In the "Things I Hadn't Even Thought of Our Employees Doing" category, three CNAs at a Michigan Nursing Home are battling their State Licensing Agency after getting caught posing for pictures with a deceased nursing home resident.
Hopefully this isn't something I need to write a policy for.
I also stumbled across a blog post from a nurse who was concerned that the CNAs would wrap a towel around the neck of a resident who had just passed away to prevent the mortuary from breaking the neck when they moved the body. They considered this "standard practice." The nurse put an end to this in order to retain some dignity for the resident when the family came to say their final goodbyes at the facility.
I'd never heard that one either.
Does your facility have a policy and procedure for resident deaths? When was the last time you re-visited it? Has your staff become so desensitized that the death of a human being is just another event in their eight hour shift? Perhaps your staff go to the opposite extreme, removing all residents from the hallway and closing doors when the funeral home comes to pick up a body. The attendant gets sneaked in through a back door and rushed out as quickly as possible, as though our resident are not familiar with the concept of death.
Everyone deals with death in a different way, including residents and staff. It is important that you are sensitive to both extremes. At the same time you have to consider families and apparently, the deceased resident. Below is a list of tips for addressing the death of a resident while the body is still in the facility:
1. Remove the roommate. While I'm not an advocate for closing all doors and shielding our residents from a death, it is important to have consideration for anyone else living in the same room. Often there has been a large influx of family members in the room prior to the actual death, and if this is the case, hopefully you have already offered the roommate alternate accommodations. If not, give them an equal opportunity to say their goodbyes, but don't make them stay in the room.
2. Make attending the body a priority. If family was not there, they will be quickly. Do not let their lasting memory of their loved one including an IV hanging out of an arm, a bedpan within arms reach, or sweaty, matted hair. Go beyond cleaning the body. Straighten the room as much as possible, take out trash, turn off TV or music, and leave a fresh box of Kleenex.
3. Only allow assigned staff members in the room. In the situation with the photographing of the resident, five CNAs were in the room at one point. Regardless of their intentions, there is no reason to have an entire crew involved in the process. Some could argue that staff need an opportunity to grieve and say goodbyes, but this is not the time for that process. One nurse and one aide should attend to the process. This gives the nurse the opportunity to document the final note in the clinical record.
4. Make phone calls in private. Our nurses stations are generally public places, whether we admit it or not. Call the physician, funeral home, and family in a private space. Otherwise these conversations may be overhead by residents and families in the vicinity. While I believe that it is important to allow people to openly express their feelings, the nurses station is not the forum to make death announcements.
5. Never force someone to work with a deceased resident. Identify workers that are comfortable and provided them with both education on your facility policies and grief resolution outlets. If an employee says they are not comfortable preparing a deceased body, never press the issue.
Don't be afraid to ask your staff what they do when a resident dies. You may be surprised at what you find. By training staff on some basic procedures, you can help preserve both resident dignity and staff attitudes. As always, never assume that staff know what to do when it comes to something as significant as the death of a human being.