Transcript 4ae50d92b0fa914

Quality Of Life From
Transculture Nursing Perspective For
Chronically Ill Patients
Prepared By
Eman Mokhtar Mohamed
2nd Term Doctorate
Under supervision
Prof. Dr. Tahany Elsonousy
.Prof. of Medical Surgical Nursing
Faculty of Nursing
Ain-Shams University
2010
Quality Of Life From Transculture Nursing
Perspective For Chronically Ill Patients
0UTLINES
 Introduction
 Definitions of
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quality of life, (QOL)
Transcultural nursing,
Chronically Ill Patient
Phases of ch. illness
Factors affecting Quality Of Life (QOL)
Dimensions OF health related ( HRQOL)
QOL MODEL
Leaninger's theory of culture care bearing upon QOL
Nursing care plane
Strategies to enhance diamentions of health related QOL
General Objectives
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At the end of this lecture the group
participant should be able to:
Applied nursing care plane on chronic illness
with consideration of culture
Specific Objectives
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Identify quality of life
Identify Transcultural nursing,
Identify Chronically Ill Patients
Enumerate factors affecting QOL
Discuss dimensions OF health related ( HRQOL) and nursing
management
Explain quality of life model
Apply leaninger's theory of culture care bearing upon QOL
Explain strategies to enhance diamentions of health related QOL
INTRODUCTION
Introduction
Why quality of life is important?
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First, a good or a poor quality of life is, in some ways, the ultimate
marker of the success of preventive health practices and of health care.
Second, many health care regimens often seem to detract from quality
of life, at least in the short run. As individuals, with the help of their
physicians, make decisions about treatment choices, they may take
quality of life into account, and may seek information about the likely
effects on the quality of their life.
Third, and related to the previous point, especially in terms of end-oflife treatments; the argument is sometimes made that some treatments
are inadvisable because the quality of life likely to result for the extra
time gained is too poor
Introduction (cont.)
Why Transculture is important?
•World has become intensely multicultural and will be more so nurses
must become Transculturally knowledgeable, sensitive, and competent.
•Migration of people worldwide is increasing
•Communication and health technology bring diverse cultures closer
•Increased cultural conflict, clashes, and lawsuits
•Health consumers expect their cultural beliefs, values, and rights to be
respected
•Use of complementary “alternative” medicines and folk practices
•Promoting peace, harmony and healthy living
Definition Quality of life
(QOL)
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The World Health Organization (WHO) has
described QoL as "individuals' perception of their
position in life in the context of the culture and
value systems in which they live and in relation to
their goals, expectations, standards and concerns"
Definition of transculture
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Transculture nursing is a formal area of study and
practice focused on comparative holistic culture care
& health and illness patterns of people...
with respect to differences & similarities in their
cultural values, beliefs, and life ways with the goal...
to provide culturally congruent, competent and
compassionate care.(leninger,2000)
Definition of chronic ill patient
Chronic diseases as prolonged illnesses that do not
resolve spontaneously and are rarely cured
completely. According to the CDC, chronic
illnesses such as cardiovascular disease, cancer,
respiratory disease, cerebrovascular disease, and
diabetes The Centers for Disease Control and
Prevention (CDC), (2009)
Definition of disability
Disability : The World Health Organization(2008) defines
Disability as follows: "Disabilities is an umbrella term, covering
impairments, activity limitations, and participation restrictions.
Disabilities include :
Sensory impairments (particularly hearing and vision) physical
mobility impairments (from injury, chronic illness, congenital
defect,
or
psychiatric
conditions),
emotional/cognitive
impairments.
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PHASES OF CHRONIC ILLNESS
Nine phases have been identified
1. The pre trajectory phase
2. trajectory phase
3. The stable phase
4. The unstable phase
5. The acute phase
6. The crisis phase
7. The comeback phase
8. The downward phase
9. The dying phase
Factors affecting QOL
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Age
Duration of disease
Type of treatment
Physical capabilities &degree of disabilities
General well being
Life satisfaction
Culture & characterstics of disease, present
life style, past experience, hops for future and
dreams
Dimension of quality of life
Physical well being.
Functional ability.
Strength and fatigue.
Sleep and rest.
Over all physical health.
Psychological well being.
Control
Anxiety
Depression
Leisure
Work
Dimension of quality of life (cont.)
Spiritual well being
Meaning of illness
Religiosity
Hope
Social well being
Family distress.
