe in God. Euthanasia is intentionally killing another person to
relieve his or her suffering. [4] It is not the withdrawal or withholding of treatment that results in
death, or necessary pain and symptom- relief treatment that might shorten life, if that is the only
 effective treatment. It is the intentional killing by act or omission of a dependent human being for
his or her alleged benefits. 41SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA
42. 42. Involuntary euthanasia – where a person is killed against their expressed wishes 42SHRI
VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA Non-voluntary euthanasia – where a
person is unable to give their consent (for example, because they are in a coma or are severely
brain damaged) and another person takes the decision on their behalf, often because the ill person
previously expressed a wish for their life to be ended in such circumstances  Voluntary
euthanasia – where a person makes a conscious decision to die and asks for help to do this 
Passive euthanasia (ommission) – where a person causes death by withholding or withdrawing
treatment that is necessary to maintain life, such as withholding antibiotics from someone
withpneumonia  Active euthanasia (action)– where a person deliberately intervenes to end
someone’s life – for example, by injecting them with a large dose of sedatives Euthanasia can
be classified in different ways, including:
43. 43. A person who makes a dying declaration must,
however, be competent at the time he or she ma kes a statement, otherwise, it is inadmissible.
43SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA
A statement by a person who is conscious and kno ws that death is imminent concerning what he
or she believes to be the cause or circumstances of death that can be introduced into evidence
during a trial in certain cases  A will is a document by which a person regulates the rights of
others over his property or family after death. 
44. 44. Organ donation should take place with in 2-6hrs after the death. 44SHRI VINOBA BHAVE
COLLEGE OF NURSINGH, SILVASSA Organs usually donated :- kidney, heart, lungs, liver,
bone, cornea  All organ donation are voluntary and there should not be any compulsion for the
patient / family members  Organs removed from the body following the death cannot be sold. 
The request for organ donation should be done by patent in the presence of a physician or a
nurse  Transplantation  Therapy  Advancement of medical or dental science  Research  For
medical or dental education  A person 18 years or older and of sound mind can donate all or any
part of their own body for the following purposes:  ORGAN DONATION 
45. 45. Given the eve Organ transplantation is truly one of the miracles of modern medicine, saving
the lives of many patients and improving the quality of life for many more.  Information to the
patient should consist of a balanced discussion of the available options and counseling to help
patients or their families reach the choice that is best for them, including the provision of
information about the urgent need for organs and the consolation that many families derive from
knowing that their loved one was able to help others. 45SHRI VINOBA BHAVE COLLEGE OF
NURSINGH, SILVASSA Nurses have to ensure that the consent process is informed and
voluntary. r-increasing gap between the number of organs needed and the supply, nurses have
an ethical obligation to help ensure that the desires of people who want to donate organs are
respected.
46. 46. o Obtain follow-up information 46SHRI VINOBA BHAVE COLLEGE OF NURSINGH,
SILVASSA o Review medical records once received  o Collaborate with pathologist to
determine the appropriate medical records  o Understand subtle signs of abuse and neglect 
o Normally, only uniformed officers attend the natural death scene  o Provide link between
pathologists and lay investigative staff  o Collaborate with organ/tissue procurement agencies 
o Conduct post mortem , sexual assault/child abuse examinations  o Do investigation -the
natural death and infant/child death  o Obtain death reports  · Suspicion of criminal action
· Accidents  · Poisoning  · Violent death  · Suicide  · Unknown
cause of death  · Drug-related injury  · Abuse of children, elderly, and spouse 
47. 47. An unexpected death must be confirmed by the attending medical officer and if confirmed the
service manager should be contacted or duty manager out of hours. Incident form to be completed
47SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA Confirmation of death must be
recorded in the patient’s healthcare record  In the case of an expected adult death, a registered
nurse deemed competent by the Trust may confirm death  Inform the nurse in charge and inform
the medical staff of the patient’s death 
48. 48. Ask if the relatives wish to see the chaplain or an appropriate religious leader or other
appropriate person to the person’s faith or ethnic origins that need to be attended to immediately
48SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA Inform the patient’s
relatives/next of kin of the patient’s death. Ensure that this is handled in a sensitive and
appropriate manner with as much privacy as possible. 
