A conceptual framework for end-of-life care: a reconsideration of factors influencing the integrity of the human person.
In this article, we examine emerging themes in the research and theoretical literature on care at the end of life to develop a conceptual framework to guide further research in this area. The integrity of the human person is the organizing concept, and the spiritual domain is at the core of the psychological, physical, and functional domains. This framework extends beyond previous frameworks for care at the end of life by including the relationship of the health professional and the health care organization to the integrity of the person. Also, outcomes in this framework extend beyond quality of life and comfort to include patient decision-making methods and achievement of life goals. Attention is given to the cultural dimension of personhood in our multicultural society, and the definition of end of life is expanded to include both the acute phase of terminal illness and the frailty of health associated with advanced age.
Nolan
Marie T
MT
Center for Nursing Research, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205, USA. mnolan@son.jhmi.edu
Mock
Victoria
V
D000203:Activities of Daily Living; D001293:Attitude to Death; D018864:Cultural Diversity; D003657:Decision Making; D005190:Family / Q000523:psychology; D006040:Goals; D007722:Health Knowledge, Attitudes, Practice; D006694:Holistic Health; D006801:Humans; D007258:Informed Consent; D016294:Models, Nursing; D009723:Nurse-Patient Relations; D015403:Nursing Evaluation Research / Q000458:organization & administration; D015279:Organizational Culture; D017063:Outcome Assessment, Health Care; D010358:Patient Participation; D018802:Patient-Centered Care / Q000458:organization & administration*; D028723:Personhood; D011788:Quality of Life; D029181:Spirituality; D013727:Terminal Care / Q000458:organization & administration / Q000523:psychology