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

1. Cornelia Ruland, RN, Ph.D.Nursing Theorist on Peaceful End of Life Care Presented by: Stacy Sutherland, RN

2. Cornelia M. Ruland, RN, P.D.

3. Biography • Education • Undergraduate • University of Bergen, Bergen, Norway • Haukeland School of Nursing, Bergen, Norway • Certified Nurse Specialist • National Hospital, Oslo, Norway • MSN • University of Oslo, Oslo, Norway • Ph.D. • Case Western Reserve University, Cleveland, Ohio (Ruland, 2014)

4. Biography • Positions Held • Nursing • Other (Ruland, 2014)

5. Middle Range Nursing Theory Peaceful 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

6. Development of the Peaceful End of Life Theory • Developed 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

7. Reduction of outcome criteria from the standard to outcome indicators of the proposed theory • Outcome Criteria • Not to have pain • Not to experience nausea • Not to experience thirst • Experience optimal comfort • Experience 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 Indicator • Not being in pain • Experience of comfort • Experience of dignity/respect (Ruland & Moore, 1998)

8. Reduction of outcome criteria from the standard to outcome indicators of the proposed theory • Outcome Criteria • Maintain 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 alone • Patient is at peace • Significant Others • Takes part in caring for the patient as they wish • Able to say farewell to the patient in compliance with their beliefs, cultural rites, and wishes • Informed about different funeral procedures and possibilities. • Outcome Indicator • Being at Peace • Closeness to significant others/persons who care (Ruland & Moore, 1998)

9. Conclusion This 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

10. References • 1Mosby’s 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