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Nurse‐led clinics are known to positively impact and benefit patients; however, there is little understanding of the role of the nurse in a nurse‐led male Lower Urinary Tract Symptoms (LUTS) clinic. LUTS affect up to 30% of males over 65 in the United Kingdom and can significantly impact the quality of life of the person experiencing them. LUTS can be managed with conservative changes, as well as with medication and surgical intervention. The aim of this scoping review is to map what is known about the role of the nurse in a nurse‐led male LUTS clinic and what research tells us regarding, the barriers and enablers in nurses leading a male LUTS clinic. This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐SCR) checklist and the methodological guidelines set out by the Joanna Briggs institute. A literature search was carried out over three databases (CINAHL, Medline Ovid, ProQuest health and medical collection) and systematically searched from 2000 to 2021. Grey literature was also searched, and citation chaining was undertaken. Following a systematic review of the literature, four papers met the inclusion criteria for this scoping review. The emergent themes across the four papers consisted of structure, assessment and resources, and effectiveness of the nurse‐led male LUTS clinic. There was clear agreement across the literature regarding the investigations and assessment the nurse should carry out. Ongoing practical, theoretical, and observational training and education is required to ensure the nurse is competent in running a male LUTS clinic. The papers reviewed showed the nurse provided a supportive role to the consultant. However, there is evidence indicating there is a move towards autonomous practice. There is a dearth of the current research relating to the role of the nurse in nurse‐led male LUTS clinics and the enablers and barriers in nurses leading male LUTS clinics. Further research should be considered to gain a better understanding of where nurse‐led male LUTS clinics currently take place, what the role of the nurse is in leading a LUTS clinic and what enablers and barriers exist. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to analyse the status, hotspots and trends of research on oral care for the elderly in mainland China in the past 20 years through bibliometrics, which aims to provide new ideas and targets for future clinical work and research. Design: Bibliometric analysis. Methods: Relevant literature was retrieved from China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database, Web of Science and PubMed. NoteExpress, Co‐Occurrence and CiteSpace were used to analyse bibliometric features in terms of year of publication, journal of publication, authors, institution and keywords. Results: A total of 716 related articles were obtained. The number of publications shows an increasing trend over time, only 2017–2021; 309 papers were published, accounting for 43.2% of the total number of publications. A total of 238 articles were published in Science Citation Index journals or Chinese core journals, accounting for 33.2% of the total number of articles. The study of oral health‐related quality of life in the elderly is a hot research topic. There is a lack of research on the elderly living in elderly care facilities. [ABSTRACT FROM AUTHOR]

AIM AND OBJECTIVES: To provide an overview of tinnitus, current management and its psychosocial impact offering strategies for managing acute and chronic tinnitus in practice. BACKGROUND: Tinnitus, characterised by the perception of sound in the absence of external stimuli, is experienced by about 10% of the population at some time in their lives. It may be temporary/longstanding; approximately 5% adults experience severe, persistent tinnitus affecting their lifestyle. Although many adjust successfully, others are disabled by the condition. Though often unrecognised, tinnitus affects many patients regardless of their presenting illness. DESIGN: A literature review including descriptive, theoretical and empirical material. Databases were searched using the keyword 'tinnitus' providing diverse information which was used to address the research questions. RESULTS: Tinnitus represents more than 'simple' ringing in the ears and may be accompanied by many distressing changes. It may be acute or chronic. It is difficult to treat, care may be directed towards management rather than cure. Many patients are, however, told that 'nothing can be done'. Relevance to clinical practice. Despite the high prevalence of tinnitus, there is a paucity of relevant nursing literature suggesting that there is an information deficit amongst nurses. The information provided shows that understanding the full impact of the condition and identification of patients' needs are essential to effective care. Strategies to help affected patients are given. CONCLUSIONS: Tinnitus, a widespread, often intractable condition, affects millions of people; there is considerable debate about its causes. Tinnitus is distressing and may be severe enough to affect lifestyle and quality of life. Affected patients need considerable support and advice on healthcare options, encouragement to try different treatments and recognition that help and hope are available. Though patients may have to learn to live with tinnitus, the most important thing is that they recognise that help is available. [ABSTRACT FROM AUTHOR]

Rationale and Aim: Advanced Practice Nurse (APN) is a specialist who has acquired clinical skills to make complex decisions for a better professional practice. In the United States, this figure has been developed in different ways, but in some European countries, it is not yet fully developed, although it may imply a significant advance in terms of continuity and quality of care in patients with chronic or multiple pathologies, including cardiac ones and, more specifically, heart failure (HF). The follow‐up of HF patients in many countries has focused on the medical management of the process, neglecting all the other comprehensive health aspects that contribute to decompensation of HF, worsening quality indicators or patient satisfaction, and there are not updated reviews to clarify the relevance of APN in HF, comparing the results of APN interventions with doctors clinical practice, since the complexity of care that HF patients need makes it difficult to control the disease through regular treatment. For this reason, this systematic review was proposed in order to update the available knowledge on the effectiveness of APN interventions in HF patients, analysing four PICO questions (Patients, Interventions, Comparison and Outcomes): whether APN implies a reduction in the number of hospital readmissions, if it reduces mortality, if it has a positive cost‐benefit relationship and if it implies any improvement in the quality of life of HF patients. Design and Methods: A systematic review was performed based on the PRISMA statement, searching at four databases: PubMed, CINAHL, Scopus and Cuiden. Articles were selected based on the following criteria: English/Spanish language, up to 6 years since publication, and original quantitative studies of experimental, quasi‐experimental or observational character. Papers were excluded if they do not comply with CONSORT or STROBE checklists, and if they had not been published in journals indexed in JCR and/or SJR. For the analysis, two separate researchers used the Cochrane Handbook form for systematic reviews of intervention, collecting authorship variables, study methods, risks of bias, intervention and comparison groups, results obtained, PICO question or questions answered, and the main conclusions. Results: A total of 43,754 patients participated in the 11 included studies for the development of this review, mostly from United States and non‐European countries, with a clearly visible lack of European publications. Regarding the results related to first PICO question, researches reviewed proved that APN implied a reduction in the number of hospital readmissions in patients with heart failure (up to 33%). Regarding the second question, mortality was always lower in groups assisted by APN versus in control groups (up to 7.8% vs. 17.7%). Regarding the third question, APN was cost‐effective in this type of patient as the cost reduction was eventually calculated in 1.9 million euros. Regarding the last question, quality of life of patients who have been cared for by an APN had notoriously improved, although one of the papers concluded that no significant differences were found. All the questions addressed obtained a positive answer; therefore, APN is a practice that reduced hospital readmissions and mortality in HF patients. The cost‐effectiveness is much better with APN than with usual care, and although the quality of life of HF patients seems to improve with APN, more studies are needed to support this focused on this. [ABSTRACT FROM AUTHOR]

In this indefinite pandemic situation, roles of nurses have been most illuminated by the public, but the nurses may soon start experiencing burnout. This paper highlights roles of nurses in COVID care in Korea and nursing strategies for the post‐COVID era. As we are the frontline advocators of the public, when we develop strategies for their health and quality of life, we receive public support that can help resolve our issues. We will improve our poor working environments through mutual cooperation, as we are one. Implications for Nursing: Nurses need to possess a variety of abilities, such as the digital literacy required by the non‐contact era after COVID‐19, and to expand the boundaries of the nursing profession in convergence of health services with technology. [ABSTRACT FROM AUTHOR]

SUMMARY This is the first paper in a two-part Continuing Education (CE) series focusing on psychosocial care of patients with end-stage kidney disease (ESKD), which addresses a variety of psychological responses experienced by patients when adapting to the challenges posed by living with this long-term condition. The second paper will examine further the issues of coping and adjustment to ESKD and the need for renal supportive care to ensure person-centred holistic care is provided to patients. [ABSTRACT FROM AUTHOR]

