Theory of the Peaceful End of Life

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16.06.2022
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The use of nursing theories in practice has been embraced by many nursing professionals and healthcare institutions in the recent past. Owing to their elementary concepts derived from nursing models and other related specialties, these theories provide the nursing profession with extensive comprehension of healthcare fundamentals. Particularly, mid-range nursing theories seek to investigate specific occurrences and formulate correlations that discuss feasible solutions to challenges facing nursing practice. As a result, they are imperative in enhancing the effective evidence-based practice (EBP) strategy in service delivery. The purposive approach depicted by the theories enables the skillful nursing personnel to provide quality health care across the country and beyond. Their empirical, inferential, and abstract ideas equip professional nurses with excellent intervention skills that foster solid rationales in nursing practice. For example, the theory formed a basis for the development of a model for palliative care amongst sickle cell patients (Alligood, 2014). The theory of the peaceful end of life formulated by Ruland and Moore is an instance of a mid-range nursing theory. To examine the feasibility of the mentioned theory, the backgrounds and experiences of Ruland and Moore should be investigated as well as effectiveness and application of their theory in nursing practice must be analyzed.

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Theorists’ Name and Background

Theory of the Peaceful End of Life by Ruland and Moore

The selected mid-range theory is the theory of the peaceful end of life (PEOL) put across by Ruland and Moore in 1998. I find this approach significant in my work as a nurse, especially when handling sick people who are suffering from terminal diseases. Since the eventual aftermath of such illnesses is patient death, this conceptual theory is useful, as it instills in me the necessary knowledge associated with guiding terminally-ill patients in embracing a peaceful end of life that is free from suffering. This process promotes substantive decision-making and a smooth transition of the state in the victim’s body, mind, and spirit. Additionally, it enables me to psychologically prepare the families of dying patients and encourage them to accept the situation. Consequently, theory plays an important role in my field of practice.

Background Review of Ruland and Moore

Cornelia Ruland and Shirley Moore are the two theorists who created the concepts of end-of-life and came up with the PEOL theory (Alligood, 2014). They interacted and underwent various experiences that shaped the development of their approach as described below.

Cornelia Ruland. Cornelia Ruland undertook most of her academic education in Norway. For instance, she went to the University of Bergen to pursue an Undergraduate Coursework degree in Philosophy majoring in Social Sciences. She also acquired another degree in Nursing in Haukeland School of Nursing, where she qualified as a registered nurse (RN). After that, Ruland got a certification in Pediatric Nursing as a specialist at the Oslo National Hospital. Moreover, she studied at the University of Oslo where she acquired a Master’s Degree in Nursing Administration. Finally, Cornelia Ruland went to the Case Western Reserve University (CWRU) in Ohio, where she acquired a Doctorate degree in Nursing Informatics. Throughout her nursing career, Ruland has carried out several research studies and has held many leadership positions in the profession. For now, she is the Director of Nursing Research at the Norwegian Rikshospitalet University Hospital.

Shirley Moore. Shirley Moore’s nursing education began in Youngstown Hospital Association of Nursing where she got a diploma in Nursing. She then proceeded to Kent University from where she graduated with an undergraduate degree in Nursing. After that, Moore went to CWRU, where she acquired a Master’s degree in Nursing. Moreover, she also got a doctorate degree in Nursing at the same university. Similar to Ruland, Moore has also done research and published several articles on nursing practice. In addition, she has chaired many institutions relevant to the nursing profession, and currently she is a Professor of Nursing and Associate Dean of research at CWRU.

Due to their profound knowledge acquired throughout their education and experience gained during nursing practice, Ruland and Moore are highly qualified specialists, as they took part in the early academic advancements of the nursing profession. Additionally, the interaction of the two professionals at CWRU, with the former as a student and the latter as a faculty, provided an opportunity for the development of the PEOL theory (Alligood, 2014). The theory was developed in a doctoral theory course assignment whereby Ruland was seeking to develop a standard of care for cancer patients on a gastroenterological unit in the clinical practice. It was based on Donabedian’s model which focuses on the framework, procedure, and results (Fitzpatrick & Kazer, 2012). The aim was to formulate directions for taking care of terminally ill victims while focusing on supporting them emotionally, socially, and psychologically. Consequently, their intensive academic knowledge and experience in the provision of health care for terminally ill patients were important in the development of the theory.

