Postmortem Care Research Articles

Rest in Peace or in Pieces: Post-Mortem Care Options in U.S. Advance Directives.

Advance Directives (ADs) have traditionally focused on documenting patients' end-of-life (EOL) care preferences. Recently, discussions surrounding post-mortem care as an additional aspect of EOL care planning have gained attention. This study examined ADs across all 50 states and the District of Columbia (referred to as "entities"), assessing their inclusion of two post-mortem categories: funeral planning and anatomical gifts. Results revealed that 29% of entities offered options from both categories, 43% provided options from only one of the categories, and 27% lacked options from either category. Unexpectedly, only one entity (2%) provided all post-mortem options from both categories. These findings suggest a lack of consistency in the availability of post-mortem options across ADs. By emphasizing the importance of comprehensive EOL care planning, this study provides valuable insights into the necessity for AD standardization, particularly regarding post-mortem preferences for patients who choose to express them.

Implementation of COVID-19 infection control best practices in nursing homes amid the pandemic

BackgroundThe COVID-19 pandemic has claimed around 170,000 lives among nursing home residents and staff in the United States through April 2023. In a cluster randomized controlled trial (RCT) with 136 nursing homes, we delivered training to improve COVID-19 infection control best practices. We sought to assess the implementation of infection control practices in participating nursing homes.MethodsConcurrent with the delivery of the RCT (January-November 2021), we surveyed nursing home administrators (NHAs, n = 38) at baseline and 6-month follow-up. Using validated items from the Centers for Disease Control and Prevention (CDC), the surveys inquired about 80 infection control best-practice activities (yes/no). The survey also asked seven scales corresponding to inner setting factors that may have impacted implementation. We assessed changes in infection control practices and inner setting factors between baseline and 6-month follow-up.ResultsOverall, the implementation of 11 best practices changed over time. NHAs reported an increase in the availability of informational materials for residents and families (84% vs. 100%, p = 0.031), the use of alcohol-based hand sanitizer over soap (76% vs. 97%, p = 0.008), and the development of contingency plans for increased postmortem care (53% vs. 82%, p = 0.013). The implementation of four best-practice visitation policies and three communal restrictions decreased between baseline and 6-month follow-up (all p < 0.05). Regarding inner setting factors, only culture stress (perceived strain, stress, and role overload) increased between surveys (mean scores: 3.14 vs. 3.58, p = 0.004).ConclusionThis study was among the first to report changes in implementing COVID-19 infection control best practices in nursing homes amid the pandemic. Culture stress was an important inner setting factor that may have impacted implementation activities.Trial registrationNCT04499391Date of registrationAugust 3rd, 2020

Effect of postmortem care education using a creative drama method on nursing students' knowledge, skills, and satisfaction: A randomized controlled trial

BackgroundPostmortem care is one of the most difficult aspects of the nursing profession and is frequently given in healthcare settings today. It is important to provide appropriate teaching experiences in order to prepare nursing students for their future professional roles in postmortem care. ObjectivesThis study was conducted to examine the effect of a creative drama method on nursing students' postmortem care knowledge and skill levels, learning retention, and satisfaction with the education method. DesignA randomized controlled model with a pretest-posttest control group was used in this study. SettingsOne university school of nursing in Turkey. ParticipantsThe sample consisted of 70 nursing students. MethodInformation about postmortem care was shared with the control group using the classical education method of lectures and demonstration techniques, while the experimental group was taught with a creative drama method. Research data were collected with the Descriptive Characteristics Form, Postmortem Care Knowledge Test, Postmortem Care Skills Checklist, and Education Methods Satisfaction Survey. ResultsIt was observed that the postmortem care education provided to both experimental and control group was effective in improving the knowledge and skill levels of nursing students regarding postmortem care (p < 0.05). However, the knowledge and skill levels of the experimental group regarding postmortem care, learning retention, and level of satisfaction with the education method were higher than those of the control group (p < 0.05). ConclusionCreative drama was thus found to be a more effective method than the classical education method in providing postmortem care education to nursing students. In addition, it was observed that the students were more satisfied with the education given with creative drama.

Decreasing Nurses' Anxiety About Pediatric End-of-Life Care With Simulation.

