Drawing from Ubuntu characteristics of communal living, respect and dignity of a human person, death is seen as a community event. Ubuntu is an indigenous concept describing the affirming dignity of self and others in a shared humanity (Moyo 2021). This is summarised in the expression ‘umuntu ngumuntu ngabantu’ which means, a person is a person through other persons (Müller, Eliastam & Trahar 2019). South Africa is a diverse country with different religious, cultural and linguistic groups. Human transcendence and the transition into the spiritual world are a sacred time for the family and community to prepare for the necessary rituals. Therefore, the spirit of Ubuntu is often practised in African communities.

Ubuntu is the African idea of personhood and the self is defined and understood in relation to others (Baloyi & Makobe-Rabothata 2014). African beliefs are founded on the principles of collective interest of the group and that the person cannot exist alone. Therefore, incorporating traditional sources of community support is vital in dealing with death, life crises and events (De Beer & Brysiewicz 2017:22). Ubuntu is a collective ontology that emphasises intra-community relationships in which ancestors and future generations are part of a community; therefore, it is a continuous movement of the unfolding of the universe (Van Norren 2022:2791). It symbolises togetherness and caring for each other in a community; it upholds the need for secure social equilibrium, compassion, humanness and strong consideration of the other’s humanity (Kamga 2018:624). Thus, Ubuntu calls for a humanistic approach in which the needs and well-being of the community are considered more important and the principles of sharing, caring and compassion for others are at the forefront (Mangena 2016:64).

Southern African countries are diverse with multiple cultural and religious practices. This paper is part of a larger study that seeks to understand the African human body to advocate for holistic integrated care of the touched body. In this qualitative exploratory-descriptive phase, the authors sought to understand the importance of multidisciplinary approaches in caring for the human body of the deceased using the Ubuntu principles of dignity, respect and communal approach to death.

For this phase of the study, a qualitative exploratory-descriptive design was used to understand the meaning of the human body after cessation of life within the African, Christian and nursing perspectives. The qualitative research design is a plan to collect and analyse evidence that will help the researcher answer the research question (Flick 2018). Exploratory-descriptive qualitative research is conducted to address a problem or issue that requires solution and understanding, thereby, providing insights into practical problems (Grove & Gray 2023).

The study was conducted in three countries in Southern Africa (Eswatini, South Africa and Zimbabwe), specifically targeting religious and African Christian leaders. For nurse practitioners, the study was conducted on medical and surgical wards in two selected hospitals in Gauteng province.

Three population groups participated in this study and are discussed respectively as follows:

Group 1: Religious Christian leaders – these were the priests and pastors of mainline churches such as the Catholic and Lutheran churches, including other Protestant churches and African Christian churches such as the Zionists. Participants were leaders in their respective churches, supported grieving families and conducted funeral rites for their church community. Their ages ranged from 37 to 59 years. Snowball sampling was used to recruit participants. In this sampling strategy, the second author identified the initial participants from the three countries (Eswatini, South Africa and Zimbabwe) and was then asked for names of other religious Christian leaders who shared the same relevant characteristics, leading to a chain of participants based on recommendation.

Group 2: African indigenous practitioners, the first author consulted with the first gogo who assisted with the recruitment of other participants who were African indigenous practitioners for more than 3 years and whose ancestry spirit permitted them to participate in the study. They were between 45 and 60 years old.

Group 3: Nurse practitioners – registered nurses employed in the two selected hospitals, with at least 3 years’ experience in medical and surgical units, and have provided the last office to the deceased human body. The nurse practitioners were purposively sampled. Purposive sampling is a technique for selecting individuals with specific knowledge or expertise about the topic under study (Grove & Gray 2023). The first author is an experienced registered nurse. After obtaining ethical clearance and approval from the two hospitals, she visited the eight medical and surgical units (four medical and four surgical), two from each hospital. The unit managers provided a 15 min morning slot after patient handover to explain the purpose, objectives and expectations for participating. The study information leaflet and the informed consent form were provided to the nurses interested in the study. They provided their cell phone numbers for further conversations and telephone interviews. The participants were 30–55 years old. In all, 16 nurse practitioners participated which was guided by data saturation.

In-depth interviews were conducted to understand the meaning and rituals of the deceased body from multiple perspectives. In-depth interviews involve inductive, open-ended questions, ranging from general to specific questions, in which participants provide long and detailed responses (Flick 2018). Data from the three different population groups were collected using interviews: face-to-face (n = 6), telephone (n = 16) and email (n = 8). All groups were asked three main questions, and probing was conducted to understand the information shared. Table 1 shows the questions asked of all groups.

