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706 UNIT V Middle Range Nursing Theories

dignity and respect (treating the patient with dignity, identified need for a comprehensive middle-range
empathy, and respect) (Figure 36–1). theory to guide care of patients in the end-of-life
experience, Ruland and Moore’s (2001) work clearly
Accessibility illustrates the richness of practice and standards as a
The deductive and inductive logic used to develop this source for the development of theory.
theory provides a solid basis for developing testable All of the outcome indicators are measurable, us-
hypotheses among the five concepts of the theory. ing qualitative, quantitative or both methodology
Theoretical congruency is demonstrated through the (see Figure 36–1). Unlike some middle-range theories
outcome indicators, all of which are conceptualized that have a specific instrument to measure a particu-
from the perspective of the patients and their families. lar concept, no instrument has been developed for
Peaceful End-of-Life Theory. For future studies
Importance among the five concepts, instruments need to be
As a successful synthesis of clinical practice and identified to measure hypothesized relationships.
scholarly theory development, the Peaceful End-of- Mixed methods (Tashakkori & Teddlie, 2003) was
Life Theory illustrates a way to bridge the theory- described as an appropriate approach for investigat-
practice-research continuum. Besides addressing an ing the concepts. For example, a phenomenological

Peaceful End of Life

Closeness to
Not being Experience of Experience of
in pain comfort dignity/respect Being at peace significant others/
persons who care
Monitoring and Preventing, Including patient Providing Facilitating participation
administering monitoring, and and significant emotional support of significant others
pain relief relieving physical others in in patient care
discomfort decision making Monitoring and
Applying meeting patient’s Attending to significant
pharmacological Facilitating rest, Treating patient needs for others’ grief, worries
and nonpharma- relaxation, and with dignity, antianxiety and, questions
cological contentment empathy, and medications
interventions respect Facilitating
Preventing Inspiring trust opportunities for
complications Being attentive family closeness
to patient’s
expressed needs, Providing patient/
wishes, and significant others
preferences with guidance
in practical issues

Providing physical
assistance of
another caring
person, if desired

FIGURE 36-1 Relationships among the concepts of the Peaceful End-of-Life Theory. (From 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], 174.)