What’s Angel Care for Home Nursing in Japan ?

Hi there ! I’m Mao who works for Home Nursing Station.

Angel care is something you will definitely experience when you are a visiting nurse.

Angel care is a procedure to be performed after a patient has passed away.
There are many things that you will experience even if you work at a hospital, but in Home Nursing, the environment is different from that of a hospital, so it is necessary to devise something a little different.

I will explain the basics of angel care and explain the points to note and tips for home-visit nursing.

This blog provides information about the real work of Home Nursing. See the related article if you’re interested.

Hard to Work Real Home Nursing in Japan ?

Hard to Work for Home Nursing Station ?

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Points To Keep In Mind For Angel Care

Angel care in Home Nursing is performed at the request of patients and their families.

Your family is grieving over the loss of a loved one, so you have to be careful with your words and actions.

Here are some things to keep in mind when performing angel care:

I will explain these points one by one.

1, Confirm the presence or absence of body donation registration

If possible, it is best to check before the patient pass away whether or not they have registered their body donations.

Patients can check whether or not their bodies have been registered by inquiring at a medical university (University Medical School) or dental university (University Dental School) in the prefecture in which they live, or by contacting a Body Donation Association.

Or your family may have already confirmed, so let’s ask the family.

2, Explain that angel care is not covered by insurance

Angel care provided by nurses is unfortunately not covered by insurance, so it is desirable to explain the costs incurred before patient mortality if possible.

When a patient passes away, the family becomes so busy that there is no time to grieve.

The only thing I want to avoid is that the treatment ends without knowing that the angel care is all self-funded (not covered by insurance), and that it causes trouble later.

3, Anticipate and deal with physical changes after pass away

The time spent providing angel care is a precious time in which patients and their families must say goodbye.

Keep in mind that if patient’s body temperature is still high, decomposition will progress faster, so you will have less time to change clothes and clean your body.

Also, after mortality, the body dries up, take appropriate measures quickly. I will more explain how to perform it later.

4, Angel care is basically to support the time of parting

If you have little experience with angel care, you may be at a loss as to what to do and what to say to the family who has lost a loved one.

However time is still running out, and action must be taken immediately.

For the family, it is a time when various emotions intersect, so the visiting nurse should never rush. You just support them to snuggle up.

If the nurse shows the family too busy doing many things, it can put pressure on the family as well.

5, If mortality diagnosis cannot be made immediately, check the “Three Signs of Mortality”

If the doctor is unable to visit the patient immediately and the death diagnosis is not be made for a while, check the “Three Signs of mortality” and report to the doctor first.

Then, with permission from the family, angel care is performed before the death diagnosis.
Remember that family needs a full explanation.

6, Involve the family in angel care

It will be an important time for the family while you are doing angel care.
they will pay for angel care and leave the care to the nurses, but the nurse can also ask the family to additionally support such as changing into the patient’s favorite clothes and wiping the body.

Some families are reluctant to touch the corpse directly, so we can never force it, but it would be good to ask the family to help out so that they can spend their precious time saying goodbye.

If there seems to be reluctant, the point is to offer support even if it is not direct, such as “Can I have a warm towel ?”, “Can I have a washbowl ?”.

Basic Procedure For Angel Care

I will explain the specific angel care method by focusing on 8 points.

All of these are basic procedures, so be sure to keep them in mind.

1, Prevention of corruption

The temperature at which bacteria are likely to grow in the body after mortality is 25 to 40°C, so cooling the body should keep the core body temperature and the temperature of the room below 20°C.

Since the chest and abdomen are particularly susceptible to decomposition, cooling should be started as soon as possible immediately after mortality and continued until the funeral director arrives.

If the nurse cannot visit the patient immediately after the patient passed away, it is possible to explain the treatment method over the phone, but if possible, it is desirable to do so in advance.

For cooling, it is common to cool the body by applying an ice pack directly to the chest and abdomen. applying an ice under the back is also effective.

2, Prevention of dryness

In order to prevent the corpse from drying out, do not allow the air from the air conditioner to hit the body directly.

Air conditioners and fans are exactly effective to keep the room temperature from rising, but if you use them too much, the patient’s body will dry out, so be careful not to expose patient’s skin as much as possible.

It’s surprisingly easy to overlook dry feet, so it’s a good idea to wear socks on the feet.

Moisturize patient’s hands and face with petroleum jelly or hand cream.

Even if you apply a little too much, there is no problem because the skin will absorb the cream and gradually dry out.

3, Oral care

There is also an opinion that angel care does not specifically clean the oral cavity.

The reason for this is explained in the next section, but since the jaw begins to stiffen immediately after mortality, it is necessary to fix the lower jaw as soon as possible.

As for dentures, there is no particular problem even if you can’t force them to fit, so let’s leave it to the funeral director.

4, Fixation of lower jaw

The mouth will be easier to automatically open after mortality, so fix the lower jaw as soon as possible.

You should raise the pillow a little with a towel etc. and put the towel under the chin and hold it.

Since the mandibular straightening begins 1 to 3 hours after mortality, it is desirable to do this within 1 hour after death if possible.