Thematic data analysis was used to identify, analyse and interpret patterns of meanings within the qualitative data (Clarke & Braun 2016:297). The authors used the four phases described by Vaismoradi et al. (2016) of thematic analysis. In the initialisation phase, the researchers read the verbatim transcripts and highlighted units meaning, coding was conducted and supported by the abstracts from the participants’ data. In the construction phase, the codes were defined, organised and compared for similarities and differences. This phase allowed the researchers to simplify the codes created so that they were translated into understandable concepts and experiences of the participants. In the rectification phase, the themes developed were described and compared to the literature to identify the existing knowledge. The finalisation of themes phase, supported the development of the storyline, in which the results were narrated by describing and linking various themes to the aim of the study.

Trustworthiness refers to the degree of confidence in data, interpretation and methods used to ensure the quality of a study (Connelly 2016:435). Table 2 presents the trustworthiness principles and their application in the study.

The study received an Ethical Clearance Certificate from the College of Human Sciences Research Ethics Committee (CREC) with reference number 90414357_CREC_CHS_202 from the University of South Africa. The principles of autonomy and informed consent were adhered to by informing participants about the nature of the study, its purpose, its benefits and how they will participate in the study. Before conducting the interviews, participants were requested to sign informed consent, and the nurse practitioners and Christian leaders emailed their informed consent forms. To protect their identity, all documents with personal information were saved in a password-protected folder. For the African indigenous practitioners, informed consent was collected by author 1 before the commencement of the face-to-face interviews. During telephonic interviews, MS Teams caller was used to record the interviews. Only voice recording was done; the participants were requested to consent to the recording. The participants were treated with respect and dignity. Their cultural and religious values were acknowledged and protected by not asking offensive questions, respecting time by conducting the interviews at the date and time agreed upon and reporting the findings accurately. All raw data were saved in the researchers’ computers in password-protected folders. Only the two researchers had access to the data. No identifiable information was disseminated, and each participant had a code.

The findings from the three groups were integrated to present comprehensive meanings and interpretations. Table 3 presents the themes and sub-themes:

Nurse practitioners defined death as a lack of response to physical stimulation. This definition is consistent with biological death, which refers to the irreversible process of cellular and tissue functions leading to cardiopulmonary failure caused by the predominant cessation of spontaneous breathing, heartbeat and circulation (Le Roux-Kemp 2013:77). According to the South African National Health Act, the moment of death is defined as brain death (South Africa 2003). The Birth and Death Registration Act 51 of 1992 requires that a medical practitioner must issue a notification of death stating the cause of death for the Home Affair to register a death and provide a death certificate to the family. The Christian and African views of death suggest that there is spiritual life either with God or ancestors. For Christians, when a person dies, he or she is called to eternal life, which is life in heaven with God the Creator (Hamilton et al. 2017:665). Death is the end of the human lifespan, which essentially represents the separation between soul and body (Hartin 2022:279). In African indigenous practice, death was described as transitioning to an ancestral role. The African traditions view death as an act of reunification with ancestors; it is seen as a transition from one mode of existence to another, changing from a physical person to a spiritualised life (Mosima 2023:159). It is going home where one belongs, rejoining the old relatives for eternal life (Zungu 2021). Death is not the end, but merely a transition from the physical world to the world of spirits and ancestors (Potocnik & Adum-Kyeremen 2022:89).

The loss of physical life liberates the individual and allows them to access the spiritual world as a disembodied spirit (Attoe 2023:319). They are in a state of collective immortality in the company of the spirit (Baloyi & Makobe-Rabothata 2014).

The cleanliness of the body is crucial, regardless of whether it is alive or deceased. The participants attached importance to maintaining physical dignity during the final care of the deceased body. Rituals such as washing, dressing and being looked at by relatives are crucial for the final farewell to the deceased. The washing ritual is an intimate component of care as it involves close physical contact, exposure of the body and the transgression of some established boundaries of the social body (Vilakati & Shakwane 2024:2). The washing of the body allows families to identify, gaze and touch their loved ones. It allows them to embody and express their grief through tactile care work (Zengin 2022:360). Shakwane (2023) found that patients who were hospitalised during the coronavirus disease 2019 (COVID-19) pandemic were not afraid to die but feared to die dirty, emphasising the importance of cleanliness of the body before crossover or transitioning to ancestorhood. The body needs to be cleansed to return to its Creator God or ancestors as pure as at birth (Lobar, Youngblut & Drooten 2006:47). Zengin (2022) emphasises that washing the deceased with careful care and respect is a symbol of respect for the dead body as a newborn baby for another universe accessible in the afterlife.

Nurse practitioners who participated in the study described their responsibilities during the last office as cleaning the patient, positioning them correctly and final identification. Shortly after death, the patient is positioned in an acknowledged social form, eyes and mouth closed. Washing the body occurs within the first few hours after death, while the dead body may still be warm and more akin to a living body; soiled, blood stains and other signs of suffering from the dead body are removed (Hadders 2007). While nurses wash the deceased body, they wash the patient’s private parts with a towel, protecting the privacy and integrity of the deceased (Hadders 2007:220). During the last office, the patient’s body is both dead and naked; identity has been removed and recreated as a corpse by the addition of shrouds and labels (Quested & Rudge 2003:589). Therefore, the deceased body should be treated with respect and dignity.