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Literature Review on the Relevance of the PEOL Theory and its Applications

In many intensive care units and high dependency units, end-of-life care is often delivered to the patients whose chances of survival are limited, especially in the case of those who undergo life supporting therapies. As a result, the PEOL theory has been recognized and endorsed by various scholars and practitioners as illustrated.

Fitzpatrick & Kazer (2012) analyzed the PEOL theory by Ruland and Moore. They argue that every terminally ill patient is entitled to respect and value as a human being. In accordance with this notion, the PEOL theory sums up the concepts of individual worth and respect as well as incorporates the ethical principle of respect for people by protecting their feelings and thoughts during their terminal stage of life. As a result, Fitzpatrick & Kazer (2012) endorse the PEOL theory as being fully applicable in nursing practice.

The peaceful end of life theory also promotes physical and emotional peace as per Rome et al. (2011). They describe internal peace as a feeling of tranquility and satisfaction that is free from worry. Fitzpatrick & Kazer (2012) give the example of patients suffering from sickle cell anemia. According to the authors, these individuals need holistic care particularly during their final stages of life. The pain and psychological stress that they undergo in the process often culminate in the feeling of social isolation, and in some cases, they give up. Therefore, the PEOL theory is important in taking care of such patients.

Lippincott Williams & Wilkins (2013) explain that most terminally ill patients are afraid and feel anxiety in confronting death. According to them, reasons such as fear of the unknown, death, guilt, and judgment and punishment after death pose a psychological stress to the ill persons. The authors thus support the PEOL theory, as it handles this issue by providing emotional coaching to the patients while preparing them to their demise.

Problems Addressed by the Theory

The PEOL theory addresses three problems faced by terminally ill patients. First, it considers the issue of psychological challenges of the patients. The feeling and knowledge that one’s death is approaching are difficult to contain and thus pose an emotional suffering on the ill people (Forero et al., 2012). As the theory asserts, a nurse handles this problem by carefully and systematically offering therapies to the patients to foster acceptance and encouraging them to press on. Besides, the approach considers the challenges related to personality, mood swings, and depression and addresses them accordingly.

Additionally, the PEOL theory emphasizes on individual dignity and sense of belonging. In some cases, the patients suffer neglect from family members while in the hospital. Some ill individuals are rarely visited by their relatives, and this demoralizes them to a great extent that they end up feeling like a burden to their families (Rome et al., 2011). The theory addresses these concerns by harmonizing relationships between the patients and their family members by encouraging the latter to regularly check on their patient. As a result, emotional support is provided and a sense of belonging of the ill person to the family is established.

Finally, the theory expresses concern on decision making. Sometimes patients are required to make important decisions regarding their families, as in the case of making a will. The PEOL theory guides the nursing practitioners in assisting the terminally ill individual to make sound and viable wills about their family and their property. Consequently, the theory enhances decision-making amongst patients.

Theory Description

Inductive and Deductive Reasoning

The PEOL theory uses both inductive and deductive reasoning (Alligood, 2014). Inductive reasoning, on the one hand, involves a combination of logical propositions to come up with a final statement. It is often used in scenarios that are associated with forecasting or predictive phenomena. On the other hand, deductive reasoning approaches issues from a general point of view. As for the peaceful end of life theory, Ruland and Moore developed it from a standard of care as a response towards the need for holistic care for terminally ill patients in a Norwegian hospital (Alligood, 2014). The need for patients’ care formed the basis of inductive logic whereas the standard developed provided a basis for deductive logic. Consequently, the standard linked theory and clinical practice resulting in a relationship between the two types of reasoning.

