Kavod v’Nichum: Nurses, the Dying, and the Newly Dead
“On my way home I stopped and picked up some things for her, like baby shampoo and stuff…because I wanted to give her a little something extra because it was her last day.”
–Neonatal Intensive Care Nurse, discussing the imminent death of her tiny patient.
For nurses, caring for the dead and the dying is a privilege and an obligation. Sitting with families, holding patients’ hands, closing patients’ eyes, washing bodies—all of this is in a day’s work. Many times, the quiet moments of last breaths and family gatherings are preceeded by rapid-fire, aggressive resuscitation—the last, futile attempts at preserving life. The transition from noise, drugs, commands, and physical action to quiet is stark and often jarring.
For hundreds of years, nurses have cared for the dying and the dead. Still, knowledge about how to care for patients as they are dying and after death comes largely from personal intuition. Education in caring for a dying patient is now available (e.g., ELNEC), but caring for a dead patient is often an afterthought. It is assumed that a nurse will know how to care for a dead patient and his family. But assuming is a risky proposition. If the knowledge is not simply “known” but can be taught, then what might we teach and how might we teach it?
For thousands of years, Jews have practiced and taught the ritual of taharah. Perhaps by exploring what nursing and Jewish practices have in common and what is different, we can learn how each can enhance the other. Here we consider how the practice of taharah can inform nursing practice in caring for the dead.
We conducted focus group discussions with nurse attendees at the Kavod v’Nichum 2013 annual conference and with our local Chevrah Kaddisha members to identify key themes that could inform nursing practice. We identified two themes that may help nurses frame their practice— acknowledging a transitional period and creating sacred space.
Acknowledging the transitional moment was described in terms of recognizing that the soul may still reside in the body at the time of the taharah, and that the hands and eyes of the Chevrah Kadisha members would be the last to touch the patient. It is understood that a significant period exists for both the dead person (meyt(ah)) and the caretaker immediately after the end of the physical status we label “life” and the emptying of the body as vessel of the “soul.”
Creating sacred space for taharah involves focusing solely on the meyt(ah), working in silence or quietly singing or humming psalms and prayers, and maintaining calm even under difficult circumstances. It also calls for respect and modesty, moving the meyt(ah) only as necessary and then as gently as possible and exposing only parts of the body being washed or dressed. There is a recognition that although the body is forever damaged, there is still respect due the value of the person who has died. Although these activities and modifications are grounded in respect for the meyt(ah), they infuse the Chevrah members with a spiritual sense that this is a profound and pivotal time in the person’s “life” and reminds us that we are doing holy work. It also reminds us that one day we will be cared for in this way. We are honored to perform this mitzvah.
In the hectic healthcare environment where the time to spend caring for a patient who has recently died is often short and nurses are aware that there are competing obligations to other patients, it is easy to make short shrift of the tasks necessary to prepare the patient for family visitation or to be transported from the hospital. Working efficiently need not require the nurse to separate emotionally from the patient. Nurses’ level of comfort with the practice of caring for the dead is largely dependent on past experience, culture and upbringing, and an intuitive sense of maintaining dignity. An awareness of the body in transition—recognition that this may be a last bath, the last time the family sees the patient—and setting a sacred space of quiet, calm, and competence may be helpful to those nurses looking for guidance in fulfilling the professional obligation of caring for the dying patient and family before and after death.
Elayne Kornblatt Phillips RN, MPH, PhD, FAAN, is a Clinical Associate Professor of Nursing at the University of Virginia School of Nursing, and former Director of Research at the International Healthcare Worker Safety Center in the School of Medicine. She is a founder and chair of the Women's Chevrah Kadisha at Congregation Beth Israel, Charlottesville, VA. She has been a student at the Gamliel Institute.
Beth Epstein, PhD, RN is an Associate Professor at the University of Virginia School of Nursing. She conducts research in ethics and pediatrics and is a member of the Ethics Consult Service for the UVA Health System. Beth currently serves as President of Congregation Beth Israel in Charlottesville, Virginia and is a member of Congregation Beth Israel’s Chevrah Kadisha.
Kavod v'Nichum Conference!
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UPCOMING GAMLIEL INSTITUTE COURSES
Starting in May:
Chevrah Kadisha: Educating, Organizing, & Training. Tuesdays. 12 online sessions. (Orientation session on Monday May 11th, classes start the 12th). 8-9:30 pm EST. Working with and educating the members of the Chevrah Kadisha, your congregation, the community, other organizations, and the public. Includes undertaking a project that will have practical and real world effect, and will also serve as information and a resource for others.
Chevrah Kadisha: Nechama. Thursdays. 12 online sesions. (Orientation session on May 11th, classes start on the 14th). 8-9:30 pm EST. Helping to provde practical skills, tools, and resources for those providing comfort at all points along the spectrum from approaching final illness, through death, and on the journey of grief and mourning, using texts, videos, role plays, discussions, and chevruta study.
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