Caring for pediatric patients at the end of life (EOL) can lead to anxiety and burnout for critical care nurses. New graduate nurses (NGNs) often report receiving inadequate education related to EOL care and then enter the workforce with limited clinical experience in caring for patients at EOL. A quality improvement project at a pediatric academic hospital sought to determine whether a simulation-based educational program for NGNs working in critical care could reduce anxiety about EOL care. Eight NGNs participated in a case study and simulation-based educational program that encompassed topics such as communication, symptom management, postmortem care, and support for the family at EOL. Anxiety was measured pre- and postprogram with the Spielberger State-Trait Anxiety Inventory (STAI©). Anxiety levels after participation in the EOL educational program decreased by 24.1% from preprogram levels. Providing NGNs in critical care with a case- and simulation-based EOL educational program can reduce anxiety levels and potentially decrease caregiver burnout. [J Contin Educ Nurs. 2023;54(12):574-580.].

At the Epicentre of the COVID-19 Pandemic in Canada: Experiences and Recommendations of Family Care Partners of an Older Person Living in a Long-Term Care Home.

The roles of family care partners of older persons living in long-term care homes (LTCH) were severely disrupted during the coronavirus disease (COVID-19) pandemic. Our aim was to describe their experiences and to solicit their recommendations for supportive actions. We conducted a critical ethnography with 24 care partners who cared or had cared for an older person living in an LTCH in Québec during the COVID-19 pandemic. We collected data during interviews and used Spradley's method to analyse them. Care partners experienced a forced separation from the older persons they cared for, which resulted in significant distress. Care, including post-mortem care, was considered inadequate and sometimes even inhumane. Communication was inconsistent, and this variability was also noted in visitation rules. Care partners perceived LTCHs as a neglected community. Supportive actions were recommended. The results illustrated the essential contribution of care partners, and the supportive actions they recommended must be a catalyst for change toward more humane care in LTCH settings.

Ignored and distressed: a cross-sectional study of the impact of COVID-19 on last responders

BackgroundLast responders constitute an occupational category that includes all those that are involved in the postmortem care of deceased persons and their families. Last responders are exposed to several categories of work-related stressors that affect their health and well-being. COVID-19 exacerbated these stressors. Research to understand the consequences of COVID-19 on the health and wellbeing of last responders is nascent. This study aimed to assess COVID-19 related stress, coping and wellbeing among last responders in the United States.MethodsWe conducted a national cross-sectional survey of last responders in July through September of 2020. The survey measured wellbeing, stress, coping, and stigma; COVID-19 experiences, and socio-demographics. A ridge regression model was fit for the outcome variables.ResultsAnalysis was conducted on 366 respondents from 43 states. Respondents were male (55.4%), age 50 + (57.4%), and White non-Hispanic (90.3%); 54% reported moderate-high stress and 41% endorsed mild-severe anxiety. Seventy-seven percent had experienced at least one form of stigma related to their occupation. Variables associated with higher perceived stress and anxiety included gender (female), shorter length of employment, perceiving a higher impact from COVID-19 on everyday life, and increased perceived stigma.ConclusionsLast responders are a critical part of the health care system. Throughout this pandemic, last responders have been frequently ignored and not prioritized for protection and support. Interventions to support last responders cope with stress, and to decrease anxiety are urgently needed. There is also a critical need to challenge community stigma towards last responders.

Doing old(er) age in a translocal context: Turkish-born women’s experiences of ageing, care and post-mortem care practices

This article elaborates on how Turkish-born women in Sweden do old age in relation to gender and migrancy and aims to understand the fluid process of doing over their life course. It draws upon 20 in-depth and semi-structured interviews with Turkish-born women aged 60–78 and aims to address the tensions between agency and intersecting power positions. Theoretically, the article relies on critical feminist gerontology and doing old age to address the negotiations and performances of the interviewed women. The findings show that there are several ambivalences and dilemmas in how the women do old age in a transnational setting. Intergenerational and gendered old age care comes to fore as a significant negotiation site. The women negotiate identity categories with both imagined others and the social actors in their lives (such as their children) over their life course, which implies the situated and relational aspect of doing old age.

Mediating worlds: the role of nurses as ritual specialists in caring for the dead and dying

ABSTRACT Rituals are central to the everyday life of the nurse, yet the fundamental roles that rituals play in caring for the dead and dying has often been neglected. This paper explores modern palliative and post-mortem care – its practices, practitioners and arenas – against the background of long-held, global concerns regarding the dead and dying. Comparison with the archaeological and ethnographic records demonstrates the ubiquitous and enduring practices surrounding death, and the centrality of ritual specialists to this complex social and biological process. This deep-time perspective highlights the importance of nurses, and their associated nursing rituals, in the transition of patients between life and death, and the difficult journeys that nurse, patient and family undertake in this mediation between worlds. Such a perspective not only empowers nurses in their daily practices, and places nursing rituals firmly at the centre of modern palliative care work, but demonstrates the value of archaeology and ethnography in contextualising the challenges of today.