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Concepts of the Peaceful End of Life Theory

The PEOL theory is based on five concepts which revolve around the livelihood of the patients with terminal illnesses. They include;

· Being at peace: the fundamental aspect of this theory lies in the peace of the patient physically, emotionally, and spiritually. As stipulated by the approach, the nursing officer is tasked with the commitment to ensuring the peace of the ill person. The nursing professional is required to engage the patient in meaningful discussions and conversations geared towards achieving peace with oneself (Lippincott Williams & Wilkins, 2013). In this case, the nurse describes the process and predicament that the suffering individual is undergoing including what is to be expected and any possible occurrences;

· Patient comfort: the theory requires that the patients’ comfort should be paramount in all clinical procedures administered to them, and that their experience in the facility should be comfortable and safe (Silva et al., 2015). It further emphasizes that the nurse should ensure that the environment is clean and tranquil to foster contentment and relaxation of the ill people;

· Patient dignity and respect: according to the PEOL theory, the patient as a human being should be accorded utmost respect and treated with dignity during service delivery. This implies that ill people should be consulted during decision-making, and their needs should be addressed emphatically. While ensuring a peaceful end of life for a patient, the nurse should withhold patient rights, practice integrity, and observe professional ethics to promote a smooth transition of the patient to the next stage;

· Protection of the patient from pain: Ruland and Moore describe the pain as an uncomfortable feeling and emotional restlessness that is related to body injury (Alligood, 2014). Their theory affirms that the patient is supposed to be protected from painful experiences where possible by palliative intervention. In this way, a peaceful end of life can be approached with the ill individuals being free from pain;

· Closeness to family and friends: the theory depicts the relationship of the patients and their significant others as being therapeutic in psychological well-being. As per Ruland and Moore, the nurse has a duty to strengthen this relationship to facilitate the patients’ peaceful end of life (Alligood, 2014). This concept is important in maintaining connections between the ill people and their families and friends thus eradicating loneliness and the feeling of isolation.

Ruland and Moore are consistent in using the terms and describing the concepts in the theory. They illustrate close interactions between the concepts and how they interrelate to collectively support a terminally ill patient towards a peaceful death.

Interpretation of the Definition of Concepts

The concepts of the PEOL theory have been explicitly defined by the authors in detail and without any discrepancies. The concept of peace implies that an individual is progressively counseled by a nursing professional to accept the reality. Nevertheless, the ill individuals is, first of all, required to understand the situation in which he or she is, and then appreciate the importance of embracing a peaceful transition.

Patient comfort as a concept entails physical and emotional comfort (Silva et al., 2015). It goes beyond a calm environment. The people around the patients are required to assist them with any needs that they may have considering their preferences to ensure that they get the best care.

Patient dignity and respect encompass the process of involving the patients and their loved ones in discussing matters concerning them and considering their opinions in making decisions. Moreover, they theory maintains that they should be treated as equal and respected as important members of the society. Care should be observed by those interacting with the patients to ensure that they are not exposed to anything that breaches their values.

As the theory explains, the patients should be protected from pain not only physically but also emotionally. Fitzpatrick & Kazer (2012) argue that emotional pain can arise due to the feeling of isolation and ill-treatment by those around them. Thus, the nurse should ensure both emotional and physical pain is not inflicted on the patient to enhance a peaceful death.

Closeness to family and friends goes beyond their support to the patients. The nurse should also attend to those who are grieving, worrying, and questioning about their loved one. He or she should also facilitate and maximize opportunities for interactions between the patients and their loved ones.

Relationships among Major Concepts

While developing the peaceful end of life theory, Ruland and Moore ensured that the basic concepts of the theory interrelate and depend upon each other. For example, pain and comfort are complementary aspects. The presence of pain implies that comfort will be compromised and vice versa (Rome et al., 2011). As a result, the patient’s peace of mind will be inconsistent. Similarly, treating ill people with dignity and respect promotes internal peace. The closeness of family and friends also leads to peace and enhances comfort. As a result, the five concepts correlate to satisfy the requirements of the theory and its applicability in nursing practice.

