Peaceful End of Life Theory

Of all the areas of nursing practice, I consider oncology nursing as the most difficult area. It is not only physically and mentally taxing but also emotionally draining. In 2001,I have had the chance to work in the oncology department of Ziekenhuis Gooi-Noord in The Netherlands. The hospitals there do not allow the presence of a carer beside the patient.Visitors were only allowed during visiting hours unlike in the Philippines,where patients have a “bantay” to attend to all their needs. Part of my uniform then wasa beeper,so that I could be signaled by the patients wherever I was. The patients wouldbell for varying reasons, from pain or just to get something from their bags. So in that aspect alone, I realized that I have to be everything for the patients.

Given the gravity of end of life palliative care, it is very useful to follow a nursing theory as guide. At that time I have not yet heard about the Peaceful End Of Life nursing theory of Ruland and Moore. Although it was also around that time that the theory was created in Norway. Luckily, thedutch nurses guided me in the framework of care which is consistent to the relatively new middle range nursing theory by Ruland and Moore. I appreciated the organized well coordinated approach to care that we rendered to the patient/family. In EOL cases, it is very important to establish first a clear understanding of the plan of management and care between the patient, family, doctors and head nurse.This decision will be the basis of the individualized plan of care.As part of the nursing team, I remember how detailedour planning anddiscussionswere, taking into consideration the patient’s wishes.

The Peaceful End of Life Nursing Theory of Ruland and Moore proposes that by easing fears and anxiety, both real and or perceived for the patient and family, nurses can create a more peaceful end of life,rather than simply completing the task at hand in the day to day care of the patient.

Peaceful End Of Life Scenario

Mrs. Janssen 75y/o widow admitted for Stage IV Colon cancer.
She is in and out of consciousness, but most of the time asleep.
Unable to eat, drink and speak.
Grimaces quite often.
Expressed to the family that she wants no life prolonging procedure
Pain medication given via morphine pump.
Render comfort measures
Encourage the family to spend time with the patient and participate in patient care.
Encourage the family to continue talking to the patient in a soft voice. Explaining that even in coma, their loved one can still hear them. Encourage the family to reassure Mrs. Janssen that they will stay nearby. And to hold Mrs. Janssen’s hand or stroke her hair.
Nurses answer any questions and provide emotional support.
Facilitate a vigil/continuous visiting hours as requested by family; offer coffie or tea.
Facilitate spiritual (priest or pastor)support as needed.
Mrs. Janssen receives comfortable, pain- free end of life care compatible to her wishes.

The outcome of the peaceful end of life theory can be evaluated by the family through an existing instrument like comfort questionnaire developed by Kolcaba in 2003.

The Peaceful End of Life Nursing theory helps advance the practice of nursing because it offers basic guidelines and principles . In the field of education, as continuing education for critical care nurses, oncology nurses, and caregivers. And as a basis for further research for the improvement ofnursing administration, hospital policies, and budget allocations.

The Peaceful End Of Life concept of comfort was based on Katherine Kolcaba’sComfort Theory’s definition of comfort. Comfort is the state that is experienced by recipients of comfort measures. It is the immediate holistic experience of having needs met in four contexts of experience (physical, psychospiritual, social and environmental). Comfort measures are defined as nursing interventionsdesigned to address specific comfort needs of recipient, including physiological,social, financial, psychological, spiritual, environmental and physical interventions. It is in this concept that the Peaceful End Of Life theory relates to the Comfort theory. Both theories are similar on the issues of comfort measuresin but with different nursing outcomes. In Comfort theory the nurse performs comforting actions for a patient to increase comfort level with expected positive outcome while in the Peaceful End of Life theory the nurse helps the patient/family achieve a peaceful death.

“The systematic accumulation of knowledge is essential to progress in any

profession . . . however theory and practice must be constantly interactive.

Theory without practice is empty and practice without theory is blind.”

( Cross, 1981 , p. 110).

-Maria Elena S. Feliciano

N 207 Group D