Dear Editor:
Concerning the article written by Maureen T. Marthaler, which appeared in the September/October 2005 issue of DCCN:
Postmortem care provides for the appropriate disposition of a patient's body and belongings after death. Since 1966, many researchers and more than 30 professional organizations, including the American Association of Critical Care Nurses, have come together to endorse the factors that contribute to quality end-of-life care. This Statement of Principles, put forth by the American Geriatrics Society, recommends attention to 9 factors to specifically promote quality end-of-life care.1All factors listed encourage active participation in supporting the living patient through the stages of decline unto death. The overall goal is to ensure that the patient's quality of life is good despite declining health.
The Institute of Medicine (IOM), Last Acts, Americans for Better Care of the Dying, and the professional organizations for hospice and palliative care continue to work to assess where end-of-life care falls short. Yet, even within the IOM's 4 identified major areas for suggested improvement, there is no reference to postmortem care.2 A literature review for end-of-life care does not produce postmortem care as the principle domain of end-of-life care.
Postmortem care is exactly what it says it is: care following death of an individual.
One can debate semantics regarding Maureen T. Marthaler's article on end-of-life practical tips in the September/October 2005 issue of DCCN, but hospice and palliative care have long sought to bring quality of life and end-of-life care into synonymous domain. To interchangeably use postmortem care (death) with end-of-life care simply furthers the struggle to promote the benefits of palliative care at earlier stages of diagnosis and of hospice to gain acceptance when poor prognosis is inevitable.
End-of-life care crosses all life-threatening illnesses and sudden death. Nurses are becoming knowledgeable, skilled, professional advocates for the dying and their families by providing evidenced-based pain and symptom management in compassionate, culturally sensitive arenas that include the whole family unit.3 Whatever the cause of death, nurses must be familiar with the trajectory of end-of-life care, understand the nature of grief, and serve to provide necessary links to bereavement follow-up and counseling.
The information contained in the article covers what most hospital policy manuals dictate to preserve the dignity and respect of the deceased. Religious death rituals are now common components of hospital cultural diversity programs aimed at meeting the needs of both patients and the staff who serve them. We can never overemphasize the importance of ritual and respect for the dead, but please do not confuse postmortem care (death) with the dynamics of end- of-life care that actively seeks to improve function and autonomy of the living individual.
Karen Overmeyer, MS, RN, ANP
Richmond, Virginia
([email protected])
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