District Nurse (community)

Care provided after death

District Nurses (DN’s) play a central role in the primary healthcare team and coordinate the services that support patient’s dying at home. They ensure that the contact details of nursing and medical support is readily available for the family caring for a terminally ill relative at home and the care they provide after death includes:

  • Communicating with the bereaved family, offering condolence and comfort,  mindful of the shock and distress that  may be experienced
  • Reporting death to the doctor responsible for the patients care to ensure timely verification of death, certification of death or other actions as appropriate to the circumstances. NB In some cases appropriately trained nursing staff can verify death.
  • Informing other members of the healthcare team or services involved in the patients care about the death
  • Caring for the deceased patient’s body (Last Offices) if present when the patient dies, ensuring that such care is guided by health, safety and legal requirements and informed by the personal preferences, culture, religion and spiritual values of the deceased
  • Recording fact of death and actions taken afterwards in the nursing notes
  • Arranging the sensitive removal of medical items and aids from the home at a time suitable to relatives, aware of the significance and impact that the removal of equipment can have
  • Making a follow up bereavement visit in the days following the death which is good practice and often appreciated

Works Alongside

  • Relatives
  • GP
  • Community Nursing colleagues
  • Specialist Services who the patient was known to e.g. Heart Failure, Palliative Care, Marie Curie Nursing Service, Renal, etc.
  • Domiciliary Care Service
  • Integrated Care Team
  • Student nurses
    • Faith representatives
    • Social Workers
    • PSNI when acting on behalf of the Coroner
    • Governance lead
    • Services responsible for return of equipment
    • Community and Voluntary sector bereavement support services

The standard of bereavement care is enhanced when:

  • Good communication is received by the DN about the death/imminent death of a patient especially during shift changes and handover
  • Nursing care documentation is kept up to date with information valuable when a patient dies e.g. contact details for medical/nursing support
  • Events are recorded in the patients nursing care plan and administration systems
  • GPs inform nursing staff when the Coroners directs that a post mortem is required so care of the body and preservation of evidence procedures in such circumstances are followed
  • Other services involved with the patient are informed about the death
  • Learning and development of student nurses on placement in the community and care assistants in the provision of safe, effective and sensitive care of the deceased and their relatives is supported and supervised
  • Healthcare organisations have training, supervision and support systems in place for DNs

Standards and Guidelines

  • The Code: Standards of conduct, performance and ethics for nurses and midwives. 2008. Nursing and Midwifery Council (NMC) nmc-uk.org
  • Record Keeping: Guidance for nurses and midwives. 2009. Nursing and Midwifery Council (NMC) http://www.nmc-uk.org/Documents/NMC-Publications/NMC-Record-Keeping-Guidance.pdf
  • Last Offices Procedure – Royal Marsden Hospital Manual of Clinical Nursing Procedures 8th Edition (available to access from HSC Trust intranet sites)
  • National End of Life Care Programme (2011) Guidance for staff responsible for care after death (last offices). National Nurse Consultant Group, Royal College of Nursing, Royal College of Pathologists. enfoflifecareforadults.nhs.uk
  • The Northern Ireland Regional Infection Prevention and Control manual – Last Offices section. http://www.infectioncontrolmanual.co.ni
  • HSC Trust/Employers policies and procedures in relation to death and bereavement care.