Nursing Theory and End-of-Life Care: A DNR Case Study
This paper presents a case study from the perspective of a new EMT responding to a call involving a 78-year-old male cancer patient with a Do Not Resuscitate (DNR) order. The paper applies two theoretical frameworks to the encounter: Boykin and Schoenhofer's "Nursing as Caring" theory and Elisabeth Kübler-Ross's stages of grief and dying. The analysis examines how both theories address individual dignity, patient autonomy, and compassionate care, while arguing that Kübler-Ross's framework is particularly relevant given the patient's deliberate DNR decision. Key ethical principles—including autonomy, beneficence, and paternalism—are explored in the context of end-of-life nursing practice.
- Case Study Overview: EMT encounter with DNR cancer patient and distressed wife
- Nursing Theory: Nursing as Caring: Boykin and Schoenhofer's caring-centered nursing framework
- Borrowed Theory: Kübler-Ross on Grief and Dying: Kübler-Ross on death, dignity, and transformative grief
- Analysis and Evaluation of Both Theories: Comparing theories against DNR case and ethics
- Conclusion: Compassion, autonomy, and dignity in end-of-life care
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What makes this paper effective
- The paper grounds abstract nursing theory in a concrete, emotionally resonant clinical scenario, making theoretical concepts immediately applicable to real-world practice.
- It draws meaningful parallels between two distinct frameworks—Nursing as Caring and Kübler-Ross's grief model—while clearly distinguishing why one is more contextually appropriate than the other.
- The use of a direct quotation from Kübler-Ross to challenge oversimplified interpretations of her own stage model demonstrates critical engagement with primary sources.
Key academic technique demonstrated
The paper demonstrates comparative theoretical application: two frameworks are introduced independently, then evaluated side by side against a specific case. Rather than simply summarizing each theory, the author assesses fit and relevance, culminating in a reasoned preference for Kübler-Ross given the patient's DNR decision. This move from description to evaluative judgment is a hallmark of graduate-level analytical writing.
Structure breakdown
The paper opens with a narrative case overview, then introduces each theoretical framework in its own section before moving to a combined analysis. The analysis section identifies shared values (empathy, individual-centered care) before distinguishing the theories, then closes by applying key ethical principles—autonomy, beneficence, and paternalism—to the case. This structure mirrors a classic theory-to-practice argumentative format suited to health sciences writing.
Case Study Overview
This case study is presented from the perspective of a new EMT. The patient was a 78-year-old male presenting with breathing difficulties. He had early-stage cancer and wore a DNR (Do Not Resuscitate) bracelet, accompanied by a written DNR order. The patient's wife was aware of the DNR, but her natural reaction was to try to save her husband. The call, therefore, was directed more toward reassuring the wife than the patient himself, who had accepted his situation, though he remained visibly distressed.
Nursing Theory: Nursing as Caring
"Nursing as Caring" was developed by Boykin and Schoenhofer in the 1980s as they examined the dimensions of caring and how those dimensions applied to the overall patient–healthcare paradigm. In general, the theory functions as a framework and toolkit for addressing common issues in modern healthcare. Its central dimensions hold that caring is what makes humans fundamentally human, that caring is a moment-to-moment and uniquely individual model required within healthcare, and that the medical professional's own personhood and empathy are developed through a caring model (University, 2010).
Borrowed Theory: Kübler-Ross on Grief and Dying
In many traditional cultures, the process of dying is accepted as a natural part of the rhythm of human existence and is treated with reverence. In the modern developed world, however, death is frequently feared, and those who are dying are often institutionalized and removed from general society. Rather than allowing a person to die with dignity, every possible measure—even if uncomfortable and invasive—is taken to keep a loved one alive, not for the patient's sake, but for the sake of the living.
Elisabeth Kübler-Ross believed the opposite: that grief and loss are transformative experiences, and that a person's process of dying is a natural outgrowth of life (Kübler-Ross, 2007). Her framework challenges the medicalized suppression of death and instead affirms the dying person's right to experience the end of life on their own terms.
Conclusion
Both the Theory of Nursing as Caring and Kübler-Ross's framework on grief and dying offer meaningful guidance for an EMT or nurse encountering a patient with a DNR order. Where Nursing as Caring emphasizes the moment-to-moment empathic relationship between caregiver and patient, Kübler-Ross provides a philosophical and ethical foundation for honoring the patient's autonomous decision to forgo aggressive intervention. In this case, the most important role of the responding EMT was not to override the patient's documented wishes, but to provide compassionate presence and comfort to both the patient and his distressed wife—affirming the dignity of a life well lived and a death chosen on the patient's own terms.
Works Cited
University. (2010, June). Anne Boykin & Savina Schoenhofer — Nursing as Caring. Retrieved from stritch.edu.
Kübler-Ross, E. (2007). On grief and grieving. New York: Scribner.
Kübler-Ross, E. (2007, April). The Kübler-Ross grief cycle. Retrieved from Changing Minds.
Kübler-Ross, E. (2013, January). On death and dying. Retrieved from EKR Foundation: http://www.ekrfoundation.org/
Rai, G. (2009). Medical ethics and the elderly. New York: Radcliffe Publications.
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