Peaceful End of Life Theory: A Critical Analysis of Its Use to Improve Nursing Practice

BackgroundProvision of empathetic palliative care in agreement with patient’s favorites is an indispensable attitude of healthcare providers. A Peaceful End of Life Theory was designed by Rulandand Moore (1998),to provide theoretical framework for nurses who care for patients at end stage of their life.MethodsChinn and Kramer theory analysis guideline was used to analyse this theory to suggest its improvement.ResultsFive major concepts and sub-concepts are identified.This theory informs the nursing profession on the relieving interventions at the end of life. It provides a guidance to supportively manage terminally ill patients in collaboration with their families.ConclusionThis theory is important to guide nursing practice,research, and education. However, there is a lack of an instrument to measure the desired outcomes, some subconcepts do not cleary specify the nursing interventions, and it lacks the spiritual comfort to the terminally ill patients who believe in eternal life.Rwanda J Med Health Sci 2021;4(3):412-417

Care for critically and terminally ill patients and moral distress of physicians and nurses in tertiary hospitals in South Korea: A qualitative study

Physicians and nurses working in acute care settings, such as tertiary hospitals, are involved in various stages of critical and terminal care, ranging from diagnosis of life-threatening diseases to care for the dying. It is well known that critical and terminal care causes moral distress to healthcare professionals. This study aimed to explore moral distress in critical and terminal care in acute hospital settings by analyzing the experiences of physicians and nurses from various departments. Semi-structured in-depth interviews were conducted in two tertiary hospitals in South Korea. The collected data were analyzed using grounded theory. A total of 22 physicians and nurses who had experienced moral difficulties regarding critical and terminal care were recruited via purposive maximum variation sampling, and 21 reported moral distress. The following points were what participants believed to be right for the patients: minimizing meaningless interventions during the terminal stage, letting patients know of their poor prognosis, saving lives, offering palliative care, and providing care with compassion. However, family dominance, hierarchy, the clinical culture of avoiding the discussion of death, lack of support for the surviving patients, and intensive workload challenged what the participants were pursuing and frustrated them. As a result, the participants experienced stress, lack of enthusiasm, guilt, depression, and skepticism. This study revealed that healthcare professionals working in tertiary hospitals in South Korea experienced moral distress when taking care of critically and terminally ill patients, in similar ways to the medical staff working in other settings. On the other hand, the present study uniquely identified that the aspects of saving lives and the necessity of palliative care were reported as those valued by healthcare professionals. This study contributes to the literature by adding data collected from two tertiary hospitals in South Korea.

Relieving from Breathlessness in the Wind: A Meta-Analysis and Subjective Report of Effectiveness of Fan Blowing in Patients with Cardiorespiratory Diseases or Cancer

Objectives Breathlessness is common among terminally ill patients with cardiorespiratory disease or cancer. The experience may induce secondary physiological and behavioral responses that limit patient well-being and independence and cause emotional distress. Methods We conducted a meta-analysis on randomized controlled trials (RCTs) that examined the effectiveness of fan blowing on breathlessness among patients with cardiorespiratory diseases or cancer. The PubMed, Cochrane Library, Embase, SCOPUS, and CINAHL databases were searched to retrieve potential articles. The primary outcome was breathlessness severity. The secondary outcomes were SpO2, anxiety, depression, and quality of life. Also, we presented the changes of vital signs and subjective feeling of a male patient who used fan blowing for relieving his breathlessness. Results Eight RCTs were available for analysis. The pooled results demonstrated no significant difference in breathlessness severity between fan-to-face blowing and control methods (standard mean difference: −0.21, 95% confidence interval: −.59 to .17); however, a significant reduction in breathlessness severity was observed in the short-time intervention compared with long-time intervention. A trend occurred toward significance in the reduction of respiratory rate in fan-to-face blowing compared with control methods (MD: −.64, 95% CI: −1.37 to .09). No differences were observed between groups in oxygen saturation, anxiety, depression, or QoL. The male patient who used fan blowing showed an improved vital signs and a satisfied subjective feeling. Conclusions Consistent short-time fan-to-face blowing is effective for relieving breathlessness among conscious terminally ill patients with cardiorespiratory diseases or cancer. The use of this convenient method for relieving breathlessness symptoms in terminally ill patients is recommended.

Chosen Moments: a Reflective Journey Illustrating Terminally Ill Patients Choosing the Moment to Die

<p>In this project the author reveals how she is observing and thinking as she cares for people who are dying. She records her reflections and insights and most profoundly reveals that there is life right up to the moment of death, having observed terminally ill patients choosing the precise moment to die. She describes her observations of these moments by using poetry and stories, and explores the implications for her practice as a result. The author presents her reflections using an individualistic, reflective and exploratory perspective which is informed by the work of nursing scholars; Taylor (2000), Benner (1984) and Johnstone (1999). This paper is framed using the metaphors of a journey and a window to indicate the reflective process that the author used to journal her observations in practice over time. This offers a professional and personal record of the author's insights.</p>

Chosen Moments: a Reflective Journey Illustrating Terminally Ill Patients Choosing the Moment to Die

<p>In this project the author reveals how she is observing and thinking as she cares for people who are dying. She records her reflections and insights and most profoundly reveals that there is life right up to the moment of death, having observed terminally ill patients choosing the precise moment to die. She describes her observations of these moments by using poetry and stories, and explores the implications for her practice as a result. The author presents her reflections using an individualistic, reflective and exploratory perspective which is informed by the work of nursing scholars; Taylor (2000), Benner (1984) and Johnstone (1999). This paper is framed using the metaphors of a journey and a window to indicate the reflective process that the author used to journal her observations in practice over time. This offers a professional and personal record of the author's insights.</p>