Roles and relation
Isolation
Finance
Work
QOL MODEL
Defined as degree to which person enjoys the
important possibilities of his/her is enjoyment of the
important possibilities occurs in the three major life
domain include (being, belonging, becoming)
A. Being: reflect (who one is) contain 3 domain
 1.physical being (physical health-personal hygienenutrition…)
 2.Psychological being (cognition, feeling,
adjustment)
 3.spiritual being: reflects to one's personal values,
standers of conduct, spiritual beliefs
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Belonging domain concerns the
person feels with his environment
B. Belonging.
1.physical belonging due to physical
environment (home-work place-schoolcommunity)
 2.social belonging as social environment
(acceptance by others- family, friends)
 3. Community belonging as adequate
income, health
c. Becoming: refers to activities carried out in daily
living including personal goals, hopes and
aspirations
 practical becoming describes day to day activities,
volunteers activities
 leisure becoming: activities promote relaxation and
enjoyment, stress reduction
 growth becoming: activities promote improvement
of knowledge and skills and adapting to change.
Madeleine Leininger’s
Culture Care Theory
Transcultural Nursing
Transcultural nursing is the combination of both
the
nursing
theory
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practice
and
the
anthropology, where different nursing principles
study the various
are used as a ground to
aspects of the delivery of care and the human
behavior, origins, customs, development and
.social relationships are
studied respectively
Transcultural nursing
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is both a specialty and a general practice
area. It focuses on worldwide cultures and
comparative cultural caring, health, and
nursing phenomena.
transcultural nursing's goal is to provide
culturally congruent care. As summarized by
one nursing leader in the field,
“Transcultural nursing is a body of knowledge
that helps us to provide culturally relevant
care”.
Application of Theory
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Care always occurs in a cultural context
Culture is viewed as framework people
use to solve human problems
Culture is “the lifeways of an individual
or a group with reference to values,
beliefs, norms, patterns, and practices”
(Leininger, 1997,)
Generic
care
Nursing
care
Professional
System
APPLYING THE NURSING PROCESS
The focus of care for patients with chronic conditions
is determined largely by illness phase and directed
by the nursing process,
which includes
 assessment,
 diagnosis,
 planning,
 implementation,
 and evaluation
Step 1: Identifying the Trajectory Phase
The first step is assessment of the patient to
determine the specific phase
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Assessment enables the nurse to
identify the specific medical, social, and
psychological problems likely to be
encountered in a phase.
CULTURAL CONSIDERATIONS
When obtaining the health history, the interviewer takes into
account the person’s cultural background Cultural attitudes
and beliefs about health, illness, health care,
hospitalization, the use of medications, and the use of
complementary therapies are derived from each person’s
experiences. They vary according to the person’s ethnic
and cultural background.
A person from another culture may have a different view
of personal health practices than the health care practitioner.
(Weber & Kelley, 2003).
Content Of The Health History
includes the following:
• Biographical data
• Chief complaint
• Present health concern (or present illness)
• Past history
• Family history
• Review of systems
• Patient profile
Applied Ng. process on ch. illness
Domain
Biological
Specific Assessments
Past, present medical history
Labe result,…
Psychological Lifestyle,: "'
Self-confidence levels,
attitude toward exercise
Sociocultural Client's social activities . , Cultural
beliefs regardinig physical activities
Exercise preferences
Specific Assessments
Spiritual/Religious
Client's introspection
Meaning of
exercise and fitness for client; Religious
prohibitional of exerted on certain days
Environmental Lives alone •
conducive to exercise
Enviromental influences
affecting ability to exercise
Technological Client technological competence
|ife attitude with new
technology;
Nursing Diagnoses
Domain Nursing Diagnoses
Biological • Activity Intolerance Related to Generalized Weakness
• Risk for Decreased Activity Intolerance Related to
Circulatory Problems
• Decreased Cardiac Output Related to Altered Heart
Contractility
• Impaired Physical Mobility Related to Obesity
Psychological •
Ineffective Coping Related to Inadequate Resources
• Fatigue Related to Stress
• Hopelessness Related to Lost Belief in God
Risk for powerlessness.
Sociological••
Ineffective Health Maintenance Related to Ineffective
Family Coping
Risk for impaired social interaction.
Nursing Diagnoses
Cultural
Noncompliance Related to Cultural Values *
• Impaired Physical Mobility Related to Cultural
Beliefs Regarding Age-Appropriate Activity
Risk for ineffective role performance.
Environmental
Risk for disuse syndrome related to prescribed
immobilization
•Sedentary Lifestyle Related to Deficient Knowledge
Spiritual
•'Spiritual Distress Related to Social Alternation
technological•;
Impaired Wheelchair Mobility Related to Impaired
Ability to Operate Wheelchair
• Risk for Spiritual Distress Related to
Environmental and Natural Disasters
Step 2: Establishing Goals
The establishment of goals should be a collaborative effort with the
patient, family, and nurse working together, for the attainment of a goal
is unlikely if it is primarily the nurse’s and not the patient’s.
The following example of goals to be determined collaboratively, then
written in the language of the nursing process.
