Postmortem care in adult critical care: It’s all about respect, death rituals and family care

An article written by Professor Melissa Bloomer

Death in critical care settings, such as an intensive care unit (ICU) is common. The provision of end-of-life care is a core responsibility for ICU nurses, but a nurses’ role and responsibilities do not end when a patient dies. Rather, nursing care continues after death until the deceased’s body and family leave the ICU.

We know that providing end-of-life care and supporting bereaved family members can be emotionally and psychologically demanding. This is because not all nurses feel adequately prepared for patient death, particularly when the momentum of ICU care is about saving lives. Nurses may also not feel prepared for supporting families in their grief, with limited opportunities for experiential learning.

Whilst Australian-specific guidelines are available to support nurses in the provision of high-quality evidence-based end-of-life care [1], less is known about what happens after patient death. To address this, we undertook a review to better understand nurses’ experiences after the death of an adult patient in ICU. [2] Thirty-five studies were included in our review, providing interesting findings about respecting and honouring the deceased during postmortem care, and supporting family members in their grief and bereavement.

Whilst preparing a deceased patient’s body is a fundamental part of the nurse’s role, nurses also emphasised the importance of demonstrating respect for the deceased. Nurses showed their respect by mimicking the way they cared for living patients, such as handling the body with care and making the deceased look comfortable, and speaking softly to the deceased to ’bid him farewell’. [3] Others described clearing the bed space of clinical equipment, controlling the lighting and environmental noise, using music to signify ’a feeling of peace’. [4]

Death rituals were also important for acknowledging and respecting culture and religion. Some death rituals were founded on the ‘ritual art of nursing practice’, [4] and others were intended to legitimise and honour the death. Death rituals were often personal to each nurse, and seldom shared with bereaved family. Some nurses had access to religious artefacts such as a Bible, Koran, amulet beads and a book of hymns. Others relied on hymns or prayer, holding the deceased patient’s hand, or making the sign of a cross over the patient’s body. Opening a window was also thought to allow the deceased person’s soul to fly or escape ‘to the other side’. [4] Even when the nurse was not religious, respecting the religion of others was seen as important.

Whilst not all nurses were comfortable providing immediate grief and bereavement support to family members, they were motivated by their desire to reach out to other human beings, in a way that was profoundly human and ’validates the family grief and loss’. [5] The use of mementos, such as a hand print or lock of the patient’s hair, were also used to support family grieving.

These findings emphasise how a patient death in ICU has clinical, professional, and profoundly personal impacts. Critical care nurses understand the fragility of human life. Nurses prioritised actions that emphasised the importance of the life of the deceased, and the significance of the family’s loss. Tailoring care for the deceased, acknowledging the death, and using death rituals to show respect demonstrates their openness to, and acceptance of cultural and religious difference.

Whilst a focus on the provision of high-quality end-of-life care should always remain a priority in critical care nursing, recognising that the care after death is equally important and the last demonstration of respect for life, is key.

Authors

Professor Melissa J Bloomer PhD, RN

Professor in Critical Care Nursing

Griffith University and Princess Alexandra Hospital ICU, Brisbane

References

1. Bloomer MJ, Ranse K, Butler A, Brooks L. A national Position Statement on adult end-of-life care in critical care. Aust Crit Care. 2022 Jul;35(4):480-487.
2. Bloomer MJ, Ranse K, Adams L, Brooks L, Coventry A. "Time and life is fragile": An integrative review of nurses' experiences after patient death in adult critical care. Aust Crit Care. 2023 Sep;36(5):872-888.
3. Benbenishty J, Bennun M, Lind R. Qualitative analysis of European and Middle East intensive care unit nursing death rituals. Nurs Crit Care. 2020 Sep;25(5):284-290.
4. Holm MS, Fålun N, Gjengedal E, Norekvål TM. Music during after-death care: A focus group study. Nurs Crit Care. 2012 Nov-Dec;17(6):302-8.
5. Kirchhoff KT, Spuhler V, Walker L, Hutton A.  Intensive care nurses' experiences with end-of-life care. Am J Crit Care. 2000;9(1), 36.