Aim. To explore the impact of renal cancer treatment on patients' quality of life.Background. Renal cancer accounts for 95,000 deaths worldwide and its incidence rate is rising. At present there are several therapeutic approaches to the treatment of renal cancer, ranging through surgery, immunological therapies and vaccine treatment. Each of these therapies may have a substantial effect upon patients' quality of life. However, a systematic appraisal of the empirical evidence about treatment impact is lacking.Design. Literature review.Methods. A structured review of the empirical literature on the impact of renal cancer treatment upon quality of life was undertaken. Literature was appraised and themed according to the treatment modalities included in the study.Results. From 873 papers initially identified 52 were retrieved for detailed scrutiny resulting in a final 16 papers being included in the review.Conclusions. This review discusses the complex effect of renal cancer upon a patient's quality of life as treatment modalities change. The need for nursing education and awareness of these issues is therefore highlighted to maximise patient care.Relevance to clinical practice. Understanding the impact of treatment for renal cancer enables nurses to empathise more significantly with patients and also act as mediators in regard to treatment choice and treatment cessation. It also enables nurses to inform and educate renal cancer patients prior to making treatment choices. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to provide measurement properties evaluation and factor analysis of the Brazilian version of the diabetic foot ulcer scale‐short form (DFS‐SF). This methodological study evaluated the measurement properties of the DFS‐SF by ceiling and floor effect reliability, responsiveness, and structural construct validity. The study included 290 people with diabetic foot under regular follow‐up in a specialised outpatient clinic in inland São Paulo. Reliability was assessed by internal consistency using Cronbach's alpha and composite reliability. Ceiling and floor effects were assessed by the percentage of participants who scored the 15% worst (floor) and 15% best (ceiling) possible scale results. Validity was tested by correlating the instrument values with the domains of the Brazilian version of the Short Form Health Survey (SF‐36). Responsiveness (n = 34) was accessed through the wound area obtained by photography and evaluated by the Image J Features program and the DFS‐SF score at two moments, with a 4‐week interval between them. The instrument had good evidence of reliability, shown by adequate internal consistency (Cronbach's alpha in domains >0.70) and compound reliability (0.84 > CC > 0.92); and of convergent validity, by significant positive correlations of moderate to strong magnitude with SF‐36. Structural construct validity was examined by applying the DFS‐SF confirmatory factor analysis, which indicated that the Brazilian version of the instrument is properly fitted to the original dimensional structure. The ceiling and floor effect analysis showed no ceiling or floor effects. Responsiveness was observed in the wound area, but not in the DFS‐SF scores in the times. The Brazilian version of the DFS‐SF presented evidence of validity and reliability, suggesting that this instrument is a valid tool for assessing the quality of life of people with diabetic foot in the Brazilian population. [ABSTRACT FROM AUTHOR]

Title. Adequacy of health-related quality of life measures in children under 5 years old: systematic review Aim. This paper is a report of a systematic review to assess the adequacy of measures evaluating generic health-related quality of life outcomes in children less than 5 years old. Background. Evaluating generic health-related quality of life outcomes in children is important to assess the effectiveness of interventions, nursing care and services. Methods. A methodological systematic review was carried out for the period 1980–2005 in accord with the UK Centre of Reviews and Dissemination guidelines on systematic reviews. We searched multiple electronic databases, hand-searched key texts, and contacted investigators. We included all English language publications describing primary empirical research of generic health-related quality of life, health status, functional status or wellbeing measures, with published psychometric evidence. All measures (proxy and/or self-complete) for use in children under 5 years were included; single dimension measures were excluded. Results. Seventy-six papers (70 studies) referring to 16 generic health-related quality of life measures met our inclusion criteria. None of the 16 measures were adequate in terms of their conceptual content or psychometric criteria; quality scores were poor (0–8). No current, generic health-related quality of life measure is both psychometrically and conceptually robust, although the Health Utilities Index has the most comprehensive psychometric data published. However, not all dimensions of health are assessed, with little evidence of reliability in children under 5 years of age. Conclusion. There is a need to develop empirically robust and conceptually comprehensive health-related quality of life measures, particularly in the context of proxy-completion measures for very young children. [ABSTRACT FROM AUTHOR]

Aim: The article addresses selected determinants of the nursing shortage in Poland and other countries in the face of employee ageing. Background: Global demographic changes have led to a systematic increase in the elderly population and a decreasing number of births, which have impacted health policy and healthcare systems in various countries. Both processes necessitate transitions in global health care. Nursing care, which has faced a human resources crisis, is a strategic area within this context. Sources of evidence: This study is based on national listings and strategic documents for nursing policy in Poland, including Increasing average age of nurses and midwives prepared by the Polish Main Council of Nurses and Midwives, the incorporation of big data, international reports and a literature review on nursing and healthcare challenges. Discussion/Conclusions: This paper argues that the causes of the nursing shortage are multifaceted with no single global or local measure of its nature. An overview of the problem indicates ineffective planning and use of available nursing resources, poor recruitment or an undersupply of a new staff, and global demographic conditions. The overview highlights the fact that nursing shortages have reached a critical point for healthcare services on both the local and global levels. Conclusions for nursing and health policy: The general recommendations for nursing policy include the need to prepare and implement national social security agendas into services provided by nurses. Such a programme would include general issues: improving working and employment conditions, implementing mechanisms regulating salary and providing the possibility of lifelong learning with the incorporation of mobile and technological innovations as a sustainable solution. [ABSTRACT FROM AUTHOR]

Pressure injuries are a significant concern for patients undergoing neurosurgical procedures due to prolonged immobility and the complexity of care. This study evaluates the efficacy of standardized pressure ulcer management protocols in preventing pressure injuries and enhancing patient care in a neurosurgical context. A comprehensive retrospective analysis was conducted at a single institution from December 2020 to December 2023, comparing 50 patients who received standardized pressure ulcer management (intervention group) with 50 patients who received conventional care (control group). The study assessed the incidence of pressure ulcers, patient comfort levels using the Kolcaba Comfort Scale and sleep quality using the Richards‐Campbell Sleep Questionnaire (RCSQ). Statistical analysis was performed using SPSS software, version 27.0, applying t‐tests and chi‐square tests as appropriate. The intervention group exhibited a significantly lower incidence of pressure ulcers at all measured time points post‐surgery compared to the control group. Patient comfort levels in the intervention group were consistently higher across psychological, environmental, physiological and socio‐cultural domains. Sleep quality metrics, including sleep depth, latency to sleep onset and overall sleep quality, were significantly improved in the intervention group. The implementation of standardized pressure ulcer management protocols in neurosurgical care significantly reduces the incidence of pressure injuries, enhances patient comfort and improves sleep quality. These findings highlight the importance of adopting structured care protocols to improve postoperative outcomes and patient well‐being in neurosurgical settings. [ABSTRACT FROM AUTHOR]

