Welcome to House of Light, a blog produced and managed by the staff of Casa de la Luz Hospice. Casa de la Luz ("house of light" in Spanish) is a locally owned and operated hospice, serving the city and surrounding communities of Tucson, Arizona. Through this blog, we hope to offer education, information, and support about caregiving and hospice care to terminally ill patients and their loved ones. For more information, visit the contact us page.

Monday, November 19, 2012

Hospice Care: After the Death of a Patient, Part 1

One of the benefits of a home hospice death is that it's not an emergency. No fire truck or police cruiser to show up with lights and sirens. No crush of strangers in the room. No whisking away of the body so beloved by the family. "We'll go at the family's pace," I tell people. "There are things to be done, but there's no hurry."

In my time with the family I am guided by these principles: It's okay to cry or not cry; doing simple tasks helps people; people don't know what to say until they are asked a question; be kind and gentle, slow and respectful; share information in small bits as it is needed.

I arrive at a home knowing that one of our patients has died, and the name of the person who reported it to the hospice staff. I introduce myself and locate the next of kin, offering sympathy with gentle words and touch. Next I go through the ritual of listening for a heartbeat, checking pupils and determining that the patient is dead. Every touch is gentle and respectful, as though the patient could feel and be comforted. I meet the eyes of the family and affirm, "Yes, she's gone." Of course they know their loved one is dead, but seeing the ritual and hearing it from the nurse makes it more real.

As a hospice nurse, my goal is to not only provide patient care, but also to support the family. I will determine what the family needs as they are processing their loved one's death. If the family wants, I can call for the hospice chaplain or hospice social worker. A few of the practical tasks that need to be completed after a patient death are to bathe and dress the body, call the mortuary, and dispose of narcotic medications.

Bathing the body is a time-honored tradition and American culture allows for what is meaningful to the family. I explain that I will clean and dress the body, and that they may participate or observe, or not, per their choice. Warm water is used to bathe the body. Reminiscing is encouraged. I speak to the person as I do when I am bathing a patient.

With the family's permission, clothing is cut away from the body and new clothing is cut to slip onto it, then tucked into good fit. It is important that the family choose the clothing because this is the last time they will see the patient at home. When people are nearby, but not engaged, I find a task for them. A 15-year-old girl can find her Tia's hairbrush and say how she styled her hair. A young man can shave his grandfather's face. Young adults can move cars for the mortuary van and furniture for the gurney. I always ask for help, because the more involved each person is, the less helpless he feels.

I think after the body is bathed and dressed, the family tends to feel more grounded. Tasks are done, respect is shown, "Dad looks like he's napping," and family members have learned that they can put one foot in front of the other and keep going a few minutes at a time.

(Editor's Note: Continue reading next week for part 2 of the series to learn how to prepare for the transfer to the mortuary, and how hospice continues to support families after a patient's death.)

by Mary Toren, RN

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