Nurses, the Dying, and the Newly Dead by Elayne Kornblatt Phillips & Beth Epstein
[Ed. Note: The following is a reprise from January of 2015. — JB]
“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 preceded 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 to 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 the 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.
GAMLIEL INSTITUTE COURSES
LOOKING FORWARD: UPCOMING COURSE
The Gamliel Institute will be offering course 2, Chevrah Kadisha: Taharah & Shmirah, online, afternoons/evenings, in the Fall semester, starting September 5th, 2017. This is the core course focusing on Taharah and Shmirah ritual, liturgy, practical matters, how-to, and what it means.
The course will meet online for twelve Tuesdays (the day will be adjusted in any weeks with Jewish holidays during this course).
There will be an orientation session on how to use the online platform and access the materials on Monday, September 4th, 2017, at 5 pm PDST/8 pm EDST online.
Information on attending the online orientation and course will be sent to those registered. Register or contact us for more information.
For more information, visit the Gamliel Institute website, or at the Kavod v’Nichum website. Please contact us for information or assistance by email firstname.lastname@example.org, or phone at 410-733-3700.
Gamliel Students are invited to an informal online monthly session on the 3rd Wednedsays of most months. Each month, a different person will offer a short teaching or share some thoughts on a topic of interest to them, and those who are online will have a chance to respond, share their own stories and information, and build our Gamliel Institute community connections. This initiative is being headed up by Rena Boroditsky and Rick Light. You should receive email reminders monthly. The next scheduled session of the Gamliel Café is October 18th.
Gamliel Graduate Courses
Graduates of the Gamliel Institute, and Gamliel students who have completed three or more Gamliel Institute courses should be on the lookout for information on a series of “Gamliel Graduate’ Courses, advanced sessions focusing in on different topics. These will be in groups of three sessions each quarter (three consecutive weeks), with different topics addressed in each series. The goal is to look at these topics in more depth than possible during the core courses. We plan to begin this Fall, in October and November. The first series will be on Psalms. Registration will be required, and there will be a tuition charge of $72 for the three sessions. Heading this intiative is the dynamic duo of Rena Boroditsky and Rick Light. Contact us – register at www.jewish-funerals.org/gamreg/, or email email@example.com.
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You can donate online at http://jewish-funerals.org/gamliel-institute-financial-support or by snail mail to: either Kavod v’Nichum, or to The Gamliel Institute, both c/o David Zinner, Executive Director, Kavod v’Nichum, 8112 Sea Water Path, Columbia, MD 21045. Kavod v’Nichum [and the Gamliel Institute] is a recognized and registered 501(c)(3) organization, and donations may be tax-deductible to the full extent provided by law. Call 410-733-3700 if you have any questions or want to know more about supporting Kavod v’Nichum or the Gamliel Institute.
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If you would like to receive the periodic Kavod v’Nichum Newsletter by email, or be added to the Kavod v’Nichum Chevrah Kadisha & Jewish Cemetery email discussion list, please be in touch and let us know at firstname.lastname@example.org.
Be sure to check out the Kavod V’Nichum website at www.jewish-funerals.org, and for information on the Gamliel Institute, courses planned, and student work in this field also visit the Gamliel.Institute website.
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If you have an idea for an entry you would like to submit to this blog, please be in touch. Email J.email@example.com. We are always interested in original unpublished materials that would be of interest to our readers, relating to the broad topics surrounding the continuum of Jewish preparation, planning, rituals, rites, customs, practices, activities, and celebrations approaching the end of life, at the time of death, during the funeral, in the grief and mourning process, and in comforting those dying and those mourning, as well as the actions and work of those who address those needs, including those serving in Bikkur Cholim, Caring Committees, the Chevrah Kadisha, as Shomrim, funeral providers, in funeral homes and mortuaries, and operators and maintainers of cemeteries.