Aims. This paper explores certain key critiques of spirituality-in-nursing as they have been offered by people outside of the discipline. It argues that nurses have not taken seriously enough the recent criticism of the nature and role of spirituality in nursing. Not to listen to the ‘enemies’ of spirituality-in-nursing is to risk stagnation and a drift into obscurity. Background. The area of spirituality has become a growing field of interest for nurses and has produced a burgeoning body of research literature. Yet, whilst much has been written about the positive aspects of spirituality, nurses have offered almost no critique of the ways in which spirituality and spiritual care are understood, despite the fact that there are clearly certain key issues that require robust critique and thoughtful reflection. Almost all of the major criticisms of spirituality-in-nursing have come from people outside of the discipline of nursing. The paper argues that nurses need to listen carefully to the criticisms of spirituality and spiritual care offered by the ‘enemies’ of spiritual care in nursing. When listened to constructively, they highlight issues that are vital for the development and forward movement of this important area of nursing practice. Methods. Literature review and critical reflection on current critiques of spirituality in nursing practice. Conclusions. The paper concludes that nurses need to begin to develop spirituality as a specific field of enquiry with its own bodies of knowledge, methodologies, assumptions and core disciplines. Relevance to clinical practice. In listening to and taking seriously its ‘enemies’, nursing has the opportunity to establish spirituality as an important, creative and vibrant aspect of nursing practice that has the capacity to grow and respond constructively to its ‘enemies’, in ways that make whole-person-care a real possibility. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to add a qualitative dimension to the body of knowledge about fatigue by revealing the meaning given by women living with chronic illness to the experience of fatigue. Background. Fatigue is a common symptom experienced by people who live with chronic illness. It pervades every aspect of life and may be experienced in physical, psychological, emotional or social dimensions. Management of fatigue relies heavily on the individual's ability to employ self-care actions. The invisibility of fatigue is recognized as one of the most frustrating aspects, which can lead to lack of understanding and misunderstanding by others. Method. We report the findings of data from research in progress (2003-2005). Data were generated via email group conversations between us and 30 women who live with long-term illness. Findings. A recurring conversational thread has been women's experiences of fatigue when living with long-term illness. Although fatigue has been reported to be a major obstacle to maintaining usual daily activities and quality of life, few studies have explored this common symptom from the perspective of people themselves. Common themes found in the experience of fatigue as described by women are the meaning of fatigue, awareness as self-care, fatigue as invisible to others, seeking medical validation and accountability for self-care. Conclusion. It is vital for healthcare workers to give opportunities for women to talk about fatigue, validate their experiences and provide support with self-care. Healthcare workers are encouraged to challenge their own meanings and expectations surrounding a person's report of fatigue so that opportunities for therapeutic intervention can be facilitated. [ABSTRACT FROM AUTHOR]

wiles j. (2005) International Journal of Older People Nursing in association with Journal of Clinical Nursing 14, 8b, 100–108 Conceptualizing place in the care of older people: the contributions of geographical gerontology This paper introduces the subdiscipline of geographical gerontology to the readers of International Journal of Older People Nursing, and the ways in which geographers and others have conceptualized place in relation to the experiences of older people and their health and well-being. Particular attention is paid to place as a process; its role in the exertion and negotiation of power; and as an experience open to interpretation; and how these relate to clinical practitioners. This review sets the scene for the following papers on practice and the future research agenda. [ABSTRACT FROM AUTHOR]

This paper offers a critical examination of how the concept of Quality of Life might be used to enhance learning disability nursing practice. Quality of Life will increasingly influence the provision and evaluation of services and practice in the field of learning disability. Attempting to define and assess Quality of Life is, however, problematic because of the complexity and multidimensional nature of the concept. The use of domains to measure Quality of Life is advocated by many researchers for both objective and subjective measures and use of Quality of Life as an evaluation tool is seen as a way of improving the life quality of people with learning disabilities. However, there are concerns that the use of such an approach could perpetuate professional agendas rather than empower people with learning disabilities themselves. To date, Quality of Life approaches have not had a major impact on learning disability nursing. However, it is suggested that they can be helpful as sensitizing concepts, a basis for collaborative care planning and a framework for evaluation. Recommendations are made for education, practice and research. [ABSTRACT FROM AUTHOR]

The article comments on "Quality of life in palliative care cancer patients: A literature review," a paper by H.R. Jocham and colleagues that was published in the 2006 issue. The literature review has attempted to debate an issue of importance to palliative care nursing practice. The challenges presented by current understanding about quality of life (QOL) and how nurses might assess it within the context of palliative care are discussed.

The article comments on a paper which examines the asthma quality of life for Swedish children. The authors stress that this paper is useful in helping nurses to understand better the full impact of asthma on the lives of their patients. They assert that the study reinforces the need for nurses to promote physical activity among children with asthma. They emphasize that the paper highlights the importance of accurate nursing assessment of these patients.

Aims: This study compared those living with and without an intestinal stoma in relation to physical and psychological health, stress and coping, quality of life and resilience. Also, identifying factors that could be used to promote better self‐care in stoma patients in the future. Design: A cross‐sectional and comparative study design was employed. Methods: Participants were recruited via email and social media (Facebook and Twitter) between August 2018 and March 2019, to complete an online survey. The data were analysed using analysis of variance to examine group difference and a series of hierarchical linear regression analyses determining predictors of psychological well‐being. Results: Of 278 participants aged 18–68 years who completed the survey, 129 (46%) had a stoma and reported significantly poorer physical health. Approximately one‐fifth experienced problems with stoma management. Psychological well‐being was mediated by the duration of living with a stoma (under 3 years) and frequency of leaks (weekly and monthly). [ABSTRACT FROM AUTHOR]

Aim: To investigate the association of resilience with self‐care and quality of life in people with chronic obstructive pulmonary disease. Design: Cross‐sectional study. Methods: Data were collected between February and May 2021. Self‐care was measured with the self‐care of chronic illness inventory, quality of life was measured with the clinical chronic obstructive pulmonary disease questionnaire and resilience was measured with the resilience evaluation scale. Possible confounders were included (sex, age, smoking, time since diagnosis of chronic obstructive pulmonary disease, educational level, social support and pulmonary function). Multiple regression analysis was performed among the determinants, confounders and both outcomes. Results: Participants scored fairly well on resilience (mean 22.5). Self‐care scored reasonably well (mean maintenance 65.9, mean monitoring 70.9, mean management 59.9 and mean confidence 71.5). Quality of life scored mediocre (mean 2.6). The results of the linear multiple regression were resilience, which is associated with self‐care confidence and quality of life when adjusted for possible confounders. This means people with chronic obstructive pulmonary disease with higher resilience have better self‐care confidence and higher quality of life. The outcome contributes to strengthening nursing care and further developing nurses' knowledge. The results can contribute to increasing awareness for healthcare professionals that resilience can potentially increase self‐care and quality of life. [ABSTRACT FROM AUTHOR]

