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Peaceful End of Life

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by

Ma Medrocillo

on 4 September 2013

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Transcript of Peaceful End of Life

Notes
Ideas
Ideas
Ideas
Peaceful End of Life
Objectives
At the end of the discussion the student will be able to;

Know the Theorists
Cornelia M. Ruland
Shirley M. Moore
Define the following terms and major concepts
Not Being in Pain
Experience of Comfort
Experience of Dignity and Respect
Being at Peace
Closeness to Significant Other
Discuss the Major Assumptions of Peaceful EOL
Discuss the theoretical Assertions
Apply the major concept in presenting an actual case

Theoretical Assertions
Application
Mr. Kelly is retired 85-years-old engineer with advance dementia. His large, extended family includes his wife, children, and grandchildren, and their families. Mr. Kelly has been a resident in the nursing home for six months; his family visits frequently, and his friends, easy going personality makes him a favorite with staff members. In the past month, Mr. Kelly has become increasingly confused withdrawn, and nonverbal; he takes food and fluids sparingly and only with much urging. He did not leave any written instructions about end-of-life measures although he told his wife that he did not want extraordinary measures, and she has signed a DNR order. There is discussion about starting intravenous fluids and tube feeding, and family and staff member differ in their opinions on the best options fro Mr. Kelly’s care.

by Cornelia M. Ruland & Shirley M. Moore
Not Being in Pain

Being Free of the suffering or symptom distress is the central part of many patients’ EOL experience

Definition of Terms and Major Concepts
Comfort is defined as “relief from discomfort, the state of ease and peaceful contentment, and whatever makes life easy or pleasurable.

Experience of Comfort
Experience of Dignity and Respect
Each terminally ill patient is “respected and valued as human being. This concept incorporates the idea of personal worth, as expressed by
the ethical principle of autonomy or respect for
persons, which states that
individuals should
be treated as autonomous
agent and persons
with diminished autonomy
are entitled to protection
Peace is a “feeling of calmness, harmony and contentment, (free of) anxiety, restlessness, worries and fear. A Peaceful state includes physical, psychological and spiritual dimensions
Being at Peace
Closeness is “the feeling of connectedness to other human being who care”. It involves a physical or emotional nearness that is expressed through warm, intimate relationships
Closeness to Significant Others
Peaceful End of Life
Figure 1,
Major Assumption

The occurrence and feelings at the EOL experience are personal and individualized.

Nursing care is crucial for creating a peaceful EOL experience. Nurses assess and interpret cues that reflect the person’s EOL experience and intervene appropriately to attain or maintain a peaceful experience, even when the dying person cannot communicate verbally.

Family, a term that includes all significant others, is an important part of EOL care.

Two additional assumption are implicit
The goal of EOL care is not to optimize care, in the sense that it must be the best, most technologically advance treatment, a type of care that frequently results in overtreatment. Rather, the goal in EOL care is care to maximize treatment, that is the judicious use of technology and comfort measures, in order to enhance quality of life and achieve a peaceful death.

Monitoring and administering pain relief and applying pharmacological or non pharmacological interventions contribute to the patient’s experiences of not being in pain.

Preventing, monitoring and relieving physical discomfort, facilitating rest, relaxation, and contentment, and preventing complications contribute to the patient’s experience of comfort.

Including the patient and significant others in decision making regarding patient care, treating the patient with dignity, empathy and respect, and being attentive to the patient’s expressed needs, wishes, and preference contribute to the patient’s experience of dignity and respect.

Providing emotional support, monitoring and meeting the patient’s expressed needs for anti anxiety medications, inspiring trust, providing the patient and significant others with guidance in practical issue, and providing physical preference of another caring person if desired contribute to the patient’s experience of being at peace.

Facilitating participation of significant others’ grief, worries, and questions, and facilitating opportunities for family closeness contribute to the patient’s experience of closeness to significant others or person who care.

The patient’s experiences of not being in pain, comfort, dignity, and respect, being at peace, closeness to significant others or person who contribute to peaceful end of life
established an extensive research program on improving shared decision making and patient-provider partnerships in health care, and the development, implementation, and evaluation of information system to support it.
holds an appointment as adjunct faculty at the Department of Biomedical Informatics, Columbia University, in New York.

confronted with difficult treatment or screening decisions for which they need help to understand the potential benefits and harms of alternative options and to elicit their values and preferences
Preference-adjusted management of chromic or serious long term illness over time.
bachelor’s degree in nursing from Kent State University (1974).
Case Western Reseve University, she earned a master’s degree in psychiatric and mental health nursing (1990), as well as a Ph.D in nursing science (1993).

Influenced by these experiences, Moore has assisted in the development and publication of several and has considered theory construction a skill essential to doctoral student.

Cornelian M. Ruland
received her Ph.D in nursing from Case Western Reserve University, Cleveland, Ohio, in 1998.

Director of the Center Shared Decision Making and Nursing Research at Rikashospitalet University Hospital in Oslo, Norway.

Shirley M.Moore
Associate Dean for Research and Professor, School of Nursing, Case Western Reserve University.

received her diploma in nursing from the Youngstown Hospital Association School of Nursing (1969)

taught nursing theory and nursing science to all level of nursing students
The Rosemary Ellis Theory Conference, held annually for several years at Case Western Reserve University, offered Moore another opportunity to explore theory as a practical tool for practitioners, researchers and teachers.

Not being in Pain.
During the Stay of Mr. Kelly in the nursing homes his dementia got worse. The Nurse administers pain relief medication to alleviate his discomfort. They also conduct activities that would alleviate his pain like having music therapy sessions, letting him read his favorite book or allowing him to watch his favorite movies.
Experience Comfort
Every now and the then the nurse check upon Mr. Kelly, they are very keen in observing his needs it might be verbally or non-verbal. They monitor frequently and make sure that he is relieved from any physical discomfort. Time scheduled are given and maximum rest is well provided to lessen any complications.
Experience of dignity/respect
As an individual Mr. Kelly is entitle to his self. Event though he had not made any advance directives he made it clear to his wife that he doesn’t want any extraordinary measures. Mr. Kelly has become increasingly confused, withdrawn and non verbal the nurses and all the family members were there to support, love and respect him regarding the situation.
Being at Peace
Before he become increasingly confused, withdraw and non-verbal he made sure that he has done everything he can. He made peace to those people he hurt, appreciate and give thanks to his extended family to his wife, children and grandchildren.
Closeness to significant others
During his stay in the nursing homes his family never forget to pay him a visit everyday. They stay at least 3-4 hours a day reminiscing the past, enjoying, playing that for them every second counts. Hugs and kisses from his wife, children and grandchildren was enough for him and he was happy.
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