Dr. Aida Abd El-Razek *Associate Professor of Maternal and Newborn Health Nursing Faculty of...

Dr. Aida Abd El-Razek

*Associate Professor of Maternal and Newborn Health Nursing Faculty of Nursing,

ILOs At the end of this

lecture the student’s will be able toDr. Aida Abd El_razek

Associate Proffesor Obstetric & Gynaecology of Nursing

Understand Quality of life

Explain Powell’s Model of

Quality of life

Dr. Aida Abd El_razek Associate Proffesor

Obstetric & Gynaecology of Nursing

Classify Principles Quality of Life

Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing

Applying Conceptual framework of Quality

of lifeDr. Aida Abd El_razek Associate Proffesor

Definition of Quality of life

Principles of Quality of life.

Critique of Health-Related Q.L

Principles of Q. LPalliative care and treatment of pain to improve Q. L

Clinical Vignettes in Quality of Life

Definitions of Quality

of LifeDr. Aida Abd El_razek Associate Proffesor

Quality of life is the degree of need and satisfaction within the physical, psychological, social, activity, material and structural area.

Quality of life is the subjective evaluation of good and satisfactory character of life as a whole.

Quality of life is a state of well-being which is a composite of two components: 1) the ability to perform everyday activities which reflects physical psychological, and social well-being and 2) patient satisfaction with levels of functioning and the control of disease and/or treatment related symptoms

The most fundamental goal of Nursing care is the improvement of quality of life for all those who need and seek care, and also relief of pain and improvement of function.

All activities, such as nursing care, examining, evaluating, diagnosing, treating, curing, comforting and educating, aim at improving the patient’s quality of life. Dr. Aida Abd El_razek Associate Proffesor

It expresses a value judgment: the experience of living, as a whole or in some aspect, is judged to be “good” or “bad”, “better” or “worse”.

In recent years, efforts have been made to develop measures of quality of life that can be used to evaluate outcomes of clinical interventions.

Such measures list a variety of physical functions, such as mobility, performance of activities of daily living, absence or presence of pain, social interaction, and mental acuity.

In general, quality of life can be defined as a multidimensional construct that includes “performance and enjoyment of social roles, physical health, intellectual functioning, emotional state, and life satisfaction or well-being.”

Quality-of –life judgments must consider personal and social function and performance, symptoms, prognosis, and the individual, often unique values that patients ascribe to the quality of their life. Dr. Aida Abd El_razek Associate Proffesor

Who is making the evaluation—the person living the life or an observer?

What criteria are being used for evaluation?

What types of clinical decisions are justified by reference to quality-of- life judgment? Dr. Aida Abd El_razek Associate Proffesor Obstetric &

Gynaecology of Nursing

Recently, Nursing & Medical skills have been used to improve on normal conditions ： cosmetic surgery responds to the desires of individuals for a more beautiful appearance, administration of growth hormone increases height for persons of short stature……

Treatment attempt to respond to physical, physiologic, or psychological defects that deprive persons of normal characteristics.

Enhancement are made in response to patient preference and to improve quality of life. Dr. Aida Abd El_razek Associate Proffesor

QOL is, “the degree to which the person enjoys the important possibilities of his or her life" (Renwick & Brown, 1996).

Humanistic-existential modelHumans have needs

◦Physical, psychological, and spiritual◦Affiliation and self-actualization

3 Elements of their Model ◦Being, belonging, and becoming.

Quality of Life

Objective Subjective

Behavioral Competence leisure and discretionary activities

Environmental Quality structure and process of care

Perceived QOL time, friends, family

Psychological Well Being satisfaction, affect

1. QOL is multidimensional2. QOL is bio-psycho-social3. QOL appraisal must be holistic4. QOL components are common to all

people and the human condition, i.e. not different for people with disability

5. Disability doesn’t imply increased or decreased QOL

6. QOL meaning is individualDr. Aida Abd El_razek Associate Proffesor

Being is comprised of physical, psychological and spiritual dimensions;Spiritual

Belonging is comprised of social, community, and ecological dimensionsCommunity

Becoming is constituted by personal growth, leisure, and practical. Growth

Quality of Life

Personal Values

Physical• Personal safety • Health• Fitness• Mobility

Social• Relationships family, friends• Community

Material• Finance• Housing• Transport• Security & tenure

Development & Activity• Competence independence, choice & control• Productivity job, education home life, leisure

Emotional Well Being• Mental health• Self-esteem• Faith• Sexuality• Fulfillment

Palliative care is defined as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

Relief of pain is a traditional nursing goal.