Integrated immediate postmortem and acute bereavement care: Competency-based entrustable professional activities for nursing

BackgroundIntegrated immediate postmortem and acute bereavement care alleviates emotional distress due to losing a loved one; however, the provision of effective nursing care remains insufficient. Therefore, preparing nursing students with such skills is essential in end-of-life care education, and entrustable professional activities (EPAs) offer potential to address this gap. ObjectivesTo establish EPAs concerning immediate postmortem and acute bereavement care with a seven-category description for EPAs, milestones, and assessment tools. DesignWe used a modified Delphi method and four-step consensus-building approach to i) identifying the list of possible EPA items related to immediate postmortem and acute bereavement care based on a literature review and clinical experiences, ii) select an expert panel, iii) pool, review, and revise the EPAs, and iv) validate EPA quality using the Queen's EPA Quality rubric. Data analysis was performed via modes and quartile deviations. ResultsThe following four major EPA components were identified: i) cultural and religious ritual assessment; ii) death preparation; iii) postmortem care; and iv) acute bereavement care. Three essential competencies were identified as highly correlated: general clinical skills, communication and teamwork capabilities, and caring. Consensus was achieved after three survey rounds. A 100 % questionnaire response rate was obtained. In the third round, all items received 4 or 5 points from >95 % of the panel members and were found to meet the quartile deviation cutoff score of <0.6, indicating that a high consensus level was established. The average Queen's EPA Quality rubric score was 62.5, with an average item score of 4.46, which was higher than the cut-off score of 4.07. Three major parts of EPAs were developed: task descriptions, milestones, and the assessment tool. ConclusionThe development of EPAs assessments concerning immediate postmortem and acute bereavement care may guide nursing curricula planning to bridge the gap between competencies and clinical practice.

COVID-19 pandemic experiences, ethical conflict and decision-making process in critical care professionals (Quali-Ethics-COVID-19 research part 1): An international qualitative study.

The aim of this study was to explore the sources of ethical conflict and the decision-making processes of ICU nurses and physicians during the first and subsequent waves of the COVID-19 pandemic. Depside several studies exploring ethical conflicts during COVID-19 pandemic, few studies have explored in depth the perceptions and experiences of critical care professionals regarding these conflicts, the decision-making process or which have analysed the complexity of actually implementing the recommendations of scientific societies and professional/healthcare institutions in interdisciplinary samples. A descriptive phenomenological study. Thirty-eight in-depth interviews were conducted with critical care nurses and physicians from five hospitals in Spain and Italy between December 2020 and May 2021. A thematic content analysis of the interview transcripts was conducted by two researchers. Consolidated criteria for reporting qualitative research (COREQ) were employed to ensure the quality and transparency of this study. Two main themes emerged as sources of ethical conflict: the approach to end of life in exceptional circumstances and the lack of humanisation and care resources. The former comprised two subthemes: end-of-life care and withholding and withdrawal of life-sustaining treatment; the latter comprised three subthemes: the impossibility of guaranteeing the same opportunities to all, fear of contagion as a barrier to taking decisions and the need to humanise care. Professionals sought to take their decisions in line with professional ethics and bioethical principles, but, nevertheless, they experienced moral dilemmas and moral distress when not being able to care for, or to treat, their patients as they believed fit. Further education and training are recommended on the provision of end-of-life and post-mortem care, effective communication techniques via video calls, disclosure of bad news and bioethical models for decision-making in highly demanding situations of uncertainty, such as those experienced during the COVID-19 pandemic.

SARS-CoV-2 Transmission from Virus-Infected Dead Hamsters.

Although it has been 2.5 years since the coronavirus disease 2019 (COVID-19) pandemic began, the transmissibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a dead infected body remains unclear, and in Japan, bereaved family members are often not allowed to view in person a loved one who has died from COVID-19. In this study, we analyzed the possibility of SARS-CoV-2 transmission from a dead body using a hamster model. We also analyzed the effect of "angel care"--in which the pharynx, nostrils, and rectum are plugged--and embalming on reducing transmissibility from dead bodies. We found that SARS-CoV-2 could be transmitted from the bodies of animals that had died within a few days of infection; however, angel care and embalming were effective in preventing transmission from the dead bodies. These results suggest that protection from infection is essential when in contact with a SARS-CoV-2-infected dead body and that sealing the cavities of a dead body is an important infection control step if embalming is not performed. IMPORTANCE We found that SARS-CoV-2 could be transmitted from a dead body, presumably via postmortem gases. However, we also found that postmortem care, such as plugging the pharynx, nostrils, and rectum or embalming the corpse, could prevent transmission from the dead body. These results indicate that protection from infection is essential when handling infected corpses and that appropriate care of SARS-CoV-2-infected corpses is important.

