Peaceful End of Life Theory

7/21/2019 Peaceful End of Life Theory.

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PEACEFUL END OF LIFEby Cornelia M. Ruland and Shirley

M. Moore

Presented by Jennifer Totten, Angela

Baird, and Amy Howard

Group 3Nursing 324



Letter to organization:

Dear Hospice organization,

We would like to introduce ourselves today as advocators for the Peaceful End of Life Theory.

Through our practice and research of theory we hope that your nursing organization will

adopt this theory to your everyday nursing practice of terminally ill patients as we have. This

theory can be used in all settings of Hospice care, where ever the patient or family chooses.

This includes their home, nursing home , hospital, and inpatient hospice care facility. We will

introduce you to the founders of the theory and give just a little background of their nursing

career. So get comfortable and let us show you what we feel is the up and coming theory for

your practice. This theory that will make you more knowledgeable about the complex care for

the dying patient and how you can make it the best experience for the patient, significant

other, and family during their peaceful end of life.

Angela, Amy and Jennifer.

http://images.google.com/imgres?imgurl=http://www.britsattheirbest.com/images/ii_hospice_hands.gif&imgrefurl=http://www.britsattheirbest.com/ingenious/ii_20th_century_1950_1970.htm&usg=__eoEcYxcnArP_E5m78sI1FHefuFs=&h=293&w=390&sz=52&hl=en&start=10&tbnid=jH9iYa6UZ08mxM:&tbnh=92&tbnw=123&prev=/images?q=hospice&gbv=2&hl=en



The terminally ill patient has a illness that within6 months or less are expected to die. The

terminally ill patient no longer wishes to have

procedures done on them in the hope of acure. He/she has accepted the fact of their

death and is preparing to die with the best

experience for them, their significant other

and family.



With terminal patients the doctor does not

focus on them, so it is up to the nurses to

show knowledge about the dying process and

symptom management. The nurse needs to

know the complexity of taking care of a

terminally ill patient and how they can

contribute to a peaceful end of life.



Theorists

• Cornelia M. Ruland

Received her PhD in nursing from CaseWestern Reserve University, Cleveland,

Ohio in 1998. Currently she is the Directorof the Center for shared Decision Making

and Nursing Research at RikshospitaletUniversity hospital in Oslo, Norway and

holds an appointment as adjunct faculty atthe Department of Biomedical Informatics

at Columbia University in New York.Ruland has been the major investigator in

many research projects and had wonawards for her work (Tomey & Alligood

p.775).

• Shirley M Moore

Received her master’s degree in Psychiatricand Mental Health nursing (1990) and her

PhD in Nursing Science (1993) at CaseWestern Reserve University, Cleveland,

Ohio. She has taught nursing theory and

science to all levels of nursing students.Moore also conducts research and theory

development in the recovery of cardiacevents and has assisted in development

and publication in several theories

(Tomey & Alligood p.775).



The Peaceful End of Life theory was developedfrom the standard of care of peaceful end of

life. The standard of care was developed by a

experienced group of nurses in Norway. This

was on a gastroenterological unit where half

of the patients were diagnosed with cancer

and dealing with terminal illness was on a

daily basis (Ruland and Moore 1998).



These nurses all had 5 or more years experience

with terminally ill patients and had attended

seminars and other post graduate education

on this group of patients (Ruland and Moore1998).

http://images.google.com/imgres?imgurl=https://www.naturespassage.com/images/hospice.jpg&imgrefurl=https://www.naturespassage.com/preplanning.php&usg=__TrN8RNO0lAuOlA5iDn3dAxahX-0=&h=248&w=299&sz=19&hl=en&start=5&tbnid=pUu3KdRFMJj3vM:&tbnh=96&tbnw=116&prev=/images?q=hospice&gbv=2&hl=en



They identified a need for clinical guidance in

taking care of these patients and giving them

quality care. This resulted in the development

of the theory for the Peaceful End of Life by

Ruland and Moore (Ruland and Moore 1998).



The focus was not on dying in itself but onpeaceful and meaningful living during the final

days that remained for the patients,

significant others, and family members. It also

reflected the complexity that is involved with

taking care of the terminally ill patient and the

need to have knowledge on pain relief and

symptommanagement (Ruland and Moore 1998).



He/she needs to have a caring attitude,

awareness, sensitivity and compassion for the

terminally ill patient (Ruland and Moore

1998).



This model started while Ruland was astudent in one of Moore’s classes. Ruland

helped develop a standard of practice for end

of life to provide a structured framework

where there had previously been none.

Ruland with the help of Moore then

developed the Peaceful End of Life Theory

from this standard of practice (Tomey &Alligood 2006, pp. 775-8).



The major concepts that this theory

is based on are:

1) Being free of pain

2) Experiencing comfort

3) Experiencing dignity and respect

4) Being at peace5) Being close to your significant

others



Free of pain

Not being in pain is defined within this theory as

not having the experience of pain(Ruland &

Moore 1998).

