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End of Life and Palliative Care

It always surprises me when nurses ask if Comfort Theory (CT) is appropriate for palliative, end of life, or critical care. Of course it is! A peaceful death is one of three categories of health seeking behaviors in the theory. When we actually apply CT to these difficult settings, we do not have to state the actual final goal for our comforting interventions or those of the health care team, which usually is a “peaceful death.” We, as nurses, just know that this is the most likely and hopeful outcome. The question then becomes what is hopeful and for whom? Often the patient may be ready to die, but the family or medical team is not ready to let go.  In our research with hospice patients, we found that patients had a very different view about their own comfort compared to that of their family member in the caregiver role. And it was difficult for this gap to be bridged…


Nurses can help bridge this gap with skillfully presented questions and discussions. These discussions take time and require trust, but expert nurses know how to do this. Once the family and patient are on the same page, hope can be defined in terms of a peaceful death. In my book I define “peaceful death” as a death in which conflicts have been resolved, symptoms are well managed, and acceptance by the patient and family members allows for the patient to “let go” quietly and with dignity (p. 257). A chapter of my book is devoted to the Ethics of Comfort Care, a term which means much more than a “last resort” in advance directives. (See critical care article)

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