Aims: To analyse the aspects involved in the care of individuals assessed as kidney transplant candidates and to identify the role of nurses in providing specialised care for this population. Design: Scoping review. The results were summarised using a narrative synthesis technique. Data Sources: A review of the literature published between 2001 and 2021 was conducted between October and November 2021 using PubMed, CINAHL and SciELO. Review Methods: The research team agreed on a search strategy based on clinical practice guidelines for assessing kidney transplantation candidates. Quantitative, qualitative and mixed methods studies published in peer‐reviewed journals in English, Spanish, French and Portuguese were included. Results: A total of 377 studies were identified, and 49 articles were included after the inclusion and exclusion criteria were applied. The narrative synthesis was structured into four themes: Physical needs; Psychological and quality of life needs; Education and adherence needs; and Nurses' role. Conclusion: Nursing assessment of kidney transplantation candidates should encompass physical, psychosocial and adherence aspects. A variety of methodologies and resources are available for this assessment. Nurses contribute to coordinating access to kidney transplantation, aiming to improve adherence to an appropriate lifestyle to prevent patients from being excluded from kidney transplantation or suffering from kidney transplantation–related complications. Impact: Based on our findings, we managed to design a nursing care map for kidney transplantation candidates combining the main elements of nursing care that should be incorporated into this process. Advanced practice nursing professionals play a crucial role in accessing renal transplant care. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study conducted to compare middle-aged female family caregivers and non-caregivers in terms of: (a) differences in quality of life and health-promoting lifestyle behaviors; and (b) the relationship between health-promoting lifestyle behaviors and quality of life. BACKGROUND: Caregiving for older relatives is a stressful responsibility that detracts from the quality of life of female caregivers and imposes barriers to practising healthy behaviors. Recent studies on caregiving responsibilities have been primarily conducted in Western cultural contexts, with few studies of Chinese groups. METHOD: This cross-sectional, comparative study included a convenience sample of 39 female caregivers and 98 non-caregivers recruited in southern Taiwan in 2007. Data were collected using the World Health Organization Quality of Life Instrument-BREF Taiwanese version and Health Promotion Lifestyle Profile II. RESULTS: The majority of caregivers reported a low level of caregiving input with family support. They also reported a statistically significantly higher proportion of health-promoting behaviors than non-caregivers, although quality of life did not differ between the two groups. Practising healthy behaviors may more strongly influence quality of life in caregivers than in non-caregivers. CONCLUSION: Policymakers should consider direct family support and uphold the value of family cohesion in order to maintain healthy behaviors and a high quality of life in family caregivers. Further studies with larger and more comparably-sized participant groups are recommended to investigate the interactions between levels of care, family support, caregiving consequences, health-promoting behaviors and the caregivers' quality of life. [ABSTRACT FROM AUTHOR]

Title. Clients’ experiences of living at home with a mechanical ventilator. Aim. This paper reports on a study of how clients experience living with home mechanical ventilation and how they experience care and supervision of healthcare personnel. Background. The number of people living at home with mechanical ventilators is increasing, and this is considered a successful approach to reducing incapacity and mortality. Method. Qualitative interviews were conducted with 10 service users in 2006. The informants were 18–75 years old and had varying diagnoses and levels of functioning. The interviews were tape recorded, transcribed and analysed by qualitative content analysis. Findings. Two main themes emerged: Theme 1. Having a home ventilator enhances quality of life – a life worth living. The ventilator treatment builds up strength and improves well-being. Participants emphasized that it was important to feel in control of their own situation and had an overriding wish to live a normal and active life; Theme 2. Competence and continuity of healthcare personnel are factors for success. The experience was that competence and follow-up by healthcare personnel varied, and that good quality teaching and information were important. Conclusion. Users of home mechanical ventilators should be active partners in their own care so that their experience is taken into account. It is important for clients having home mechanical ventilation to be empowered and have control in their daily lives, as well as having competent caregivers and continuity of care. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to examine the degree to which socio-demographic variables, clinical variables and health-related quality of life are related to perceptions of disease severity and changes in disease severity in patients with multiple sclerosis. Background. Studies have shown that patients with multiple sclerosis report lower quality of life than the general population. Method. Questionnaires measuring health-related quality of life and perceived multiple sclerosis severity were mailed twice, 1 year apart, in May/June of 2000 and 2001, (t1 and t2), to patients with confirmed multiple sclerosis in Oslo, Norway ( n = 502). Clinical data about disease onset and course were retrieved from the Oslo City Multiple Sclerosis Registry. Findings. Among the 313 (62·4%) people who responded at both times, those with primary progressive disease course reported higher perceived multiple sclerosis severity ( P < 0·001), more mental health problems ( P = 0·004) and lower physical functioning ( P < 0·001) than those with a relapsing remitting/secondary progressive disease course. Patients with primary progressive disease course reported higher mean scores for multiple sclerosis severity at t2 than at t1. Multivariate regression analysis showed that social functioning was the only factor with statistically significant relationships to perceived multiple sclerosis severity among all sub-domains of health-related quality of life or personal factors. However, physical impairment was also independently related to patients' ratings of changes in multiple sclerosis severity during the year and illness severity 1 year later. Conclusion. In addition to patients' physical impairment, healthcare workers should pay special attention to issues related to their social functioning. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to explore health problems, physical and mental functioning, and physical activity in working-age patients after myocardial infarction, in order to assess the possible effects of these factors on return to work. Background. A diagnosis of myocardial infarction may discourage patients from continuing an active working life. Enabling myocardial infarction patients to return to work has benefits for both individuals and society. Methods. A convenience sample was recruited of 88 patients, <=65 years of age, who had suffered a myocardial infarction. Assessments of employment, health-related quality of life and physical activity (footsteps per day) were conducted in 2005-2006, 4-6 months after myocardial infarction. To explore data and compare groups, t-tests were applied. Logistic regression analyses were performed to identify variables that best predicted return to work. Results. Differences were identified between individuals who were employed after myocardial infarction and those who were not. Those not in work scored lower on variables related to the physical dimension of health-related quality of life and on physical activity. Logistic regression revealed that a multivariate model including age, physical dimension of health-related quality of life and footsteps per day predicted return to work in 68% of all cases ( R2 = 0·344). Conclusion. Low physical health and low physical activity after myocardial infarction negatively affect returning to work. These findings stress the importance of clinical assessment of myocardial infarction patients' daily physical activity and physical functioning. [ABSTRACT FROM AUTHOR]

Background and aim Since 1998, many leg ulcer practice guidelines were developed. The aim of this paper is to describe the methodological and clinical content quality of those guidelines. Methods PubMed, CINAHL, Cochrane Library and websites known for publishing or collecting clinical practice guidelines were explored from 1998 up to June 2006. Reference lists of all identified guidelines were reviewed for other guidelines to be included. Guidelines were eligible if they were written in English, Dutch, French or German, if the scope was the treatment of venous leg ulcers, if the guideline was systematically developed and if the steps in guideline development were reported clearly. Seven guidelines were critically appraised. Results The venous leg ulcer guidelines were clearly based on evidence. The stakeholder involvement varied during the development process. Especially patients’ perspectives were often not considered. There was no uniform method used to weigh the evidence. Limited attention was given to pain and lifestyle advice recommendations. A paucity of information on compliance, quality of life, organizational aspects of care and economic evaluation data was given. Most of the guidelines failed to consider the issues of dissemination and implementation. Revisions of the guidelines for leg ulcer treatment were often not available. Conclusion and implications for future guideline developers It is recommended that leg ulcer guidelines should incorporate a multidisciplinary approach and patient involvement is necessary. Extensive background information and the formulation of the rationale are needed. The development of an implementation guide that addresses the barriers particular to the adoption of guidelines for leg ulcer treatment could support the process of implementation. Recommendations on pain, lifestyle advice, compliance and other quality-of-life issues should be incorporated in guidelines for leg ulcer treatment. [ABSTRACT FROM AUTHOR]

Aims. To critique existing concept analyses of quality of life and develop a definition applicable for young people with chronic illness. Background. Quality of life is a commonly used phrase but there is no universal definition. Five perspectives of quality of life have been proposed: sociological, economic, psychological, philosophical and ethical. However, health has emerged as an important but distinct perspective. The nursing profession has made a substantial contribution to the understanding of the interrelationship of health and quality of life. Design. Literature review. Methods. A search on electronic databases to April 2007 was made using the terms 'quality of life' and 'concept analysis'. Papers were included in the review if they used a recognised method of concept analysis and were conducted by nurses. A new concept analysis was then performed specifically focusing on young people's experiences of living with chronic illness. Results. Eight concept analyses were identified, all of which had limitations. All the concept analyses were based on adult literature so did not take into consideration developmental changes, language level, or young people's construction of health and illness. The new concept analysis found that young people living with chronic illness generally view themselves and their lives in the same way as their healthy peers. While their aspirations are often constrained by illness and treatment the relationship between illness and life cannot be seen in isolation of development. Conclusion. Previous definitions of quality of life derived from concept analyses with adult populations do not adequately represent the experience of young people with chronic illnesses, but can be made more specific by incorporating important attributes such as developmental stage and the importance of peer group and family. Relevance to clinical practice. The current analysis provides a clear definition of quality of life from the health perspective which is specific for use with young people with chronic illness to guide practice and research. [ABSTRACT FROM AUTHOR]

