by his wife and next door neighbour, they had followed the ambulance to
the hospital by car. A member of staff had been assigned to meet David's
wife when she arrived in the department to ensure that she was provided
with all information regarding her husband.
David's wife was shown to the relatives room together with her
neighbour, the nurse had informed her that David was seriously ill and
that he had suffered a cardiac arrest in the ambulance. She was informed
that the team were trying to revive him and was given the chance to
witness this, she declined as she was understandably too upset by the
situation. She was kept updated by the assigned nurse on David's
condition. It is important that when it is recognised resuscitation may be
unsuccessful the family are made aware of this fact. This provides the
family with time, even though it may be only minutes to come to terms
with the seriousness of the situation (Alexander, Fawcett & Runciman,
The team tried to revive David for some time, unfortunately their efforts
were unsuccessful, he was pronounced dead approximately 30 minutes
later. His wife was immediately informed and given the chance to say
goodbye to David, this was a difficult situation for her as the suddenness
of her husbands death had left her in a state of shock. The staff were very
sympathetic and caring towards her. The assigned nurse did not leave her
side and was very supportive towards her, she was encouraged to stay
with David for as long as she felt she needed. After spending some time
with David his wife expressed a wish to leave but requested to return later
to view him in the mortuary.
The porters were contacted to remove David's body from the department
and to deliver it to the mortuary, the staff nurse in charge requested that I
accompany them. Having never been required to do this task before, as on
previous occasions the porters have collected the deceased in a mortuary
trolley, I enquired as to why they needed to be accompanied. The
explanation received produced feelings of shock and disbelief within me.
My initial thought was that somebody was playing a practical joke upon
Hospital protocol states that the deceased remains upon the trolley with a
sheet folded down over the shoulders. An oxygen mask is applied to the
mouth, this procedure apparently assures the general public within the
department that the patient on the trolley is alive and being transferred to
a ward or another department. I questioned why the deceased is not
removed in the traditional way of the mortuary trolley and was told it
would upset too many people in the department who viewed it.
To transfer David to the mortuary we had to go through the Accident and
Emergency department and then through the main foyer of the hospital.
Both were busy with large numbers of the general public being present,
the main foyer was especially busy as it was visiting time within the
My experience of the whole incident has evoked both positive and
negative feelings within me. As a student nurse in an emergency situation
such as this I felt the need to take a step back and learn by observing the
team in action during the attempted resuscitation. Every member of the
team had their role to perform, the way with which they all worked
together whilst remaining calm left me awestruck. They were all
extremely professional in the way with which they dealt with the
David's death had been unexpected and sudden, the staff nurse assigned
to care for his wife communicated with her in a caring and sympathetic
manner. Wright (1996) describes bereavement as a traumatic event but
suggests that sudden death is the most traumatic experience of all. Within
the Accident and Emergency department effective communication and
interpersonal skills are imperative in order to avoid maladaptive grief.
The ability to break the news of a sudden death requires skill and
sensitivity as the grief process commences immediately after the
announcement (Fontaine, 2001). David's wife was offered the chance of
being present during the attempted resuscitation of him but she declined.
It has been identified that family members who witness cardiopulmonary
resuscitation may be more accepting of the death of their loved one, it
may also improve the grieving process for them (Kidby, 2003).
The way in which the staff treated David's wife was exemplary, they
offered her adequate support in a sensitive and caring manner and
encouraged her to stay with him for as long as she needed. Reflecting on
this incident caused me to question whether the situation would have
been treated differently if there had been other patients present in the
resuscitation room. It would not have been an ideal environment for
David's wife to see him after his death, in my opinion there should be a
room allocated within the department for this purpose. The relatives
would then be able to stay with their loved one for as long as they needed
after a death, especially when the death occurred as suddenly as David's
The negative feelings which were aroused within me was caused by the
way David's body was transported to the mortuary. The explanation
received as to why David was transported on a trolley in the way that he
was caused me to become indignant, why was the dignity of the deceased
forsaken so members of the public were not upset by the sight of a
mortuary trolley. Sewell (2002) argues that the removal of the deceased in
a mortuary trolley, although a protective gesture, secretes the body from
public view. He suggests that this method of removal furthers the
perception of death as a subject to be avoided by society.
