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704 UNIT V Middle Range Nursing Theories

interventions contribute to the patient’s experience care was an interim step that effectively linked clinical
of not being in pain. practice and theory.
2. Preventing, monitoring, and relieving physical dis- Ruland and Moore (2001) detailed the steps they
comfort, facilitating rest, relaxation, and content- followed in the development of the standard for
ment, and preventing complications contribute to peaceful end of life, which included review of relevant
the patient’s experience of comfort. literature, clarification of important concepts, and
3. Including the patient and significant others in de- incorporation of clinical practice knowledge. Each
cision making regarding patient care, treating the step is analogous to those used in theory develop-
patient with dignity, empathy and respect, and ment. Thus, the logic for the development of this
being attentive to the patient’s expressed needs, theory is straightforward, and the process used is
wishes, and preferences contribute to the patient’s clearly stated.
experience of dignity and respect.
4. Providing emotional support, monitoring and Acceptance by the Nursing Community
meeting the patient’s expressed needs for anti-
anxiety medications, inspiring trust, providing the Practice
patient and significant others with guidance in A small but growing number of articles cite the Peace-
practical issues, and providing physical presence of ful End-of-Life Theory. It is included on the Clayton
another caring person if desired contribute to the State University School of Nursing Theory Link page
patient’s experience of being at peace. with a link to American Journal of Critical Care,
5. Facilitating participation of significant others in End-of-Life Care (Kirchhoff, Spuhler, Walker, et al.,
patient care; attending to significant others’ grief, 2000). Liehr and Smith (1999) refer to the theory’s
worries, and questions; and facilitating opportuni- development of a practice standard as a foundation
ties for family closeness contribute to the patient’s for developing theory, Kehl (2006) cites it in her con-
experience of closeness to significant others or cept analysis of a “good death,” and Baggs and Schmitt
persons who care. (2000) discuss the potential usefulness of the theory
6. The patient’s experiences of not being in pain, as a means to improve end-of-life decision making
comfort, dignity, and respect, being at peace, and for critically ill adults. Kirchoff (2002) continued
closeness to significant others or persons who care the discussion on creating an environment of care
contribute to the peaceful end of life (p. 174). in the intensive care unit that promotes a peaceful
death by synthesizing information from three sources
(the Peaceful End-of-Life Theory [Ruland & Moore,
Logical Form 1998], the Institute of Medicine’s definition of peace-
The Peaceful End-of-Life Theory was developed using ful death [Field & Cassell, 1997], and precepts from
inductive and deductive logic. A unique feature of the the American Association Colleges of Nursing’s
theory is its development from a standard of care. The “Peaceful Death: Recommended Competencies and
peaceful end-of-life standard was created by expert Curricular Guidelines for End of Life Nursing Care,”
nurses in response to a lack of direction for managing 1997). The Peaceful End-of-Life Theory was one of
the complex care of terminally ill patients. The stan- the theories used to develop a model for holistic
dard was developed for the surgical gastroenterologi- palliative care for sickle cell patients (Wilkie, Johnson,
cal care unit in a university hospital in Norway. Thus, Mack, et al., 2010). In Taiwan, Lee and colleagues
the standard served as a logical intermediary step (2009) cite Peaceful End-of-Life Theory as important
linking practice and theory. Standards of care serve to establish a framework to identify the major barriers
as credible, authoritative statements that describe of good end-of-life care in an ICU.
a practitioner’s roles and responsibilities and an
expected performance level of nursing care by which Education
the quality of practice can be evaluated (American Peaceful end of life has been integrated into nursing
Association of Critical Care Nurses, 1998). In this courses for generations with a focus on care of the
instance of knowledge development, the standard of patient and family. End-of-life content has become