Title. Changes and challenges to patients’ lifestyle patterns following treatment for head and neck cancer. Aim. This paper is a report of a study to explore the changes and challenges to patients’ lifestyles following treatment for head and neck cancer. Background. Head and neck cancer affects some of the most basic aspects of daily functioning, such as eating and speaking. There has been a rapid increase in the number of studies on the quality of life for people with head and neck cancer, but most studies have used quantitative methodology. Methods. Using a qualitative approach, data were collected in 2004 using semi-structured interviews with a purposive sample of 10 participants who had completed treatment 6–12 months earlier for head and neck cancer. A thematic analysis was employed to interpret the findings. Findings. Following thematic analysis seven broad themes were identified, five of which covered areas of changes and challenges to participants’ lifestyles following treatment. These were: physical changes, concerns about cancer, work and day-to-day tasks, interpersonal relationships and social functioning. The concerns and challenges experienced following treatment were not limited to one aspect of an individual’s lifestyle but spanned a number of the themes identified, highlighting the complexity of needs following treatment for head and neck cancer. The other two themes concerned personal attributes that facilitated or inhibited posttreatment coping and specific information needs in the posttreatment period. Conclusion. Specific posttreatment concerns and challenges cannot be viewed as unitary or discrete aspects of life, but should be considered within a biopsychosocial context, to address patients’ needs holistically. [ABSTRACT FROM AUTHOR]

Title. Coping, anxiety and quality of life after coronary artery bypass graft surgery Aim. This paper is a report of a study to explore the relationship between ways of coping, anxiety level and quality of life for patients after coronary artery bypass grafting. Background. Coronary artery bypass grafting requires appropriate coping strategies to achieve successful adaptation. In Taiwan, the incidence of this surgery is increasing, but research on adaptation following surgery is limited, with no research examining outcomes for women, who often have poorer adaptation outcomes than men. Methods. An integrated research design, based on Lazarus and Folkman’s transaction coping theory, was used. The research employed convenience sampling with four instruments: the Revised Ways of Coping Checklist, State-Trait Anxiety Inventory, Short Form 36-Health Survey, and a demographic questionnaire, sent to 50 men and 50 women who were recruited from a medical centre in Taiwan. Additionally, qualitative data from interviews with three men and three women, who had completed the instruments, were analysed. Findings. Better quality of life was associated with lower anxiety level, greater use of problem-focused coping strategies and those who had more gender role responsibility. Women scored lower on the physical dimensions of quality of life, used more self-blaming coping strategies and experienced slightly higher levels of anxiety compared to men. The qualitative analysis supported the conclusions of the quantitative analysis. Conclusion. The results will help nurses design specific interventions intended to lower anxiety levels, promote the use of problem-focused strategies and identify patients’ values, necessary to achieve optimal quality of life. [ABSTRACT FROM AUTHOR]

Title. Quality of life for caregivers of people with Alzheimer’s disease Aim. This paper is a report of a study to describe the meaning of quality of life for caregivers of patients with Alzheimer’s disease and to identify factors that affect their quality of life. Background. The burden for informal caregivers and change in their quality of life can lead to patients being placed in nursing homes. Factors found to worsen caregivers’ quality of life include strained finances, poor family functioning, difficult patient behaviour, financial burdens and the amount of time caregivers spend caring for family members with Alzheimer’s disease. Method. A hermeneutic phenomenological design was used to study 32 informal caregivers of patients with Alzheimer’s disease. Data were collected using interviews between November 2004 and June 2005. Findings. Caregivers associated good quality of life with serenity, tranquility, psychological well-being, freedom, general well-being, good health and good financial status. Factors that caregivers said improved their quality of life were good health of the patient, independence from the patient, and more help in caregiving. Factors that worsened their quality of life were worries about the future and progression of the patient’s illness and stress. Conclusion. Our findings may help healthcare professionals have a deeper understanding of the meaning caregivers give to quality of life and thereby aid in the design of strategies to maintain or improve quality of life. Intervention research is needed for caregivers in countries where this has not yet been performed. Researchers should also investigate whether different types of caregivers (spouse, adult child and friend) have different needs or problems. [ABSTRACT FROM AUTHOR]

