Cornelia Ruland, RN, Ph.D. Nursing Theorist on Peaceful End of Life Care

Presented by:Stacy Sutherland, RNCornelia Ruland, RN, Ph.D.

Nursing Theorist on Peaceful End of Life Care

Hello, This is Stacy Sutherland. In this nursing theory presentation I will be looking at the middle range theory of Peaceful End of Life Care based on the works of Dr. Cornelia Ruland. 1Cornelia M. Ruland, RN, P.D.

I chose to present on Dr. Ruland because of my experience and interest in hospice nursing. As a hospice nurse I was honored to be a part of a persons life at such a significant time. To be able to provide the care, comfort, and explanations they needed was gratifying. In Dr. Rulands theory, her focus is on the patient and their significant others in all aspects of end of life care. In my current position as a clinical instructor on a surgical unit I am not often faced with end of life care as I would possibly be on another unit, however the standards of pain relief, caring, and working with family are daily tasks we all perform. 2BiographyEducationUndergraduateUniversity of Bergen, Bergen, NorwayHaukeland School of Nursing, Bergen, NorwayCertified Nurse SpecialistNational Hospital, Oslo, NorwayMSNUniversity of Oslo, Oslo, NorwayPh.D.Case Western Reserve University, Cleveland, Ohio

(Ruland, 2014)

Dr. Ruland began her education at the University of Bergen in Bergen, Norway. Here she studied undergraduate courses in the field of philosophy and social sciences. She then transferred to Haukeland School of Nursing in Bergen where she graduated in 1979 with her RN. She went on to become a Certified Nurse Specialist in 1983 from National Hospital in Oslo, Norway with her specialty being in pediatric nursing. She obtained her MSN from the University of Oslo in 1994 with an emphasis in nursing administration and her Ph.D. in Nursing Informatics from Case Western University in Cleveland, Ohio in 1998.3BiographyPositions HeldNursingOther

(Ruland, 2014)

Dr. Rulands nursing career has span over many fields. Her early years as a nurse was focused primarily in the pediatric field. In 1990 she became assistant director of nursing at Aker University Hospital in Oslo, Norway. She has also held the title of assistant professor and adjunct professor before becoming a full professor with the Dept. of Medicine at the University of Oslo, a position which she still holds today. In May of 2002, Dr. Ruland became the director of the Centre for Shared Decision Making and Nursing research at Oslo University Hospital, another position she still holds today. 4Middle Range Nursing TheoryPeaceful End of Life Theory

A theory from a standard od care that focused on the peaceful end of life for terminally ill patients (Ruland & Moore, 1998).

Nurses are integral to the creation of peaceful end of life care, which includes freedom from suffering, emotional support, closeness to and participation by significant others, and treatment with empathy and respect.1

Middle range theories are precise and answer specific nursing practice questions. Dr. Rulands work on peaceful end of life care was a guided by Dr. Shirley Moore, RN in 1998. Their theory is based on nursing standards of care whose primary purpose is providing guidance to nursing practice, just as the primary purpose of theory is to guide practice and research. Both the standards of care and theory help direct nurses to provide effective nursing care. The peaceful end of life theory states that5Development of the Peaceful End of Life TheoryDeveloped from a standard of care created by expert nurses to manage the care of patients with terminal illnesses.5

Patient population-terminally ill pateints (half of whom had been diagnosed with cancer).5

Focus includes pain relief, symptom management, and caring attitudes.5

Main focus is to contribute peaceful and meaningful living in the time that remains for the the patient and their significant others.5

The development of the peaceful end of life theory included expert nurses on a gastroenterological unit at a hospital in Norway. These nurses had a minimum of 5 years experience with terminally ill patients. The study included terminally ill patients, half of whom had been diagnosed with cancer. Because there were no clearly defined guidelines to care for the terminally ill, the nurses collaborated to define a standard of care for the peaceful end of life, with focus being on pain relief, symptom management and caring attitudes which included peaceful and meaningful times with the patient and significant others during the time that remained. By developing a theory based on the standards of care set forth by the expert nurses, Dr. Ruland was able to provide a base for nurses caring for the terminally ill to follow when caring for patients and their significant others. 6Reduction of outcome criteria from the standard to outcome indicators of the proposed theoryOutcome CriteriaNot to have painNot to experience nauseaNot to experience thirstExperience optimal comfortExperience a pleasant environment (patient and significant other)Participate in decision making regarding patient care (patient and significant other).Experience being treated with dignity and respect as human beings (patient and significant other).Outcome IndicatorNot being in painExperience of comfort

Experience of dignity/respect

(Ruland & Moore, 1998)

The standards that were developed by the expert nurses were comprised of 16 outcome criteria. These 16 criteria were compiled in common themes and matched with 5 outcome indicators that contributed to the peaceful end of life theory.7Reduction of outcome criteria from the standard to outcome indicators of the proposed theory Outcome CriteriaMaintain hope and meaningfulness (patient and significant other)Assist with clarifying practical and economical issues related to the end of life stage (patient and significant other)Patient does not die alonePatient is at peaceSignificant OthersTakes part in caring for the patient as they wishAble to say farewell to the patient in compliance with their beliefs, cultural rites, and wishesInformed about different funeral procedures and possibilities.Outcome IndicatorBeing at Peace

Closeness to significant others/persons who care

(Ruland & Moore, 1998)

The peaceful end of life theory was developed on standards of care that were based on the extensive research of literature and the experience of expert nurses. With curative treatment no longer an option for the terminally ill patient, the focus of physician based care rarely exists. Nurses are usually the main providers of patients in the end stages of life. For this reason, nurses need to be able to understand and interpret the complex situations that can arise and the knowledge to help contribute to a peaceful end of life for the patient. There are limitations to each of these standards and proposed theories due to the comfort level and wishes of the significant others and the roles they wish to take in the care of the terminally ill patient.8ConclusionThis theory was developed for terminally ill patients who are no longer candidates for curative treatment. The patient and significant others know that death is emanate and this theory provides guidelines on how to physically and emotionally care for, not only the patient but the significant other as well.5

The guidelines of this theory not only provide standards for peaceful end of life care but they can be applied to all apects of nursing and patient centered care.5

9References1Mosbys Medical Dictionary 8th ed. (2009). St. Louis, MO: Elsevier. Retrieved from: http://www.medical-dictionary.thefreedictionary.com/Ruland

2Nurses.info, (2010). Cornelia Maria Ruland. Retrieved from: http://www.nurses.info/nursing_theory_midrange_theories_cornelia_ruland.htm

3Ruland, C., (2014). Centre for Shared Decision Making and Collaborative Care Research-Medicine-Oslo University Hospital Research. Retrieved from: http://www.ous-research.no/home/sps/CV/11583

4Ruland, C., (2012). Rutgers Medical Informatics History Project. Retrieved from: http://venti.rutgers.edu/mediawiki/index.php/Cornelia_Ruland

5Ruland, C., & Moore, S., (1998). Theory Construction Based on Standards of Care: A Proposed Theory of the Peaceful End of Life. Nursing Outlook, 46(4), 169-175. doi: 10.1016/S0029-6554(98)90069-0

I want to thank you for viewing my nursing theory presentation and I welcome any questions or comments that you may have.10