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 to
Dr. Aida Abd El_razek
Associate Proffesor Obstetric &
Gynaecology of Nursing
Understand
Explain
Quality of life
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 life
Dr. 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. L
 Palliative 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 Life
Dr. 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 wellbeing 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 wellbeing.”
Dr. Aida Abd El_razek
Associate Proffesor Obstetric &
Gynaecology of Nursing
–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.
 Quality-of
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
is, “the degree to which the
person
enjoys
the
important
possibilities of his or her life"
(Renwick & Brown, 1996).
 Humanistic-existential model
 Humans have needs
 QOL
◦ 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
Quality of Life
Objective
Subjective
Behavioral Competence
Perceived QOL
Environmental Quality
Psychological Well Being
leisure and discretionary activities
structure and process of care
time, friends, family
satisfaction, affect
Dr. Aida Abd El_razek
Associate Proffesor
Obstetric & Gynaecology of Nursing
1.
2.
3.
4.
5.
6.
QOL is multidimensional
QOL is bio-psycho-social
QOL appraisal must be holistic
QOL components are common to all
people and the human condition, i.e. not
different for people with disability
Disability doesn’t imply increased or
decreased QOL
QOL meaning is individual
Dr. 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 dimensions
 Community
 Becoming is constituted by personal
growth, leisure, and practical.
 Growth
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
Material
• Finance
• Housing
• Transport
• Security & tenure
Development & Activity
• Competence
independence,
choice & control
• Productivity
job, education
home life, leisure
Dr. Aida Abd El_razek
• Community
Emotional Well Being
• Mental health
• Self-esteem
• Faith
• Sexuality
• Fulfillment
Associate Proffesor
Obstetric & Gynaecology of Nursing
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.
 Palliative
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 of
a 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 clinic
 Modifies social environment
 Passive in own goals
 Angry, depressed, suspicious
 Low 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 research
Contribution to the Nursing
body of knowledge
Dr. Aida Abd El_razek
Student
Opportunity to develop
critical thinking skills
Opportunity to learn
innovation
Opportunity to start career
with an edge
Program of scholarship and
service
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
Dr. Aida Abd El_razek
 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
Associate Proffesor Obstetric &
to remove
patient
from
Gynaecology
of Nursing
Scenario 1
Female, 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
Dr. Aida Abd El_razek
Associate Proffesor
Obstetric
&
Gynaecology
of Nursing
Dies at 51
Scenario 2
Female, 45, poorly
managed adult onset
diabetes
Kidney failure
requiring dialysis
Patient chooses
hemodialysis 3 times
per week (? Years)
Complications
including stroke,
amputation
Dies (? Age)
Scenario 1
85 y.o. woman falls
and fractures T-12,
head lac, rib
fractures
Hospitalized for 3
weeks inclusive of
rehab
Refuses all pain meds
Refuses to work with
PT on taking a tub
bath
Lives to be 98 and
Dr. Aida Abd El_razek
Associate Proffesor Obstetric & Gynaecology of Nursing
Scenario 2
85 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 ? years
Dr. Aida Abd El_razek
Associate Proffesor Obstetric &
Gynaecology of Nursing