Family members or designated community members are responsible for cleanliness at the time of death. They pay their last respects to the deceased and prepare the body for the transition to the next life.

During the mourning period, religion and culture play an important role as they determine the process to be followed. Traditional sources of community support are critical in dealing with death and crisis. Ritual is a specific behaviour or activity that gives symbolic expression to certain feelings and thoughts of the actor or actors individually or as a group (Makgahlela et al. 2019:95). They are beneficial towards the process of acceptance and recovery (Woods 2014). After death, the deceased goes through ceremonies to remember the deceased and to assist the soul in going to heaven (Lobar et al. 2006:48). Rituals are also representations of cultural performances and rites of passage which mark people’s life experiences (Baloyi & Makobe-Rabothata 2014).

The nurse practitioners are responsible for notifying relatives about the death of their loved one and discharging the care of patient belongings (Quested & Rudge 2003:579). Because death is a community event, the family announces to the extended family and community for collective grief. In African communities, death is a social event that initiates a person into a social afterlife (Makgahlela et al. 2019:99), thus advocating for collective support and mourning.

Body and spirit should be connected at the funeral. Participants in this study emphasised the importance of fetching the spirit ritual performed when the person dies away from their home. The ritual of fetching the spirit refers to a traditional act that aims to retrieve the spirit or soul of a deceased person from the place of death and bring it home where it can rest in peace (Jiyane, Phiri & Peu 2012). This is done to prevent deceased wandering spirits (Khosa-Nkatini, Wepener & Meyer 2020:2). In Zulu culture ‘Umlahlankosi’, known as the Buffalo Thorn tree, is used to summon the spirit of the deceased (Hans 2015). The delegated family members use the branch where the person died and speak to the deceased to come home. The spirit of the deceased is believed to ride on the branch from the place of death to the burial site (Cann 2018). In this ritual, the dedicated person carries the branch and does not speak throughout the journey.

The burial rituals are carried out so that cohesion, peace and solidarity can be restored within the family and society (Zungu 2021:4). Current practice in Christian churches shows a similar respect and reverence for a person’s body after death. According to the Code of Canon Law of the Roman Catholic Church:

It is important to emphasise that a Christian funeral is not just the burial of a person’s body in the ground but an act of honouring the body and bringing solace and hope to the living.

The loss of physical life frees the individual and allows them access to the spiritual world as a disembodied spirit (Attoe 2023:319). They are in a state of collective immortality in the company of the spirit (Baloyi & Makobe-Rabothata 2014). It is believed that the burial of the loved one has a connection to their resting place and ensures the continuity of life beyond the grave. An individual life in a spirit world, receiving a new body that acts as an ancestor, is only possible for individuals who have lived a meaningful life (Ekore & Lanre-Abass 2016). Visiting the grave allows one to reflect on the life they shared with their loved ones come to terms with the new life without the person, and ask for success and wellbeing (Ngubane 2004).

African and Christian spirituality supports the connection between the living and spiritual worlds. The belief that death leads one to God or ancestors gives the family hope as they continue to remember their loved ones by visiting the cemetery. In isiZulu, a burial is considered ‘ukungcwaba’ or ‘ukufihla’ – Africans do not separate themselves from their dead but rather exist in relation to the world of their ancestors (Maphela 2021:6).

Nurses deal with death and dying experiences on a daily basis and provide physical care with respect and dignity. Based on the insights presented, each practitioner has a specific role to play in the person’s transition to the next life. Knowledge sharing is crucial to understanding patient and family cultures and practices for integrated collaborative care of the body. Every practice has accepted values and norms that are adhered to. Therefore, creating a safe space for the sharing of knowledge and experiences is critical to identifying common practices and divergences that need to be reconciled for deceased persons and families.

The study was limited to three Nguni cultures: Zulu, Swati and Ndebele. Because this is a qualitative exploratory-descriptive study, the results cannot be generalised. To generalise the results, different cultural groups and research designs should be used in different contexts.

The study results recommend strengthening collaborative practice in multidisciplinary practice. This collaboration aims to improve the quality of cohesion in the care of people from the physical end of life to the transition to spiritual life. Nurse practitioners should understand the patient’s cultural and religious practices to provide quality care. This can only happen when knowledge is shared openly as well as their common reasons and disagreements. The body of a deceased patient should be treated with respect and dignity during the last office procedure. African indigenous practice becomes important, especially in fetching the spirit. Diverse cultural practices should be respected and appreciated.