49. 49. Wash hands and put on disposable gloves and apron 49SHRI VINOBA BHAVE COLLEGE OF
NURSINGH, SILVASSA Assemble required equipment  If the relatives are not in the hospital
ask if they wish to view the body on the ward or at a later date  If relatives are in the hospital ask
 if they wish to assist with the last offices and/or if they have any particular wishes regarding the
procedure 
50. 50. Gently close the patient’s eyes if open by applying light pressure for 30 seconds. If corneal or
eye donation to take place, close the eye with gauze moistened with normal saline 50SHRI
VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA Straighten the patient’s limbs (if
possible) and place their arms by their sides  Lay the patient on their back with one pillow in
place (adhere to the Moving and Handling Policy)  Any injuries sustained whilst carrying out the
procedures on the deceased must be reported through the Trust risk system and follow the Trust
Sharps and Inoculation Management Procedure 
51. 51. If syringe driver in situ, disconnect and remove battery In cases where there is no referral to
the coroner required infusions can be discontinued and infusion lines, cannulae, drainage and
other tubes can be removed If referred to the coroner endo-tracheal tubes, catheters and infusion
lines should remain in situ. (see section 3) Discard all sharps into a sharps bin as per Trust Sharps
and Inoculation Management Procedure 51SHRI VINOBA BHAVE COLLEGE OF NURSINGH,
SILVASSA Do not apply tape 
52. 52. Wash the patient if necessary, unless requested not to do so for religious/cultural reasons or
patient has died in suspicious circumstances 52SHRI VINOBA BHAVE COLLEGE OF
NURSINGH, SILVASSA Exuding wounds should be covered with absorbent gauze and secured
with an occlusive dressing  Place a receiver between the patient’s legs and drain the bladder by
pressing on the lower abdomen. Pads and pants can be used to absorb any leakage 
53. 53. Clean the patient’s teeth and gums using a moistened, soft small headed nylon toothbrush
and or suction to remove any debris and secretions Clean any dentures and replace them in the
mouth – a small pillow or rolled up towel placed It may be important to the family and carers to
assist with washing, thereby continuing the care given to the patient in the period before death 
under the patient’s chin may help to keep the jaw closed and teeth in situ 53SHRI VINOBA BHAVE
COLLEGE OF NURSINGH, SILVASSA
54. 54. Remove all jewellery, in the presence of another nurse, unless requested by the family to do
otherwise. Any jewellery removed must be documented on a property form and placed in the
hospital safe until collected by the family. Wedding rings may be left in situ and taped in place. Any
jewellery remaining on the body should be documented on the identification card accompanying
the patient to the mortuary or undertakers 54SHRI VINOBA BHAVE COLLEGE OF NURSINGH,
SILVASSA Patients should not be shaved; usually a funeral director will do this. Some faiths
prohibit shaving  Tidy the hair as soon as possible after death and arrange into the preferred style
(if known) 
55. 55. Relatives should be told to contact the relevant Trust officer who supports bereavement or the
patient’s GP to collect the death certificate 55SHRI VINOBA BHAVE COLLEGE OF NURSINGH,
SILVASSA If relatives are present at the time of death, or attend the hospital shortly after, staff
should ensure that they are given the Trust Bereavement information copies of which are available
on the ward.  Unless a specific request has been made by the family for alternative clothes the
patient should be dressed in a hospital gown  Record all property in the patient property book and
pack in a labelled property bag, keeping secure until collected by the family. Pack personal
property showing consideration for the feelings of those receiving it. Discuss the issues of soiled
clothes sensitively with the family and ask whether they wish them to be disposed of or returned 
56. 56. If the patient has an implant device such as a pacemaker or an infectious disease is known or
suspected – record this fact on both patient identification cards 56SHRI VINOBA BHAVE
COLLEGE OF NURSINGH, SILVASSA Complete patient identification cards and notification of
death book clearly in capitals  Date of Birth  NHS Number  Full name  Label one wrist and one
ankle with an identification band containing the following information: 
57. 57. If the deceased person has a known infectious disease Category 3 If the body may be
infectious or there is a risk of leakage of body fluids place the body in a body bag and put the
second identification card into the pocket of the body bag  Tape one identification card to clothing