Theory Evaluation

Assumptions Underlying the Theory

According to the theorists, there are implicit and explicit assumptions regarding the peaceful end of life theory as identified below.

Implicit assumptions. The PEOL theory has two implicit assumptions. They are: (1) the family holds a significant position in end-of-life care. It includes all friends and next of kin. (2) The objective of this care is not to be regarded as the most feasible, rather maximize patient care using technology and comfort strategies to foster peaceful death (Alligood, 2014).

Explicit assumptions. The theory has the following explicit assumptions: (1) the experience of the end-of-life care is personalized and affects individuals separately. (2) The role of a nurse is imperative in enhancing a peaceful end of life process. (3) The nurse is in a position to observe a patient’s experience and respond by using appropriate interventions.

The Peaceful End of Life Theory and the Concepts of Nursing Metaparadigm

The PEOL theory identifies the four dimensions of nursing metaparadigm (Alligood, 2014). They include;

1. Person: the theorists depict the person as the patient who is suffering from terminal illness with various elements of psychological and social disorders, and high dependency levels;

2. Environment: this aspect describes the patient’s physical location and portrays his or her quality of life. It is considered in provision of care;

3. Health: the theory focuses on terminal illnesses such as cancer and sickle cell anemia and the provision of holistic end-of-life care to achieve peaceful death;

4. Nursing: the theory affirms that the objective of end-of-life care is to facilitate a peaceful process of death while ensuring that the concepts of the patient’s comfort, peace, respect, closeness to family, and protection from pain are fulfilled.

Clarity of the Theory

Lucidness. Ruland and Moore, in their PEOL theory, clarify that providing efficient end-of-life care to terminally ill patients during their last stage of life promotes a peaceful death. According to Forero et al. (2012), it also enhances counseling of the bereaved members and thus psychological therapy. The theory lays down the five basic concepts used to facilitate its implementation. Consequently, it is lucid to everyone who takes their time to study it.

Consistency. There is logic in the outline of the concepts of the theory. Due to their interdependence, the theory is thus consistent. Besides, it complements other nursing theories, since they have a common area of application which is caregiving (Fitzpatrick & Kazer, 2012). This implies that the theory is consistent.

Application of the Theory

How the Theory Can Guide Nursing Actions

From time immemorial, nurses always interact with patients and their families. Lippincott Williams & Wilkins (2013) maintain that nursing roles include assessments of the patient’s health and vital signs, diagnosis, and interventions to treat the patient. They further claim that in cases where intervention cannot be achieved, as in the scenarios of terminal illnesses, holistic care is necessary to assist the patient in handling the disease. The PEOL theory can, therefore, be used by nurses to facilitate a peaceful transition of the ill person to death. Moreover, it can be used to provide counseling therapies to the family and loved ones upon the demise of the deceased. Consequently, the nursing objectives in attending to the patient are achieved.

Application of the Theory of the Peaceful End of Life in Nursing

The PEOL theory is useful to me in my nursing practice in numerous ways. For example, it improves my guidance and counseling skills in providing emotional therapy to patients in my work area. I can confidently approach an ill person and encourage him or her to endure the suffering while supporting them psychologically. The theory also instills in me the knowledge on how to improve relationships between my patients and their significant others. In this way, I can deliver my service as a professional nurse. Additionally, I can collect facts on beliefs and misconceptions about death and diseases while interacting with my patients and their families. This will enable me to appreciate diverse cultures and add more concepts to my research.

Conclusion

Nursing theories are currently used as a basis for implementing evidence-based practice in many parts of the world. The peaceful end-of-life theory, for instance, can be used to successfully guide a nurse in caring for a terminally ill patient, as the latter embraces peaceful death. The approach used by Ruland and Moore in developing the theory implies that holistic patient care in health facilities and at home is important in ensuring patient comfort and well-being. The approach has been analyzed rigorously, and its applications in nursing indicate that it is significant in areas such as intensive care and high dependency units. Moreover, its counseling guidelines imply that it can be employed in other nursing areas to provide guidance on nurse-patient relationships.

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