Peaceful End of Life Theory This paper is written to examine Corneila Ruland and Shirley Moore’s Peaceful End of Life Theory and its examination on promoting positive outcomes for patients and their families during the dying process. Also, examine how the theory is understood in the Christian view as well as viewing ethical principles. As a Critical Care nurse I care for the dying patient mostly on a daily basis. During this process, I not only want to care for the dying but, I want to learn how I can ease the pain and heart break of the family.
During my study of Theory and Ethics, I discovered Cornelia M. Ruland and Shirley M. Moore’s Peaceful End of Life Theory. This theory shows how theory addresses the holistic care required to support a peaceful end of life. I found this theory to be useful by being free of the suffering of distress, providing comfort, respect as a human being, having peace and by being with those who care. (Martha Raile Alligood, PhD, RN, ANEF, Ann Marriner Tomey, PhD, RN, FAAN, 2010). Ruland and Moore theorize that with easing fears of death, it can be a peaceful end of life event.
Not just by providing daily needs and task but, also by caring for the dying (2010, p. 754). Many factors contribute to end of life situations for all patients, families, and health care providers. During the Peaceful End of Life Theory the standard of care is based on research in areas of pain management, comfort for the patient, nutritional needs for the patient, and relaxation needs (2010, p. 755). These factors are influenced by age, history of illness, religious values, and heath care concerns. Most of our efforts as humans are to improve our quality of life.
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Understanding the importance of having a peaceful transition into another stage of life is beneficial. Death is always inevitable and always a factor in the lives of family members facing such a stressful time. We should strive to help minimize pain and suffering at the end of our life’s journey with peace and comfort. Providing comfort is the most important part of quality care with an advanced illness. Within the peaceful EOL theory there are major concepts that are examined and reviewed by patients that are in the dying process. EOL care focuses primarily on comfort when a cure is no longer possible.
Also, being free of pain is mostly the central part of many patients going through the EOL experience. A treatment plan should take place when a patient is experiencing pain. Becoming pain free is one of the major concerns of people dying (Dunn, 2001). To have peace with yourself and your loved one, you must distinguish your pain from their pain. Showing respect and having dignity helps the patient feel that they are still loved and cherished as individuals. Having peace with the decisions they have made and the outcome helps the patient transition over into the EOL concept.
I feel that if a patient is not at peace with death and dying then it makes it extremely hard for the family. If a patient is having no worries or fears to leave this earth, then they are physically ready, psychologically ready and spiritually ready to face the end of their life. The last concept to talk about is being close to their families in a trying time (2010, p. 756). Feeling at peace and having closeness to others helps the patient transition peacefully which could be the scariest part of dying. During any point of illness patients and families need to be prepared emotionally and spiritually for death (Dunn, 2001).
Ruland and Moore identified six theoretical assertions for the peaceful end of life theory that include: monitoring and administering pain meds, getting family involved in decision making regarding decisions that need to be made for the patient, relieving physical discomfort by encouraging rest periods, relaxation, provide support to the patient and family members, encourage family participation with patient care and last, monitoring the patients comfort, dignity and respect (2010, p. 757). Critique Clarity In the peaceful end of life theory all of its theory has been covered and has clearly been understood.
The assumption of the theory, that providing comfort for the patient allows a better transition into the stages of the end of life to supporting the family through difficult times shows how the concept varies in different degrees, but are all important to the theory (2010, p. 758). Simplicity The EOL theory has been described as one of the higher levels of middle range theories. It focuses on what is important to the patient at the end of life and how the patient views life. It also has several different aims and aspects on how one values the comfort and dignity throughout the rest of their life (2010, p. 59). Generality The peaceful end of life theory concept came from a Norwegian context that based a study on the dying. The theory is based on not being in pain, the experience of comfort, having dignity and respect, being at peace, and allowing the patient to be close to significant others. This theory allows the standards to guide a person through the peaceful end of life and allows the family to respond and adapt (2010, p. 759). Empirical Precision Each part of the peaceful end of life concept is based on the inductive and reasonable part of guiding the practice.
With the EOL theory its five concepts measured were mixed. Its observations were based on the patient and family perceptions of their care with the decisions made during the dying process (2010, p. 760). In the empirical precision the EOL theory illustrates that the five concepts were beneficial to the patient and the family. As nurses dealing with end of life issues, we strive to take care of the personal values of the patient but, also the medical, legal, and ethical aspects of the decision process get in the way. Sorting through these issues helps to gain respect with the family.
Conflicts may arise with EOL decisions, but establishing report with the patient and families helps focus on the primary values of care (G. Leigh Wilkerson, 1995). Often time’s ethical issues play a big role in EOL care. For example, withdrawing care from a mechanical intubated patient is a big ethical issue. Are we prolonging life or are we delaying death. A lot of times holding people on through mechanical ventilation is not ethical. Sometimes patients get dependent on mechanical ventilation which delays death then the family has to make decisions to withdraw care.
We should respect our patient’s autonomy and allow them the freedom to make decisions for themselves. We should practice beneficence, fidelity, and non-malfeasance as health care providers. Holding on makes it harder on the patient and prolonging the inevitable (Simon, 2008). As a Christian, letting my patient die with respect and dignity would be a victory in our Saviors eyes. Life is a gift. There is a time in everybody’s life that our body is not growing and healing, but failing. This is when we enter into another phase of our life. Having a peaceful end of life is choosing quality for the rest of your life.
Reference Dunn, H. (2001). Hard Choices For Loving People 4th ed. Lansdowne, VA : A & A Publishers, Inc. G. Leigh Wilkerson, R. (1995). A Different Season The Hospice Journey. Fayetteville, AR : Limbertwig Press. Martha Raile Alligood, PhD, RN, ANEF, Ann Marriner Tomey, PhD, RN, FAAN. (2010). Nursing Theorists and Their Works 7th ed. Marylan Heights, Missouri: Mosby Elsevier. Simon, C. (2008). Ethical issues in palliative care. Retrieved from Oxford Journals: http://rcgp-innovait. oxfordjournals. org/content/1/4/274. full http://rcgp-innovait. oxfordjournals. org/content/1/4/274. full
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