An elderly man with severe progressive COPD reports increasing
difficulty breathing, even with the oxygen level set at 2 liters/min. This
interferes with his ability to carry out activities of daily living and has
decreased his quality of life. He asks the nurse for help.
The nursing diagnosis for this problem might be “Activity intolerance
related to less than adequate intake of oxygen
secondary to lung disease,” and the mutually agreed upon
goal of care might be to increase the patient’s ability to care for
himself. Nursing interventions related to this goal might include
teaching the client how to pace his activities and helping him to
obtain a home health aide to assist with the most demanding activities
of daily living.
Step 3: Establishing a Plan to Achieve
Desired Outcomes
Once goals have been established, the next step consists of
establishing a realistic and mutually agreed upon plan for
achieving them and identifying specific criteria that can be
used to assess the patient’s progress.
A plan of care for the man with COPD who complains of a
decreased ability to care for himself, for example, might
include assisting him to prioritize his activities of daily living
so he can carry out those that are most important to him
before he becomes too short of breath and tired.
Step 4: Identifying Factors That Facilitate
or Hinder Attainment of Goals
The next step involves identifying environmental, social, and
psychological factors that might interfere with or facilitate achieving
the goal.
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In the case of the patient with COPD, for example, not having sufficient
resources could prevent him from hiring a home health aide.
For this reason, the nurse might want to explore carefully the issue of
resources with the patient and, if there are financial constraints, enlist
the services of a social worker, with the patient’s consent, to explore
possible community resources. Since the patient is having trouble
breathing, the nurse should determine whether the patient is also
having difficulty cooking and eating, and whether he is losing weight
because of insufficient caloric intake to meet his nutritional needs. If
cooking is a problem, then the nurse might look into community
resources such as Meals on Wheels. If the patient is losing weight, then
the nurse should advise him to eat frequent small meals to lessen the
fatigue associated with eating and to supplement meals with highprotein drinks.
Step 5: Implementing Interventions
Nurses provide direct care, especially during acute episodes, but they
also provide the teaching and secure the resources and other
supports that enable people to integrate their illness into their lives
and have some quality of life
despite their illness . To understand what nursing care is needed, it is
important to comprehend the issues that people with chronic illness
and their families contend with and manage, often on a daily basis.
The challenges of living with chronic conditions can be summarized
as follows:
• Alleviating and managing symptoms
• Psychologically adjusting to and physically accommodating disabilities
• Preventing and managing crises and complications
• Carrying out regimens as prescribed
• Validating individual self-worth and family functioning
• Normalizing individual and family life as much as possible
• Living with altered time, social isolation, and loneliness
• Establishing the networks of support and resources that can
enhance quality of life
• Returning to a satisfactory way of life after an acute debilitating
episode (another myocardial infarction or stroke) or reactivation of a chronic condition
• Dying with dignity and comfort
Ng. intervention
Domain Interventions
Biological
Monitor client's activity levels,
Identify abnormal lab values and report
Determine plan for intensity level of activity
Start fitness program gradually according to client ability
Determine fitness program using FIT model
Educate client on proper activity equipment, including
appropriate attire and shoes Specify importance of warmup and cool down exercises
Set up self-monitoring diary
Establish exercise contract
Psychological
Refer to appropriate counseling if stress levels high
Set up fitness plan utilizing small attainable goals
Refer to specialist, if necessary
Sociocultural
Encourage involvement with formal and informal fitness
groups
Ng. intervention
Spiritual/Religious
Encourage client to discuss spiritual/religious needs that
may be influential in setting up fitness program
Include specific spiritual/religious beliefs in the fitness
plan
Environmental
Include enviromental. Conditions affecting activity
and fitness plan
Counsel client to be cognizant of environmental
influences on exercise, e.g,excessively hot or cold
temperatures, pollution levels
Educate on the appropriate clothing to wear when
exercising
Technological
Educate client on new exercise machinery
Monitor client's use of exercise equipment
STRESS AND COPING RESPONSES
Each person handles stress differently. How well we
adapt depends on our ability to cope.
During a health history, past coping patterns and
perceptions of current stresses and anticipated
outcomes are explored to identify the person’s
overall ability to handle stress.
It is especially important to identify expectations
that the person may have of family, friends, and
caregivers in providing financial, emotional, or
physical support
6-Evaluation
should
include
the
nurse's
selfevaluation of attitudes and emotions
toward providing nursing care to
clients from diverse sociocultural
backgrounds.
6-Evaluation
In chronic illness, maintaining the stability of the
condition while at the same time preserving the
patient’s control over his or her life and a sense
of identity and accomplishment is the primary
goal.
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Success may be defined, however, as merely
making progress toward a goal when a patient
finds it difficult to implement rapid and drastic
changes in the way that he or she does things..