Pain further is described as an unpleasant,

sensory, and emotional experience associated

with actual and potential tissue damage or

described in terms of such damage (Ruland &

Moore 1998).



Comfort

The experience of comfort for this theory

was defined as the relief from

discomfort, the state of ease andpeaceful contentment, and whatever

makes life easy or pleasurable (Ruland

and Moore 1998).



Experiencing dignity and respect

The experience of dignity was defined as beingrespected and valued as a human being, having the

value of worth (Ruland and Moore 1998).

This includes, being acknowledged and respected as an

equal and not being exposed to anything that

violates the patient’s integrity and values (Ruland

and Moore 1998).



Being at peace

The definition for being at peace for this theory

involves the feeling of calmness, harmony, and

contentment (Ruland and Moore 1998).

To be free of anxiety, fear, and worry.



Closeness to significant others

Closeness of significant others for this theory is

the feeling of connectedness to other humanbeings who care (Ruland and Moore 1998).



Peaceful End of Life

(Ruland and Moore 1998 p.174)

Not being in pain Experience ofComfort

Experience ofDignity/Respect

Being at Peace Closeness to SignificantOthers/Persons Who Care

Monitoring and

Administering pain

relief

Applying

Pharmacological and

Non-pharmacological

Interventions

Preventing,

Monitoring and

Relieving Physical

Discomfort

Facilitating Rest,

Relaxation and

Contentment

Including patient

and Significant

Others in Decision

Making

Treating Patient

with Dignity,

Empathy and

Respect

Being Attentive to

Patient’s

Expressed Needs,

Wishes andPreferences

Providing

Emotional

Support

Monitoring and

Meeting

Patient’s Needs

for Anti-anxiety

Medications

Inspiring Trust

Providing

Patient/Significa

nt Others With

Guidance in

Practical Issues

Providing

Physical

Assistance of

Another Caring

Person, ifDesired

Facilitating

Participation of

Significant Others in

Patient Care

Attending to

Significant Others

Grief, Worries and

Questions

Attending to

Significant Others

Grief, Worries andQuestions

Facilitating

Opportunities for

Family Closeness

http://www.evergreenhospicecare.com/images/cover_image1.jpg



Reduction of outcome criteria from the standard to

outcome indicators of the proposed theoryStandard

The patient is not having pain

The patient does not experience nausea

The patient does not experience thirst

The patient does experience optimal comfort

The patient and significant others experience a pleasantenvironment

The patient and significant others participate in decision making

regarding the patient’s care The patient and significant others experience being treated with

dignity and respect as human beings

The patient and significant others maintain hope andmeaningfulness

The patient and significant others get assistance in clarifyingpractical and economical issues related to the patient’scoming to an end of life

The patient does not die alone

The patient is at peace

Significant others:

Are taking part in caring for the patient as they wish

Can say farewell wit the patient in compliance with their beliefs,cultural rites, and wishes

Are informed about different funeral procedures and possibilities

TheoryNot being in pain

Experience of comfort

Experience of dignity/respect

Being at peace

Closeness to significant others/persons who care



Outcome Criteria of the Standard of Peaceful

End of Life

The patient:• Is not having pain

• Does not experience nausea

• Does not experience thirst

• Experience optimal comfort

• Is at peace

• Does not die alone

The patient and significant other(s):•

Have confidence that they are receiving the best possible care• Maintain hope and meaningfulness

• Participation in decision making regarding the patient’s care

• Experience being treated with dignity and respect as a human being

• Get assistance in clarifying practical and economical issues related to the

• Patient’s coming to an end of life

• Experience a pleasant environment

Significant others:• Are taking part in caring for the patient as hey wish

• Can say farewell with the patient in compliance with their beliefs, cultural rites, and wishes• Are informed about different funeral procedures and possibilities

• Are offered a follow-up visit after patient’s death

Ruland, Cornelia M., RN, PhD and Shirley M. More, RN,PhD, (1998) Theory Construction Based on Standards of Care: A Proposed Theory ofthe Peaceful End of Life . Nursing outlook, 46, 169-75.



In this theory the focus is not only on

the patient but on the significant others.You are monitoring and caring for the

needs of the patient: pain, comfort,

dignity/respect, peace, and their

closeness to significant others.

You are providing guidance for the

significant other, answering questions

and offering support.



This theory could be accommodating to

any care setting or with in a patientshome. No matter where the patient

resides at, the focus on care is not to be

on cure, but instead on treating the

patient toward the goals of the five

concepts: no pain, comfort, dignity and

respect, peace, and closeness with

significant others



As the nurse, your goal will be to listen

to the patient and significant others or

to look for signs of complications with

pain, comfort, dignity and respect,

peace, and closeness with significant

others.