Aim. This study aimed to determine how the use and characteristics of absorbent products for incontinence impact on women's quality of life, and to examine the concept of ‘treatment effects’ in the context of pad use. Method. Key pad performance characteristics were identified from the literature and focus group work. Semi-structured interviews with 99 women with light incontinence were used to investigate the impact of pad use on women's quality of life, including both positive and negative ‘treatment effects’, and to rank pad characteristics by their importance. Results. Achieving effective and discrete containment of urine was the dominant factor impacting on women's lives. Sub-themes embraced physical effects, psychological impact and social functioning. The five pad characteristics ranked most important for day time use were: ‘to hold urine, to contain smell, to stay in place, discreteness, and comfort when wet. For night use discreteness was replaced by to keep skin dry’. High levels of reported anxiety were associated with perceived risk of poor pad performance, lack of discreteness and need for complex regimes for pad management. Conclusion. Insufficient attention has been paid to the balance between the beneficial and negative treatment effects of absorbent pads to date. Existing continence-related quality of life measures are not designed for conditions where change in symptoms is not an outcome measure. The study findings provide the basis for developing a more sensitive, patient-oriented, quality of life measure for pad-users which can aid product selection, new product development and inform future evaluative comparisons between products/products and treatments. Relevance to clinical practice. This paper illustrates the complex influence on quality of life caused by using absorbent pads to contain incontinence. It raises awareness of the importance of careful selection of the most appropriate pad for each individual to minimize unfavourable side effects, and the need for a new quality of life measure designed for pad-users. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to compare the perceptions of adult patients, family carers, nurses and dietitians regarding home percutaneous endoscopic gastrostomy feeding. Background. Healthcare professionals have a major role in patient selection for gastrostomy placement and the provision of aftercare but it is not clear if patients, their carers and healthcare professionals have similar perceptions of the initiation and delivery of feeding and of the care in general. Method. A cross-sectional mixed-method study using purposive sampling, semi-structured interviews and questionnaires was performed. Interviews were undertaken during 2005 with adult patients and carers of adults receiving home feeding. A questionnaire containing comparable questions was distributed to the lead district nurse and dietitian providing the individual patient's care. Binomial regression was used to analyse any differences in perceptions across the groups of respondents. Results. Nurses and dietitians had similar perceptions of gastrostomy feeding in adults. Family carers' perceptions matched those of professionals more closely than did those of patients. The greatest difference in perceptions was between patients and their family carers. Respondents' views about success of feeding and the appropriateness of the feeding regimen were similar, but greater differences existed regarding quality of life, withdrawal of feeding and choice in decisionmaking about tube placement. Conclusion. There is a need for increased patient and carer involvement in decision-making and for sufficient, appropriate information to facilitate informed decision-making. Practitioners who involve carers in decision-making, where patients lack capacity, need to be aware that carers may not represent the views of patients. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to examine, from the perspective of patients, the impact of venous leg ulcers on health-related quality of life in current and former intravenous drug users and the general population. Background. Venous ulceration can be caused by intravenous drug use. There has been little examination on how this affects the quality of life of this group of patients and how they compare with other patients who have venous ulcers. Method. A qualitative approach was adopted, using framework analysis. Semi-structured interviews with 19 participants who had a venous leg ulcer were conducted between August 2005 and February 2006. Interview audiotapes were analysed to identify recurring themes relating to the impact of venous leg ulcers on overall quality of life. Findings. A complex interaction between symptoms, social restriction and attribution of illness influenced the impact of venous leg ulcers. Smell and pain were the symptoms that had the most profound impacts. In addition to the physical and psychological consequences, participants' activities and social interactions were restricted. Intravenous drug users experienced more social isolation and difficulties in accessing treatment for their venous ulcers. Conclusion. While leg ulcer services remain focused on the needs of older people, services for young intravenous drug users are unlikely to improve. A more coherent and earlier intervention, when the ulcers are not as difficult to treat, would decrease time and costs to the health service. The challenge is to find new ways of providing effective and accessible care to this growing population. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study comparing health-related quality of life at 3–4 years of age among children born with very low birthweight (≤1500 g) to a group of non-very low birthweight controls, and to examine biological, environmental, demographic and health factors associated with quality of life of children born with very low birthweight. Background. Advances in modern medicine have increased the survival of infants with very low birthweight, but its impact on quality of life of children during preschool years has been less studied. Methods. The study sample included 118 children born with very low birthweight and 170 non-very low birthweight controls in Taiwan. Primary caregivers of the study children completed structured questionnaires during the period November 2002 to April 2003. Health-related quality of life was measured using the Mandarin version of the TZO-AZL Preschool Children Quality of Life instrument. This tool has four dimensions: physical, emotional, cognitive and social functions. Higher scores indicate better quality of life. Findings. Children born with very low birthweight had statistically significantly lower mean quality of life scores in all the four dimensions compared with controls. Among the former, those who had current physical health problems scored lower in all dimensions of quality of life. Primary caregivers with higher educational levels and increased ages of the children were associated with improved scores in the emotional and social functions. Birth gestational age was negatively associated with cognitive function. Length of stay in the neonatal intensive care unit was negatively associated with scores for the social function aspect of quality of life. Conclusion. Regular monitoring of the quality of life among very low birthweight children is needed. Nurses need to assess the child's current health state, birth gestational age, and the primary caregiver's educational level in order to identify those who are at risk for low quality of life and intervene early. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study to translate the English language version of the Quality of Life Index into Arabic and estimate its reliability and content validity. Background. Quality of life has become an important concern in health care and social policy. It is a difficult construct to define and measure, as it is determined by cultural, ethical, personal and religious values. The generic Ferrans and Powers Quality of Life Index was developed to measure quality of life of healthy individuals. Specific versions of the index were developed for particular diseases, such as diabetes, cancer and end-stage kidney disease. The instruments were initially developed for English-speaking clients and were later translated into several languages and used within a variety of cultures. However, there were no Arabic versions of the tool available to measure the quality of life of general populations or of people with particular diseases. Method. The Quality of Life Index was translated into Arabic using two of the techniques suggested in the literature for translation – back translation and bilingual technique. The same process was followed in the translation of the original scale and various disease-specific versions of the instrument. The work took place between 1995 and 2004. Findings. The translated Arabic Quality of Life Index demonstrated a high degree of accuracy of translation and estimates of content validity. Subsequent to the translation of the original scale into Arabic, 13 disease-related versions of the instrument were translated and are ready for use with clients who speak Arabic. Four of the versions have been used to collect data from clients. The results revealed high estimates of reliability for the generic, diabetes, cancer and dialysis versions. Conclusion. The Arabic version of the Quality of Life Index is highly reliable and has sufficient content validity for measuring quality of life of Arabic-speaking clients. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a study to validate and test the reliability of a questionnaire constructed to evaluate the life situation of spouses after their partners have had a stroke. BACKGROUND: Stroke is a disease with great consequences for survivors and their families. Most survivors return home after the hospitalization and rehabilitation due to the stroke event. Relatives, primarily spouses, often feel obligated to care for the survivor at home, providing emotional support or assisting the person in activities of daily living. More specific information is needed about the spouse's life situation after the stroke event in order to develop effective supportive strategies. METHODS: Psychometric testing of the Life Situation Questionnaire was undertaken with 99 spouses of stroke survivors. The 13-item questionnaire consists of four subscales: 'Worries', 'Powerlessness', 'Personal adjustment' and 'Social isolation'. RESULTS: Item analysis showed that each item correlated with its own subscale (r = 0.63-0.78). The instrument had high internal consistency, with Cronbach's alphas of 0.80-0.86 and reasonable high congruent validity when correlated with a Wellbeing instrument, with a correlation of 0.59 (P = 0.001). Exploratory factor analysis confirmed the subscales, accounting for 77% of the variance. CONCLUSION: The Life Situation Questionnaire is a valid and reliable instrument, and could serve as an assessment tool after a stroke event to identify family caregivers who have problems in their life situations and need support from healthcare services. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a systematic review and critical appraisal of the evidence on the effectiveness of Mindfulness-Based Stress Reduction for cancer supportive care. Background. The experience of cancer can have a negative impact on both psychological and physical health and on quality of life. Mindfulness-Based Stress Reduction is a therapy package that has been used with patients with a variety of conditions. In order to draw conclusions on its effectiveness for cancer patients, the evidence requires systematic assessment. Methods. A comprehensive search of major biomedical and specialist complementary medicine databases was conducted. Additionally, efforts were made to identify unpublished and ongoing research. Relevant research was categorized by study type and appraised according to study design. Clinical commentaries were obtained for each study and included in the review. Results. Three randomized controlled clinical trials and seven uncontrolled clinical trials were found. A lack of relevant qualitative research studies was identified. Studies report positive results, including improvements in mood, sleep quality and reductions in stress. A dose-response effect has been observed between practice of Mindfulness-Based Stress Reduction and improved outcome. A number of methodological limitations were identified. Modifications to the traditional Mindfulness-Based Stress Reduction programme make comparison between studies difficult and a lack of controlled studies precludes any firm conclusion on efficacy. Conclusion. Mindfulness-Based Stress Reduction has potential as a clinically valuable self-administered intervention for cancer patients. Further research into its efficacy, feasibility and safety for cancer patients in the nursing context is recommended. [ABSTRACT FROM AUTHOR]