Perceived Difficulties and Learning Needs Among Acute Care Ward Nurses Providing End-of-Life Care During the COVID-19 Pandemic: Comparison by Years of Clinical Experience.

In the daily routine of acute care wards, where priority is given to patients with severe illnesses and those who require urgent care, working with and supporting the decision making of terminally ill patients can be challenging. This study aimed to clarify the perceived difficulties of and learning needs among acute care ward nurses providing end-of-life care during the COVID-19 pandemic. In order to perform analyses by years of clinical experience, we conducted semi-structured interviews with both novice and experienced nurses. Participants were nurses working in the acute care ward of hospitals in the Kansai area. We interviewed 31 nurses who agreed to cooperate, including 18 novice/advanced beginner nurses and 13 proficient/expert nurses. Perceived difficulties were categorized into four main groups for novice/advanced beginner nurses: <explanation>, <coronavirus>, <family>, and <doctor>. Perceived difficulties were categorized into four main groups for proficient/expert nurses: <nurses>, <care>, <think>, and <family>. Perceived learning needs were categorized into three main groups for novice/advanced beginner nurses: <patient>, <family>, and <experience>. Perceived learning needs were categorized into three main groups for proficient/expert nurses: <hospital>, <angel>, and <pain>. Novice/advanced beginner nurses felt anxiety and confusion, and were overwhelmed with how to care for terminal patients. Proficient/expert nurses were able to think about how to make patients and their families feel better, and were able to think specifically about post-mortem care. Many proficient/expert nurses were thinking not only about patient care but also about patients' room environment and how to spend time with their families. They sought learning opportunities regarding angel care, including methods of teaching it and basic techniques for performing it, and realized that information sharing within wards, chain of command within the hospital, information exchange with other hospitals, and inter-hospital collaboration were all important during COVID-19 pandemic.

SIGNIFICANCE OF SECOND YEAR MEDICAL STUDENTS PARTICIPATING IN THE 48-HOUR HOSPICE HOME IMMERSION PROJECT, 2017–2018

Abstract Medical education on palliative medicine and end-of-life care is generally lacking in the medical curricula. The University of New England College of Osteopathic Medicine (UNECOM) Learning by Living: 48 Hour Hospice Home Immersion Project is an immersion-based learning model whereby UNECOM 2nd year students live in an18-bed acute care hospice house to care for dying patients, provide family support, and conduct post-mortem care. This project determined if and in what ways immersion experiences were valuable in augmenting student medical end-of-life care education during AY 2017-2018.Retrospective ethnographic/autobiographic data were analyzed from the eight randomly selected student hospice immersion journals (approx. 200 pages) who participated during academic year 2017-18. Pre-fieldwork, fieldwork, post-fieldwork journals were reviewed and analyzed using manual content analysis followed by NVivo 12+ analysis. Thematic coding resulted in representative quotes, key words, and native concepts. Inter-rater reliability was established with the use of a codebook and agreed upon thematic definitions. Four key themes included: Subversion of End of life (EOL) Expectations; Character Development/Introspection; Exposure to Diverse Cultural/Spiritual Perspectives; and Skills to Bring into Future Practice. Proximity to death/dying resulted in reflections on values and priorities, and a renewed sense for compassionate patient care. Students developed skills for future practice, including competency in EOL and post-mortem care, navigating difficult, emotionally laden family dynamics, and contributing to an interprofessional staff team even in uncomfortable situations. This immersion positively affected student perspectives about death and end-of-life care; creating life-altering experiences in patient-centered-care. Students stated significant impacts to employ as a physician.

