Nursing Discussion Essay Assignment on Peaceful End of Life and Supportive Care: A Partial Concept Analysis

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Support scholarly discussion and exploration of assignment content. Entries should significantly contribute to the discussion, such as additions and clarificamake a good point” is NOT substantial.)
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Peaceful End of Life and Supportive Care: A Partial Concept Analysis

Concept and Rationale

This concept analysis will focus on the middle-range theory “peaceful end of life,” as described by Ruland and Moore (1998).  The concept was first developed by a group of nurses on a surgical gastroenterological unit at a hospital in Norway and stemmed from the common terminal diagnoses of patients on their unit.  The purpose of making a peaceful end of life a standard of care is aimed at patient comfort and feelings of peace in the final stages of their natural lives, rather than the typical focus of life prolongation.

Defining attributes and antecedents

A peaceful end of life is a universally subjective ideal; however, there are several collective attributes that seem to define the idea of a peaceful end of life as a whole.  These include but are not limited to:

  • Absence of pain, feelings of optimal comfort and peacefulness; less invasive measures to be taken
  • Closeness to significant others, who will help carry out expressed wishes
  • Maintained dignity and fulfillment of the terminal patients’ desires as an acknowledgment of such

(Ruland & Moore, 1998; Kongsuwan et. al, 2011; Zaccara et al., 2020)

Antecedents to a peaceful end of life include the presence of a terminal diagnosis, meaning there is an overall awareness that the person is in their final stages of their natural life (Kim et al., 2014); negative repercussions of disease; mutually appreciating and accepting death; and patient spirituality (Ruland & Moore, 1998).

Consequences

Emotionally competent care focused on the fulfillment of last wishes, comfort measures, and the abandonment of the desire to prolong life or heal the physical body; letting the patient go.  The concept of a peaceful end of life does not aim to make death easy; however, it sheds light on numerous ways clinicians and communities as a whole do not adequately support those approaching death (Field et al., 1997).  In their literature review, Kongsuwan et al. described four processes of “knowing” as it pertains to the occasion of a peaceful death for ICU patients: visual, technological, intuitive, and relational (2011).  Being in tune with the dying person can make a huge impact on how they live in their final hours, days, weeks, etc. of life and can help them feel supported on their journey towards death.

References

Field, M. J., Cassel, C. K., & Institute of Medicine (U.S.). (1997). Approaching death: Improving care at the end of life. National Academies Press.

Kim, S. J., Kim, M. S., Kim, H. J., Choi, J. E., & Chang, S. O. (2014). Nursing home nurses’ ways of knowing about peaceful deaths in end-of-life care of residents. Journal of Hospice & Palliative Nursing, 16 (7), 438-445. DOI: 10.1097/NJH.0000000000000093.

Kongsuwan, W., Locsin, R.C., & Schoenhofer, S.O. (2011). Knowing the occasion of a peaceful death in intensive care units in Thailand. Nursing & Health Sciences, 13(1), 41-46. https://doi-org.access.library.miami.edu/10.1111/j.1442-2018.2011.00574.x

Ruland, C.M., Moore, S.M. (1998). Theory construction based on standards of care: A proposed theory of the peaceful end of life. Nursing Outlook, 46(4), 169-175. https://doi-org.access.library.miami.edu/10.1016/S0029-6554(98)90069-0

Zaccara, A.A.L., Batista, P.S.S., Vasconcelos, M.F., Dias, K.C.C.O., Aguiar, P.K.F., & Costa, S.F.G. Contributions of the theory of the peaceful end of life to the nursing care for o-patients under palliative care. Rev Fun Care Online.2020. Jan./Dec.; 12:1247-1252.  http://dx.doi.org/10.9789/2175-5361.rpcfo.v12.9558