5, Cleaning and wound treatment

Cleaning is a procedure to wipe the body clean, but at this time, let’s use lukewarm water.

Using hot or warm water will actually dry out the body too much.

In addition, edema will start immediately on wounds on the skin, so be sure to protect them with gauze or the like.

6, Dressing

As for dressing, put the patient wearing the clothes or Kimono that patient loved during the lifetime.

By doing this with the help of family members, I believe that I can support patients and their families in spending precious time together.

In many cases, it goes well if the nurse helps the family with dressing according to their wishes.

7, Washing and styling hair

Washing patient’s hair is quite a difficult task, so try to do it if you have time while listening to family’s wishes.

After washing the hair, it is necessary to dry it with a hairdryer.

Sometimes you just style the hair without washing it.

8, Makeup

Let’s make the patient up easily with blush, lipstick, etc. so that the complexion looks good.

This is also done while listening to the family’s wishes, but it is better to suggest that makeup is basically done regardless of gender because it will look better.

If the patient apply blush or lipstick to the areas shown in the diagram above, the complexion will be good and the face will look beautiful.

When it comes to appearance, give priority to the family’s wishes.

What To Do In Such Case For Angel Care ?

When you are doing angel care, you may be worried about the following situations.

I will also discuss appropriate methods in these cases.

1, When feces remain in the rectum

If the patient ate something just before mortality, he/she may have stool in your rectum.

Urine often comes out spontaneously, but it is common to put on a diaper or apply a urine-absorbing pad after excretion.

2, When concerning about the smell

If smell is concerned, dilute something that contains sodium hypochlorite, such as liquid chlorine bleach, with water, then wipe the inside of the mouth and pressure ulcers.

Wiping the oral cavity with a liquid chlorine bleach in front of the family may upset them, so I think it would be good if you prepared the liquid in a separate container in advance and brought it with you.

3, When the beard is growing

Shaving should be avoided as much as possible because it can cause the skin to swell afterward.

If shave is necessary, recommend the familty to use a hair removal cream or shaving lightly with a razor and then covering it with foundation.

After treatment, avoid drying as much as possible, so be sure to moisturize.

4, When wanting to keep eyes completely closed

If you want the patient to keep eyelids closed, a cleansing massage on the face may help them close naturally.

If it still doesn’t work, put a few drops of eye drops on eyeballs and then rub your hand down from forehead several times to make them close.

5, When the tape remains on the body

Do not remove the tape remaining on the body immediately, but remove it after floating it with petroleum jelly.

If the stratum corneum is removed, it will be difficult to repair, so be sure to tell the family to be careful not to remove the tape.

6, When using a tube

If tubes such as nasal cannulas and drains are in direct contact with the skin, they will be compressed and pigmentation will progress, so remove the pressure as soon as possible.

When the catheter or IV needle is removed, body fluids will leak out from that part, so in most cases, you don’t need to remove it.

What To Do After Angel Care

So far, I’ve explained the method of angel care, but there are still many things to do even after the body is handed over to the funeral home even the treatment is completed.

Below is a summary of what to do after angel care.

I will more explain these items one by one.

1, Leave home after curefully saying thanks family

When you leave home after angel care is completely done, greet the family more politely than usual before leaving.

Also, be sure to thank them for their help with Angel Care.

You need to thank the family for all the hard work they have done in the midst of grief, and for allowing you for Angel Care.

2, Say thanks for other occupations who have been involved

After leaving home for angel care, the nurse will return to the office, but as soon as possible, I expressed my gratitude to the care manager and helpers who had been involved Angel Care, and report them that angel care was completed successfully.

It seems that some people in other occupations feel regret, saying, “I wish I had done this more in patient’s lifetime.”
You can only relieve them by saying thank you.

On behalf of the family, thank the people in other professions who have been involved.

3, (If there is an opportunity at a later date) Say thanks to family and give incense to the patient.

Once the Angel Care is over, the nurse will normally no longer visit the patient’s home, but you may visit there again for paperwork, payment etc.

In this case, with the family’s consent, let’s offer incense and thank them again.

Remember the offering incense is one of the special culture in Japan.

4, Confirm the payment method

As explained at the beginning, Angel Care is not covered by public insurance, so basically you will have to bill the family for the actual cost.

For the time being, the family will be busy, so it is appropriate to confirm the payment method after a short interval of 2-3 weeks.

Sometimes the administrator will do it instead of you, but sometimes the nurse in charge will visit again and ask the family how to pay for Angel Care.

Conclusion

This time, I explained the points of Angel Care from the basics.

You may be upset by empathizing and unable to concentrate on Angel Care if the patient who has been using Home Nursing for a long time.

However, the family should be more upset in this situation, so nurses need to keep normal mind to do what we have to do as professional.

The difficult part of Angel Care in Home Nursing is not clearly determined that both nurses and family should sepaletely do the task.

Basically, nurses perform all procedures, and if necessary, the family help. So, let’s respond flexibly when sharing roles.

Angel Care is a very mentally demanding job for nurses.

The most important thing is to support the family so that they can spend their last moments with the patient meaningfully.

Please do your best to become a Home Visiting Nurse that the family will say “thank you” a lot.