Critique of the Peaceful End-of-Life Theory Using Meleis' 2012 Approach

Providing a peaceful end of life while preserving dignity is a fundamental goal of nursing care. The Peaceful End-of-Life Theory (PELT) offers a middle-range theoretical framework to guide holistic nursing care for terminally ill patients. Despite its broad application, this theory has not yet been systematically critiqued using Meleis' theory analysis framework.

This study presents a theoretical discussion employing a structured critique based on Afaf Meleis' (2012) theory analysis framework. The structural and functional components of PELT-including its concepts, assumptions, propositions, inner dimensions, clarity, consistency, practical, educational, and research utility, as well as empirical support-were systematically examined. The primary source of analysis was the original theory article by Ruland and Moore (1998), supported by relevant theoretical and empirical literature.

The analysis identified PELT as a coherent and internally consistent middle-range theory that effectively links nursing interventions to holistic patient outcomes such as pain relief, comfort, dignity, peace, and closeness to significant others. However, several limitations were noted, including insufficient operational guidance for prioritizing interventions, challenges in measuring culturally sensitive concepts such as peace and comfort, and systemic barriers to implementation such as nursing shortages and misalignment with diagnosis-focused reimbursement systems.

Although PELT provides a valuable conceptual framework for guiding end-of-life nursing care, its effective application requires further development of context-specific clinical guidelines, culturally sensitive and validated assessment tools, and supportive health policies that acknowledge the interdisciplinary and resource-intensive nature of palliative care. Addressing these gaps may enhance the theory's practical applicability and contribute to more equitable and dignified end-of-life care across diverse settings.