Last offices refer to the nursing care given to a body immediately after a doctor has confirmed and certified death. As midwives, you will occasionally face the death of a mother or a newborn, requiring a calm, compassionate, and systematic approach. Your primary duty is to treat the deceased with utmost dignity, respect cultural norms, and protect public health. The process involves washing, aligning the body, closing natural orifices to prevent leakage, and preparing the remains for transfer. Professionalism at this stage reassures the grieving family that their loved one is in safe hands. Confidentiality and empathy remain vital even after life has ceased.
Once the doctor pronounces death, time management and privacy become immediate priorities. Draw the bedside curtains or move remaining patients to maintain privacy for the bereaved family. Note the exact time of death as stated by the physician, as this must go into the nursing records. Remove any unnecessary equipment like infusion sets or oxygen tubing gently, unless a coroner's post-mortem is expected, in which case lines must be left intact. Support any grieving relatives present by offering a quiet space, a seat, and a glass of water while keeping your demeanor calm and composed.
A deceased body can still transmit infectious agents, making standard precautions non-negotiable. Always put on clean gloves, plastic aprons, and eye protection if splashing is anticipated during washing. Handle body fluids cautiously, remembering that post-mortem release of urine, faeces, or respiratory secretions frequently occurs as muscles relax. Dispose of all contaminated cotton swabs and waste in line with hospital waste management protocols. Wash your hands thoroughly with soap and water after removing personal protective equipment.
Patient belongings require careful inventory and security to prevent loss or misunderstanding. Remove rings, necklaces, earrings, and watches in the presence of a witness or a relative if they are present. List every item clearly in the hospital valuables register and have the relative or a second staff member sign for them. If no relatives are around, lock the items in the ward safe according to institutional guidelines. Complete all required nursing documentation, including the time last offices were completed, who performed them, and the destination of the body.
Nigeria's diverse cultural and religious landscape demands sensitivity from midwives during last offices. Muslim patients require burial as soon as possible, often forbidding non-family members from washing the body, so staff must respect family involvement or religious attendants. Christians may appreciate hymns, prayers, or the gentle alignment of the body according to denominational traditions. Traditional beliefs in some communities dictate specific positioning or handling of personal belongings that must be respected where they do not conflict with hospital safety laws. Always ask the family about their preferences before commencing care.
Transferring the body requires discretion and respect to maintain the dignity of the deceased and avoid disturbing other patients. Cover the trolley fully with a clean sheet so the body is not visible along hospital corridors. Ensure the correct identification tag is securely attached and matches the mortuary register. Accompany the body along with the completed death certificate, case notes, and property register. Hand over the remains personally to the mortuary attendant and sign the handover documentation before returning to the ward.