by Cornelia M Ruland and Shirley M Moore Presented by Jennifer Totten Angela Baird and Amy Howard Group 3 Nursing 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 practi ID: 362116
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PEACEFUL END OF LIFEby Cornelia M. Ruland and Shirley M. MoorePresented by Jennifer Totten, Angela Baird, and Amy Howard
Group 3
Nursing 324Slide2
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. Slide3
The terminally ill patient has a illness that within 6 months or less are expected to die. The terminally ill patient no longer wishes to have procedures done on them in the hope of a cure. 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.Slide4
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. Slide5
TheoristsCornelia M. Ruland
Received her PhD in nursing from Case Western Reserve University, Cleveland, Ohio in 1998. Currently she is the Director of the Center for shared Decision Making and Nursing Research at Rikshospitalet University hospital in Oslo, Norway and holds an appointment as adjunct faculty at the Department of Biomedical Informatics at Columbia University in New York. Ruland has been the major investigator in many research projects and had won awards for her work (Tomey & Alligood p.775).
Shirley M Moore
Received her master’s degree in Psychiatric and Mental Health nursing (1990) and her PhD in Nursing Science (1993) at Case Western 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 cardiac events and has assisted in development and publication in several theories
(Tomey & Alligood p.775).Slide6
The Peaceful End of Life theory was developed from 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).Slide7
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 Moore 1998).Slide8
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).Slide9
The focus was not on dying in itself but on peaceful 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 symptom
management (Ruland and Moore 1998).Slide10
He/she needs to have a caring attitude, awareness, sensitivity and compassion for the terminally ill patient (Ruland and Moore 1998).Slide11
This model started while Ruland was a student 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).Slide12
The major concepts that this theory is based on are:
1) Being free of pain
2) Experiencing comfort
3) Experiencing dignity and respect4) Being at peace5) Being close to your significant others Slide13
Free of painNot 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).Slide14
ComfortThe experience of comfort for this theory was defined as the relief from discomfort, the state of ease and peaceful contentment, and whatever makes life easy or pleasurable (Ruland and Moore 1998).Slide15
Experiencing dignity and respect
The experience of dignity was defined as being respected 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).Slide16
Being at peaceThe 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.
Slide17
Closeness to significant others
Closeness of significant others for this theory is the feeling of connectedness to other human beings who care (Ruland and Moore 1998).Slide18
Peaceful End of Life
(Ruland and Moore 1998 p.174)
Not being in pain
Experience of Comfort
Experience of Dignity/Respect
Being at Peace
Closeness to Significant Others/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 and Preferences
Providing Emotional Support
Monitoring and Meeting Patient’s Needs for Anti-anxiety Medications
Inspiring Trust
Providing Patient/Significant Others With Guidance in Practical Issues
Providing Physical Assistance of Another Caring Person, if Desired
Facilitating Participation of Significant Others in Patient Care
Attending to Significant Others Grief, Worries and Questions
Attending to Significant Others Grief, Worries and Questions
Facilitating Opportunities for Family ClosenessSlide19
Reduction of outcome criteria from the standard to outcome indicators of the proposed theory
Standard
The patient is not having pain
The patient does not experience nauseaThe patient does not experience thirstThe patient does experience optimal comfortThe patient and significant others experience a pleasant environmentThe patient and significant others participate in decision making regarding the patient’s careThe patient and significant others experience being treated with dignity and respect as human beings
The patient and significant others maintain hope and meaningfulness
The patient and significant others get assistance in clarifying practical and economical issues related to the patient’s coming 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
Theory
Not being in pain
Experience of comfort
Experience of dignity/respect
Being at peace
Closeness to significant others/persons who careSlide20
Outcome Criteria of the Standard of Peaceful End of Life
The patient:
Is not having pain
Does not experience nauseaDoes not experience thirstExperience optimal comfort Is at peaceDoes not die aloneThe patient and significant other(s):Have confidence that they are receiving the best possible careMaintain hope and meaningfulnessParticipation in decision making regarding the patient’s careExperience 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 of the Peaceful End of Life . Nursing outlook, 46, 169-75. Slide21
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.Slide22
This theory could be accommodating to any care setting or with in a patients home. 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 othersSlide23
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. Slide24
As the nurse, you will need to be prepared to provide pharmacological and non-pharmacological treatments. You will need to be comfortable in helping with the significant others, as well as the patient, cope with the disease and the disease process. Slide25
As nurses you will be educating the patient and significant others on the disease 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 and respect. Slide26
As the patient declines the patient may not be able to verbalize pain, discomfort, anxiety, restlessness, or other complications 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. Slide27
Education will be prepared for you and shared with you to assist you in your comfort and confidence level with this Peaceful end of life theory,included, but not limited to:Slide28
Signs and symptoms
Pain
Discomfort
NauseaIncontinenceFearConfusionEmbarrassmentHumiliationAnxietyRestlessnessWithdrawnDepression
Loneliness
Treatments
Pharmacological
Non-pharmacologicalSlide29
This model provides a framework that reminds nurses of the important aspects of care during the end of life. It reminds nurses to not only treat the patient but also the significant others. It calls for thorough assessments of the alert patient as well as the patient that no longer is alert, and to assess the need for medication or non-medication interventions. Slide30
A limitation that this model has is the fact that it does not address cultural differences toward end of life care. For example, some cultures may feel that the end of life is a very private time only allowing specific people to share time with their loved one, others have the whole family (all adults or all ages) in the room. Certain cultures may also rely on home remedies or have rituals they may wish to perform. Slide31
“Weakness of the theory include needing more 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).Slide32
Nursing Education:
Currently there are no publications that report the use of this theory for education.
This theory can be applied to a master’s prepared nurse because it is important that the master’s prepared nurse educate he/she on this theory and end of life issues. This will help to educate his/her students to understand end of life issues. Also when ever the opportunity allows, give the patient, significant other, and family the best experience possible and a peaceful end of life (Tomey & Alligood 2006). Slide33
Strengths of Theory:Can be used in everyday patient care.New and original, based on standards of care and can be directed towards patient clinical practice.Slide34
Developed for the terminally ill who expect death and can prepare for it.
With the development of the theory nurses are able to treat patients, significant others, and family with dignity, respect, and empathy.
Guides nurses in choosing interventions to decrease 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).Slide35
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 in the 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 eye drops 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. Soon someone is holding your hand, the anxiety and pain are melting away, and you are able to rest comfortably.Slide36
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 and Therapies Texas Tech University Health Sciences Center School of Nursing,
Submitted to: Yondell Masten, October 17, 2007.
Ruland, Cornelia M. RN, PhD & Moore, Shirley, M. RN, PhD. Theory Construction Based on Standards of Care: 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.