The Lived Experience of Nurses Applying with Postmortem Care: A Qualitative Evidence Synthesis

COVID‐19 is an ongoing pandemic and alarming public health issue throughout the globe. Nursing staff encounter patient deaths many times throughout their careers. The death of a patient is one of the most common stressors associated with their clinical duties. Failing to address these issues mystifies the experience and leads to nurses suppressing their emotions out of fear and discomfort. These barriers hold nurses back from reflecting and prevent them from effectively coping with patient deaths, which negatively impacts their physical and mental health .A qualitative evidence synthesis was conducted to assess the experience of nursing staff with patient deaths and during postmortem care. The databases were searched for qualitative studies published after 2009. The search resulted in a total of 802 articles that were screened for eligibility. Duplicate studies were excluded. After eligibility screening, four qualitative studies on nurses’ experience of patient deaths and postmortem care were identified and included in the analysis. An integrated analysis was conducted on the four qualitative studies. The studies were based in the United States, South Africa, Taiwan, and the United Kingdom. A total of 30 nursing staff reported their experiences of postmortem care. Three themes were identified: concerns associated with postmortem care, anxiety associated with death, and emotional alienation.

Survey of doctors and nurses awareness and practice about burning incense as postmortem care in the morgue

Survey of doctors and nurses awareness and practice about burning incense as postmortem care in the morgue

Potential Long-term Health Consequences of COVID-19

The Covid 2019 (COVID19) problem is the causal factor for very harsh symptoms of the breathing apparatus of the human body disorders Covid 2 (SARCoV2). Despite the fact that lung problems are the most severe, additional respiratory signs of COVID19 are plentiful. Confirmed cases of COVID19 have now exceeded 64 lakhs worldwide as of the month of nov of last year . With the expected rate of decline (the number of COVID19 transmissions broken down into an extended category of COVID19) varies between 1 and 7%, c It is possible that a large number of individuals have recovered from COVID19 which can accumulate a large number of long-term benefits. Despite the fact that multi-organism COVID19 outbreaks have been widely archived, the drawing ramifications of such waves continue to be revealed. MERSCoV]) all had distinct ramifications for SARSCoV2 infection status to predict limited COVID19 survival outcomes, combined respiratory, cardiovascular, hematologic, renal, essential neurologic, and emerging gastrointestinal and psychosocial utility, although well-known post-mortem care conditions. Show people with post-release COVID19 that they are aware of the extent and seriousness of the results. This can be done by reusing or starting to centralize a large number of companions who have so far focused not only on the effects learned from SARSCoV2, but also on the attributes of invulnerability due to ethnicity and imbalances wages. COVID19 and during hospitalizations. The ultimate fate of COVID19 survivors remains unsettled or undeterrmined, and if this infection persists in us for a long time, the results could increase dramatically as well. Covid 2019 has affected vital organs adversely specially in long term and mental health.

Nurse Educators' Gentle Hands.

As COVID-19 placed unprecedented demands on healthcare systems across the country, nurses were deployed to care for severely ill patients in acute and intensive care units at rates never imagined. Especially challenging for nursing staff was being witness to patients' deaths daily. This article describes the implementation and outcomes of an innovative initiative entitled Gentle Hands, in which a nurse educator team performed postmortem care for unit nurses during a COVID-19 hospital surge.

Doing More With Fewer: Optimizing Value With Limited Numbers of Autopsies

Abstract The value of autopsy is best demonstrated when the procedure is competently practiced in an appropriate clinical setting. Autopsy performance is expectedly restricted when a death raises certain forensic, religious, legal, or safety concerns. Additionally, limiting the scope of postmortem examinations to deaths that fulfill various clinical indications for the procedure will be important moving forward. This is especially true as institutions that finance autopsy services face uncertain and likely difficult financial conditions in the wake of the coronavirus disease 2019 pandemic. Autopsy pathologists should actively engage with clinicians in promoting responsible autopsy practice and delivering quality postmortem care. Using a problem-oriented autopsy record, thoughtfully evaluating postmortem histology, and purposefully reporting autopsy findings can help pathologists provide valuable data to autopsy's various stakeholders.

Charlie's Way: Changing Institutional Practices for Post-Mortem Care In Pediatrics By Bypassing The Morgue.

Charlie's Way: Changing Institutional Practices for Post-Mortem Care In Pediatrics By Bypassing The Morgue.

Mortal remains disposal in the wake of the COVID-19 pandemic.

When dealing with infectious disease-related deaths, it is important to handle the remains of the deceased in a respectful and safe manner. There is no known evidence of SARS-CoV-2 transmission through handling of COVID-19 victim remains. However, guidelines recommend appropriate precautions to ensure safety from any potential risk. Discussions of safe and dignified postmortem care in COVID-19 cases can guide future decision making to encourage safety, dignity, and respect for all.