Upload
daisy-walker
View
215
Download
1
Embed Size (px)
Citation preview
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
Obstetric & Gynaecology of Nursing
Definition of Quality of life
Principles of Quality of life.
Critique of Health-Related Q.L
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
Principles of Q. LPalliative care and treatment of pain to improve Q. L
Clinical Vignettes in Quality of Life
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
Definitions of Quality
of LifeDr. Aida Abd El_razek Associate Proffesor
Obstetric & Gynaecology of Nursing
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.
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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.
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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
Obstetric & Gynaecology of Nursing
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”.
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
In recent years, efforts have been made to develop measures of quality of life that can be used to evaluate outcomes of clinical interventions.
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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.
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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.”
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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
Obstetric & Gynaecology of Nursing
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……
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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
Obstetric & Gynaecology of Nursing
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.
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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
Obstetric & Gynaecology of Nursing
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
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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.
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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.
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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.
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
Patient should not be kept on a drug regimen inadequate to control pain because of the ignorance of the physician
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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.
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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.
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
Appropriate control of pain and symptoms;
Avoid inappropriate prolongation of dying;
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
Enhance the control of patients over their care;
Rest with family;Supported by physicians, nurses, and social workers.
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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?
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
Keeps on coming back to the clinicModifies social environmentPassive in own goalsAngry, depressed, suspiciousLow quality of life
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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
Dr. Aida Abd El_razek Associate Proffesor Obstetric & Gynaecology of Nursing
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 Proffesor Obstetric & Gynaecology of Nursing