As the nurse, you will need to be

prepared to providepharmacological and non-

pharmacological treatments. You

will need to be comfortable in

helping with the significant others,

as well as the patient, cope with thedisease and the disease process.



As nurses you will be educating the

patient and significant others on thedisease and disease process, on

what to expect as time goes on.

Remember, as you do this, keep in

mind to provide the patient and

significant others with dignity andrespect.



As the patient declines the patient may

not be able to verbalize pain, discomfort,

anxiety, restlessness, or othercomplications that need addressing.

You, the nurse, will need to be familiar

with these signs and symptoms, and

what interventions

to complete. At this point, it will be your

job to assess for problems and become

the patients advocate toward treating

these problems.



Education will be prepared for youand shared with you to assist you in

your comfort and confidence level

with this Peaceful end of life theory,

included, but not limited to:



Signs and symptoms

• Pain

• Discomfort

• Nausea

• Incontinence

• Fear

• Confusion

• Embarrassment

• Humiliation

• Anxiety

•

Restlessness• Withdrawn

• Depression

• Loneliness

Treatments

• Pharmacological

• Non-pharmacological



This model provides a framework that

reminds nurses of the important aspectsof care during the end of life. It reminds

nurses to not only treat the patient but

also the significant others. It calls forthorough assessments of the alert

patient as well as the patient that no

longer is alert, and to assess the needfor medication or non-medication

interventions.



A limitation that this model has is the

fact that it does not address cultural

differences toward end of life care. Forexample, some cultures may feel that

the end of life is a very private time only

allowing specific people to share timewith their loved one, others have the

whole family (all adults or all ages) in the

room. Certain cultures may also rely onhome remedies or have rituals they may

wish to perform.



“Weakness of the theory include needingmore research to back up the theory, as

well as the usefulness of the theory in

influencing nursing research, education,and practice. Empirical support for all the

relationships needs to be validated”

(Nursing theory 2007, p. 11).



Nursing Education:

Currently there are no publications that report theuse of this theory for education.

This theory can be applied to a master’s preparednurse because it is important that the master’s

prepared nurse educate he/she on this theoryand end of life issues. This will help to educatehis/her students to understand end of life issues.Also when ever the opportunity allows, give the

patient, significant other, and family the bestexperience possible and a peaceful end of life

(Tomey & Alligood 2006).



Strengths of Theory:Can be used in everyday patient

care.

New and original, based onstandards of care and can be

directed towards patient clinicalpractice.



Developed for the terminally ill who expect

death and can prepare for it.

With the development of the theory nurses areable to treat patients, significant others, and

family with dignity, respect, and empathy.

Guides nurses in choosing interventions todecrease suffering and make the last stages of

life a meaningful experience for the patients,

significant other and family.All nursing interventions and outcomes can be

measured (Ruland and Moore 1998).



Your mouth and eyes are dry, breathing is difficult and it is

making you nervous, and pain is present throughout your

body. Even though you can hear your family members inthe room you feel very alone. Unable to move or speak it

is impossible to make your needs known or to ask for help

and comfort. Then you hear a knock and a familiar voice,

the voice of your nurse. She swabs your mouth, puts eyedrops in your eyes, and a pill and some drops under your

tongue which instantly start to dissolve. Even though you

cannot answer she talks to you and comforts you, then

you hear her tell your family to do the same. Soonsomeone is holding your hand, the anxiety and pain are

melting away, and you are able to rest comfortably.



References:Case Western Reserve University. Frances Payne Bolten School of Nursing, picture of Shirley M. Moore

taken from http://www.fpb.case.edu, slide 5.

Columbia University. Picture of Cornelia Ruland taken from http://www.dbmi.columbia.edu, slide 5.

http://office.microsoft.com, picture slide 10.

http://www.naturespassage.com, picture slide 7

.

http://www.evergreenhospicecare.com, picture slide 18.

Nursing Theory Peaceful End of Life-Cornelia Ruland and Shirley Moore. Nursing 5330 Theories andTherapies Texas Tech University Health Sciences Center School of Nursing, Submitted to: YondellMasten, October 17, 2007.

Ruland, Cornelia M. RN, PhD & Moore, Shirley, M. RN, PhD. Theory Construction Based on Standards ofCare: A Proposed Theory of the Peaceful End of Life. Nursing Outlook , 1998, 46 (4), p.169-75.

Tomey, Ann Mariner & Alligood, Martha Raile (2006). Middle range theories: Peaceful end of life theory.Nursing Theorists and Their Work, (pp.775-781). Missouri: Mosby.

http://www.fpb.case.edu/



http://www.dbmi.columbia.edu/

http://office.microsoft.com/

http://www.naturespassage.com/

http://www.evergreenhospicecare.com/

http://www.evergreenhospicecare.com/

http://www.naturespassage.com/

http://office.microsoft.com/

http://www.dbmi.columbia.edu/


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Peaceful End of Life Theory