The nurse should continue to be the patient's advocate in protecting their
dignity even after death when they are unable to do so for themselves.
According to Hill (1997) nursing care does not end when the patient dies,
although the focus of care is transferred to the relatives. The deceased
should still be treated in a dignified manner with all the solemnity which
is usual in the family's culture. The family expect their loved one to be
treated in in an effective, sensitive and efficient way.
The subject of death is taboo within our society, Kubler-Ross (1970)
suggests that society views death as a fearful, frightening happening, and
that the fear of death is a universal one. Western culture maintains a social
avoidance of death and expels the idea of death from both its language
and daily life. Death is inevitable and it is essential that Western society
confirms the humanist element of death and bereavement rather than
delegating it to the status of social taboo (Fontaine, 2001).
Although my own personal thoughts on the way with which David was
transported to the mortuary were that is was wrong, I did agree to
participate, my refusal to participate would have perhaps been viewed as
inappropriate and not abiding with hospital protocol.
The transfer to the mortuary was swift, I became conscious of the fact
that people were staring at David, this aroused feelings of apprehension
and anger within me which in turn caused me to feel protective towards
him. My thoughts were if David's wife was aware of the situation it may
have produced unnecessary anguish for her. It was also a possibility that a
member of the public may have recognised David and approached me to
ask after his welfare, that would have placed me in a difficult position.
For the remainder of my time at the department I was able to discuss with
several members of staff the procedure of transportation of deceased to
the mortuary. Many of them showed indifference to the subject and could
not understand my thoughts and feelings, whilst others displayed concern
of the suggestion of a body being removed from the department in a
mortuary trolley. They felt that the general public would loose faith in
their ability to cure and heal if they were to witness a mortuary trolley
leaving the department. None of the staff spoken to seemed concerned
about the fact that the deceased was exposed, and in my opinion treated
with lack of dignity. I did feel hostility from certain members of staff
when questioning this procedure and felt that the explanation given was
The method of transferring the deceased to the mortuary is hospital
protocol, however, the department did not have a copy of that protocol,
my mentor informed me that it was an unwritten ruling which had
become a ritual. Walsh and Ford (1989) intimate that the care of the
deceased may be compromised because of lack of forethought or
rationale due to recurrent practice being ritualised.
Although my personal feelings on the transportation of the deceased to
the mortuary is that it is inappropriate, the design of the hospital adds to
the problems. The hospital therefore adopts the belief that it is acting in
the interests of the general public.
It must be acknowledged that caring for the dead is a unique feature of
nursing as the deceased will never be aware of the care they have
received (Sewell, 2002).
This reflective account has discussed certain issues relating to sudden
death within the Accident and Emergency department. It has considered
the positive as well as the negative feelings which the incident evoked.
The positive feelings were brought about by witnessing the professional
manner in which the team dealt with the attempted resuscitation of David
and the way with which they supported his wife after the event.
The negative aspect of the incident was the way David was transported to
the mortuary. Although it was against my own personal beliefs I had to
accept the fact that it was hospital procedure for it to be performed that
way and my opinion would not change that practice.
Alexander, M. Fawcett, J. & Runciman, P. (2000) Nursing Practice -
Hospital & Home, The Adult. 2nd edition. Edinburgh. Churchill
Fontaine, N. (2001) Chapter 19 in Toulson, S. (ed) (2001) Accident &
Emergency Nursing. London. Whurr Publishers.
Gibbs Reflective Cycle (1998) in Alexander, M. Fawcett, J. & Runciman,
P. (2000) Nursing Practice - Hospital & Home, The Adult. 2nd edition.
Edinburgh. Churchill Livingstone.
Hill, C. (1997) Evaluating the quality of after death care. Nursing
Johns, C. (2000) Becoming a Reflective Practitioner. Oxford. Blackwell
Kidby, J. (2003) Family-witnessed cardiopulmonary resuscitation.
Nursing Standard. 17(51):33-36
Kubler-Ross, E. (1970) On Death And Dying. London.
Nursing & Midwifery Council (2000) Code of Professional Conduct.
Sewell, P. (2000) Respecting a patient's care needs after death. Nursing
Walsh, M. & Ford, P (1989) Nursing Rituals, Research and Rational
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Wright, B. (1996) Sudden Death: a research base for practice. Edinburgh.