or hospital gown Wrap the body in a sheet, ensuring that face to feet are covered and that all limbs
are held securely in position  & 4 they must be placed in a heavy duty body bag and you must
inform anyone else who comes in contact with this patient e.g. funeral directors, porters. 57SHRI
VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA
58. 58. Record all the details and actions in the nursing records Any property retained on the ward out
of hours must be stored in a secure area and any valuables stored in the ward or hospital safe
58SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA Screen off the area where
removal of the body will occur  If no on site mortuary, contact local funeral directors or the funeral
directors according to the relatives wishes Screen off the area where removal of the body will
occur  If mortuary on site request porters to remove body from the ward to the mortuary 
Remove gloves and aprons. Dispose of equipment according to local policy and wash hands 
59. 59. 59SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA Autopsies are performed
for either legal or medical purposes.  It is a highly specialized surgical procedure that consists of
a thorough examination of a corpse to determine the cause and manner of death and to evaluate
any disease or injury that may be present. It is usually performed by a specialized medical doctor
called a pathologist.  —it is also known as a post-mortem examination, 
60. 60. forensic, authorized by statute. 60SHRI VINOBA BHAVE COLLEGE OF NURSINGH,
SILVASSA Medical, authorized by the decedent, decedent's family or healthcare surrogate
Autopsies are divided into 2 categories:
61. 61. 61SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA · After an autopsy ,
hospitals cannot retain any tissues/ organs without the permission of the person who signed the
consent form  · A consent should be obtain from the immediate relative :surviving spouse,
adult children, parents, siblings.  · The organs and tissues of the body are examined to
establish the exact cause of death , to learn more about a disease  o Homicide (The killing of
one human being by another )  o Unknown dead bodies  o Unknown cause of death 
o Committed suicide  It is performed in certain cases such as:  An autopsy or postmortem
examination is an examination of the body after death.  AUTOPSY 
62. 62. Embalming fluid contains a mixture of formaldehyde, methanol, ethanol and other solvents
62SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA Injection of chemicals into the
body to destroy the bacteria ; thereby prevents rapid decomposition of tissues.  It is the process
of preserving dead body from decay  Embalming prevents the process through injection of
chemicals into the body to destroy the bacteria  Embalming has a very long and cross
cultural history, with many cultures giving the embalming processes a greater religious meaning. 
The three goals of embalming are sanitization, presentation and preservation (or restoration). 
The intention is to keep them suitable for public display at a funeral, for religious reasons, or for
medical and scientific purposes such as their use as anatomical specimens.[1]  It is the art and
science of preserving human remains by treating them (in its modern form with chemicals) to
forestall decomposition. 
63. 63. Setting the Features 1. Close the eyes. 2. Close the mouth and set it naturally 3. Moisturize
the features. A small amount of creme should be used on the eyelids and lips 4. Casketing the
Body 63SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA Break the rigor mortis by
massaging the body.  Shave the body.  Disinfect the mouth, eyes, nose, and other orifices 
Remove any clothing that the person is wearing.  Make sure the body is face up 
64. 64. Surface embalming: Which supplements the other methods especially for visible, injured body
parts. 64SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA Hypodermic embalming:
The injection of embalming chemicals under the skin as needed.  Cavity embalming: The suction
of the internal fluids of the corpse and the injection of embalming chemicals into the body cavities,
using an aspirator and trocar.  Arterial embalming: which involves the injection of embalming
chemicals into the blood vessels, usually via the right common carotid artery. Blood is drained from
the right jugular vein.  The actual embalming process usually involves 4 parts:  Embalming fluid
is injected into the arteries of the deceased during embalming. Many other body fluids may be
drained or aspirated and replaced with the fluid as well. The process of embalming is designed to
slow decomposition of the body. Process of Embalming