Increasingly, palliative care nursing deals with pain and suffering at the end of life.

Palliative care nursing uses methods to achieve global aims: aiding patients to deal with their impending death and its effect on others.

Palliative care includes skilled application of pain-relieving drugs.

Competence in palliative care includes not only science and skill in managing pain but also understand and application of ethical principles.

Patient should not be kept on a drug regimen inadequate to control pain because of the ignorance of the physician

Attempt to achieve adequate pain relief have another side effect, namely, the clouding of the patient’s consciousness and the hindering of the patient’s communication with family and friends.

This consequence may be distressing to patient and family and ethically troubling to physicians and nurses.

Instead, sensitive attention to patient’s needs, together with skilled medical management, should lead as close as possible to the desired objective: maximum relief of pain with minimal diminution of consciousness and communication.

Appropriate control of pain and symptoms;

Avoid inappropriate prolongation of dying;

Enhance the control of patients over their care;

Rest with family;Supported by physicians, nurses, and social workers.

When should we ask?◦Which patients should we ask?

Response shift◦Is a low quality of life a sign ofa low physical functioning?an absence of the response shift?

Keeps on coming back to the clinicModifies social environmentPassive in own goalsAngry, depressed, suspiciousLow quality of life

A low quality of life sign of low adaptation Increase adoption will increase quality of life A starting point for psychological therapy

◦ A low quality of life◦ Malfunctioning of adaptation◦ Wrong coping strategy

Behavioral / peer group therapy

◦ Personality disorder More invasive therapy

Faculty (Collective & Individual)

Opportunity to teach critical thinking

Opportunity to foster innovation in intervention

Program of researchContribution to the Nursing

body of knowledge

StudentOpportunity to develop

critical thinking skillsOpportunity to learn

innovationOpportunity to start career

with an edgeProgram of scholarship and

service

Scenario 1 26 year old male with

lung cancer 3 children under the age

of 6 Treated for 2 years Multiple pleural effusions

and many complications Now develops brain mets

with heavy disease burden

Discussion with a nurse with a focus on QOL

Transitions to hospice Gets his steak sandwich

and eats it with his children sitting on his lap

Dies the next day

Scenario 2 26 year old male with lung

cancer 3 children under the age

of 6 Treated for 2 years Multiple pleural effusions

and many complications Now develops brain mets

with heavy disease burden Goes on ventilator for

several weeks, becomes septic, wife must decide to remove patient from vent

Scenario 1Female, 45, poorly

managed adult onset diabetes

Kidney failure requiring dialysis

Patient refuses hemodialysis and instead chooses peritoneal dialysis at home (6 years) for QOL reasons

Multiple complications including stroke, amputation of leg

Dies at 51

Scenario 2Female, 45, poorly

managed adult onset diabetes

Kidney failure requiring dialysis

Patient chooses hemodialysis 3 times per week (? Years)

Complications including stroke, amputation

Dies (? Age)Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing

Scenario 185 y.o. woman falls and

fractures T-12, head lac, rib fractures

Hospitalized for 3 weeks inclusive of rehab

Refuses all pain medsRefuses to work with PT

on taking a tub bathLives to be 98 and dies

of a massive stroke

Scenario 285 y.o. woman falls and

fractures T-12, head lac, rib fractures

Hospitalized for 3 weeks inclusive of rehab

Asks frequently for pain meds

Works with PT/OT on taking a tub bath

Lives ? yearsDr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing

Dr. Aida Abd El-Razek *Associate Professor of Maternal and Newborn Health Nursing Faculty of...

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