AIM: This paper describes gender differences in perceived coping, social support and quality of life 1, 4 and 12 months after myocardial infarction. BACKGROUND: There is a shortage of studies with a longitudinal research design investigating coping, social support and quality of life in women and men after myocardial infarction. METHODS: A longitudinal, descriptive and comparative design was used for the study, which included 74 women and 97 men. At 12 months, 60 women and 88 men remained. Data were collected using the Jalowiec Coping Scale, a social support questionnaire, the SF-36 Health Survey (health-related quality of life) and the Quality of Life Index-Cardiac version (quality of life). The data were collected during the period 1999-2001. RESULTS: No statistically significant changes over time in coping assessments emerged in the study group, except for fatalistic coping, which diminished over time in men. Women used more evasive coping than men at 4 and 12 months. The perceived efficiency in coping with physical aspects of the heart disease increased. More women than men perceived available support from grandchildren and staff of the church. Health-related quality of life increased in women and men in physical functioning, role-physical, vitality, social functioning, and role-emotional scales. Moreover, an improvement in the mental health scale was evident in women and a reduction in pain in men. No statistically significant gender differences were found for quality of life at any point in time. CONCLUSIONS: The findings can be used to inform caregivers that optimistic, self-reliant and confrontational coping were the most frequently used by both women and men over the first year after myocardial infarction, and that confrontational coping has been shown to have positive outcomes in the longer term. Nurses should tell women about the importance of seeking prompt treatment and discuss health problems with caregivers and significant others. Care planning should include family members and significant others so that they can support and encourage patients to cope with problems in daily life. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a study to compare the quality of life and its correlates for patients undergoing various types of renal replacement therapy. BACKGROUND: Patients with end stage renal disease need renal replacement therapy as a substitute for their original kidneys. Different renal replacement therapies have different levels of impact on physical, psychological and social health. Quality of life as perceived by patients with end-stage renal disease is an important measure of patient outcome. METHODS: A cross-sectional, descriptive, correlational study was carried out in 2002. A total of 240 patients were recruited from two medical centres in northern Taiwan. These patients were currently undergoing one of following types of renal replacement therapies: haemodialysis, continuous ambulatory peritoneal dialysis or transplantation. The study instrument used was the WHOQOL-BREF-TAIWAN. Data were analysed using descriptive and inferential statistics. RESULTS: The scores for quality of life of transplantation patients were higher than those for both haemodialysis and continuous ambulatory peritoneal dialysis patients. The lowest scores for all three groups were in the psychological domain. The mean age for haemodialysis and continuous ambulatory peritoneal dialysis patients was significantly higher than that for transplant patients. The educational level, proportion of single people, and employment status of transplant patients were significantly higher than those of haemodialysis and continuous ambulatory peritoneal dialysis patients. Perception of economic status as 'balanced' or 'proficient' for transplant patients was significantly higher than for continuous ambulatory peritoneal dialysis and haemodialysis patients. CONCLUSION: Information about the quality of life of patients having various types of renal replacement therapy will assist physicians, nurses, patients and their families to make decisions on treatment selection. There is a need to establish support groups for patients having renal replacement therapy in order to enhance their quality of life, especially in the psychological domain. [ABSTRACT FROM AUTHOR]

AIMS: This paper reports a study of the maintenance of individualized care from surgical patients' point of view and examines associations between individualized care, patient satisfaction with nursing care, and health-related quality of life. Rationale. There is preliminary evidence that individualized care is effective from patients' point of view, and is associated with improved patient outcomes, such as patient satisfaction and quality of life. However, individualized care has mainly been studied from the vantage-point of nurses' experiences. METHODS: In this cross-sectional, descriptive, correlational study the data were collected with surgical adult patients (n = 279, response rate 93%) in surgical wards in Finland using self-administered questionnaires including the Individualized Care Scales, Patient-Satisfaction Scale, and Finnish versions of the Nottingham Health Profile and EuroQol 5D. Associations between individualized care, satisfaction with care and health-related quality of life were examined. Cronbach's alpha values and item analysis were used to evaluate the psychometric properties of the instruments, especially the Individualized Care Scales. RESULTS: The more often patients felt they received support for individuality through specific nursing interventions, the higher the individuality of care received. Secondly, the more individualized patients regarded their care, the higher the level of reported patient satisfaction with nursing care. However, the correlation between individualized care and health-related quality of life was fairly low, albeit statistically significant. CONCLUSION: Individualized care may produce positive outcomes, such as patient satisfaction. Further research is needed to explore individualized care in relation to health-related quality of life. [ABSTRACT FROM AUTHOR]

AIM: This paper presents a new theoretical model to explain people's diverse responses to therapeutic health technology by characterizing the relationship between technology dependence and health-related quality of life (HRQL). INTRODUCTION: Technology dependence has been defined as reliance on a variety of devices, drugs and procedures to alleviate or remedy acute or chronic health problems. Health professionals must ensure that these technologies result in positive outcomes for those who must rely on them, while minimizing the potential for unintended consequences. Little research exists to inform health professionals about how dependency on therapeutic technology may affect patient-reported outcomes such as HRQL. Organizing frameworks to focus such research are also limited. MODEL: Generated from the synthesis of three theoretical frameworks and empirical research, the model proposes that attitudes towards technology dependence affect HRQL through a person's illness representations or commonsense beliefs about their illness. Symptom distress, illness history, age and gender also influence the technology dependence and HRQL relationship. Five concepts form the major components of the model: a) attitudes towards technology dependence, b) illness representation, c) symptom distress, d) HRQL and e) illness history. CONCLUSION: The model is proposed as a guide for clinical nursing research into the impact of a wide variety of therapeutic health care interventions on HRQL. Empirical validation of the model is needed to test its generality. [ABSTRACT FROM AUTHOR]

AIMS: This paper reports a study investigating the effectiveness of an adaptation training programme (ATP) to help patients with end-stage renal disease (ESRD) to cope with illness-related stresses and, thus, to alleviate depression and improve quality of life. BACKGROUND: Patients with ESRD who receive dialysis must confront the burdens of long-term illness and numerous treatment-associated stressors. The ability of these patients to cope with and adapt to these stresses, whether related to their medical regimen or to the demands of daily life, has an important influence on physical and psychological well-being. METHODS: The study was a randomized controlled trial using a convenience sample of 57 eligible, fully informed and consenting patients with ESRD who were assigned to experimental (ATP plus usual care) or control (usual care) groups. Participants in the ATP took part in weekly small group sessions over an 8-week period and monthly follow-up to help them to cope with stressors. A clinical nurse specialist and an experienced psychotherapist led them in three small groups (8-10 per group). Participants in the usual care group received routine care. Instruments comprised the Haemodialysis Stressor Scale, Beck Depression Inventory and Medical Outcomes Study SF-36. Data were collected at baseline and at three months following the intervention. RESULTS: The major stressors for these patients were limitations on time and place related to employment, limitations on fluid intake, transport difficulties, loss of bodily function, length of dialysis treatment, and limitation of physical activities. The ATP had a beneficial effect on perceived stress (P = 0.005), depression (P = 0.001) and quality of life (P = 0.02) 3 months after the intervention. CONCLUSIONS: This study supports the effectiveness of an ATP to decrease stress and depression levels, and to improve the quality of life of ATP patients receiving haemodialysis. [ABSTRACT FROM AUTHOR]

cheung p.p.y.&yam b.m.c. (2005) International Journal of Older People Nursingin association withJournal of Clinical Nursing14, 3a, 34–40Patient autonomy in physical restraintDespite initiatives to raise the awareness of patient autonomy among healthcare providers, the use of physical restraints on frail or confused older patients continues to be a common practice in many healthcare settings. This paper examines the relationship between patient autonomy and the use of physical restraints by drawing on the literature contradicting its efficacy and the assumption that its use is necessary to protect the welfare of patients. It argues that the paternalistic use of physical restraints without patient's informed consent is morally unjustified and is an unequivocal violation of their autonomy. The duty to respect individual autonomy should be extended to a duty to respect the autonomy of older people who are being restrained. Only in this way can their human dignity and quality of life be enhanced. [ABSTRACT FROM AUTHOR]

AIM: This paper reports the findings of a study exploring the relationships among patients' sense of coherence, coping ability and health-related quality of life following a critical illness. BACKGROUND: Sense of coherence is a strong determinant of positive health outcomes and successful coping. Promoting sense of coherence has been used for health promotion in the general public so that better coping ability will be achieved and, thus, better quality of life. There have been limited studies focusing on these aspects in critically ill patients, particularly during the weeks following discharge from intensive care units. METHODS: Based on the salutogenic theoretical framework, a descriptive, correlational research design using telephone interviews was used. Participants' outlook on life, quality of life and coping responses were measured using Chinese versions of Sense of Coherence scale, SF-36 and Coping Scale, respectively. RESULTS: Eighty-eight people participated in the study. Sense of coherence was significantly correlated with quality of life (r = 0.28-0.69) and with coping ability (r = 0.58). Furthermore, coping ability was significantly correlated with six (r = 0.25-0.52) out of the eight dimensions of quality of life. It was also found that high household income and support from adult children were predictors of strong sense of coherence. CONCLUSION: Patients with a strong sense of coherence are likely to take an active role in shaping their own health outcomes. The results of this study will enable nurses to design interventions in the early phase of hospitalization to enhance patients' sense of coherence and coping abilities following a critical illness so that quality of life can be promoted. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a study investigating quality of life in relation to loneliness, caregiving, social network, gender, age and economic status among caregiving men and women in a population-based sample aged 75 years or older. BACKGROUND: Because of demographic changes, in the future more care for older people will be given by informal caregivers who are themselves older. Being old and caring for another older person may affect various aspects of life, such as physical and emotional health and decreased time for respite, which may affect social life and quality of life. METHOD: A postal questionnaire including the Short Form Health Survey was used. The sample consisted of 4278 people, aged 75 years and over, living in Sweden. Of these, 783 (18%) were caregivers. FINDINGS: Caregivers had a larger social network and reported feelings of loneliness less often than non-caregivers. Forty per cent of caregivers helped every day. There were gender differences in experiences of loneliness during the last year, with the frequency of intense feelings of loneliness being higher among women. Loneliness and a small or non-existent network were significantly associated with low quality of life among caregivers, as well as in the total sample. The results showed significant association between loneliness, weak social network and low mental quality of life. CONCLUSIONS: The fact that loneliness was the most important factor predicting low quality of life among caregivers, as well as older people in general, indicates that it is crucial in the care of older people. From a nursing perspective, the findings indicate the advantage of helping older people to keep up and develop their social networks. Nursing care should involve steps to maintain the social network before an older person becomes too weak, since decreased health status makes social contacts more difficult. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a study comparing the socio-demographic data, quality of life (QoL) and symptoms of older people living at home with and without help. BACKGROUND: Despite growing numbers of older people worldwide, little is know about the differences between older people receiving help to live at home and those not receiving this, especially as regards QoL and symptoms. Not only symptoms but also dependency on others per se may reduce older people's QoL. From a nursing perspective, knowledge about such issues is important because the impact of symptoms may be reducible, even when diseases cannot be cured. METHOD: A postal questionnaire was sent to an age-stratified random sample of 1866 people aged 75 years or over. Of the respondents (n = 1248) 448 received help and 793 did not. RESULTS: The group receiving help had a significantly higher age, more women, more people widowed and living alone, more children, a higher number of self-reported diseases and symptoms, greater inability to remain alone at home and lower QoL. Loneliness, depressed mood and abdominal pain were significantly related to low QoL in both groups. Living alone, not being able to remain alone at home without help, and fatigue were also predictive of low QoL among those receiving help, and number of diseases and sleep problems in those without. CONCLUSION: Receiving help with daily living seems to be significantly related to low QoL and goes along with a high number of symptoms that need to be considered in nursing care. Through regular visits, systematic assessment and intervention, especially focusing on older people's symptoms, nurses may contribute to improved QoL for this section of the population. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a study to examine the relationships among hope, family health promotion, and quality of life after stroke, by testing hypotheses derived from the Developmental Model of Health and Nursing. BACKGROUND: Little attention has been given to the influences of family strengths on health promotion behaviours and quality of life after stroke. The majority of studies have focused on stroke survivors, not their spouses. METHOD: A descriptive, correlational study was carried out with 40 families of stroke survivors with moderate to severe functional impairments and their spouses. Both partners completed the Herth Hope Index (measure of hope), the Health Options Scale (measure of health work), the Reintegration to Normal Living Index (measure of quality of life) and a demographic questionnaire. RESULTS: For both partners, moderate, positive relationships were found between hope and health work (r = 0.52, r = 0.39, P < 0.01) and between hope and quality of life (r = 0.59, r = 0.32, P < 0.05). Family health work was positively associated with quality of life of stroke survivors (r = 0.50, P

BACKGROUND: The 1990 NHS Community Care Act established a requirement for hospital discharge policies and procedures in the United Kingdom to be developed in collaboration with local government authorities in order to ensure supported discharge for those in need. AIMS: The aim of the study reported in this paper was to track decisions about hospital discharge in relation to outcomes for a sample of medical patients and their carers, identified as at risk of experiencing unsuccessful discharge processes. METHODS: Themed unstructured interviews were conducted in three different hospitals with 30 patients identified as at risk of unsuccessful discharge and their carers pre- and postdischarge. Hospital, community and social care staff involved in the care of the patient were also interviewed. FINDINGS: Patients and carers were constantly negotiating their social roles, seeking to juggle appropriate identities and limited resources to maintain their own and each others' dignity and quality of life. When the negotiation process was destabilized (for example, by exacerbation of chronic disease, withdrawal of some resource, or the experience of additional stressors - not necessarily health-related), then either or both parties sought a way out. In all the cases examined the result was admission to hospital - usually, but not always, mediated by community professionals. CONCLUSIONS: The effective discharge of patients from hospital needs to move from a functional focus on symptom management to a negotiation of quality of life that seeks to promote health for all parties involved. [ABSTRACT FROM AUTHOR]

BACKGROUND: Knowledge of what may influence patients' perceptions of quality of life is essential for improving nursing interventions, but there has been little research on the influence of psychological distress on health status and quality of life among patients with chronic obstructive pulmonary disease. AIM: This paper reports a study whose aim was to examine how disease factors and health status affect psychological distress and subjectively perceived quality of life in patients admitted for an acute exacerbation of chronic obstructive pulmonary disease. METHOD: A convenience sample of 92 inpatients (mean age 69 years) were interviewed using the St George's Respiratory Questionnaire, Hopkins Symptoms Check List (23 item version), and World Health Organization Quality of Life Assessment. Disease variables (disease duration and pulmonary function) and health status were entered in blockwise multivariate regression analyses to examine the relationships between disease variables, psychological distress, and a single item assessment of overall quality of life. RESULTS: The St George's Respiratory Questionnaire Total and Impact subscores showed statistically significant associations with psychological distress. Pulmonary function showed a moderately significant association with subjective perceived quality of life. Pulmonary function and disease duration explained a minor part of the variance in quality of life. Psychological distress had a statistically significant association with quality of life and accounted for 34% of the total 39% variance explained by our model. CONCLUSIONS: The influence of psychological distress on quality of life implies that bringing about change in psychological distress factors may have important consequences for quality of life. The findings should be taken seriously in developing future nursing interventions for this group of patients. [ABSTRACT FROM AUTHOR]

• The purpose of this paper was to explore how a group of gravely ill patients, cared for in different care cultures, assessed their quality of life during their last month of life. • The study material comprised quality of life assessments from 47 cancer patients, completed during their last month of life. Two quality of life questionnaires, the EORTC QLQ-C30 and a psychosocial well-being questionnaire, were used. The data were treated in accordance with instructions for the respective questionnaires, and the results are presented primarily as means, mostly at the group level. Assessments from patients in two different care cultures, care-orientated and cure-orientated, were compared. • The results show that despite having an assessed lower quality of life in many dimensions than people in general, several patients experienced happiness and satisfaction during their last month of life. • ‘Cognitive functioning’ and ‘emotional functioning’ were the dimensions that differed least from those of the general population, and ‘physical functioning’, ‘role functioning’ and ‘global health status/quality of life’ differed the most. ‘Fatigue’ showed the highest mean for the symptom scales/items. • There was a tendency for those cared for in the cure-orientated care culture to report more symptoms than those in the care-orientated care culture. An exception to this was ‘pain’, which was reported more often by those in the care-orientated care culture. • The implications of the results are discussed from different angles. The significance of knowledge concerning how patients experience their quality of life is also discussed with respect to the care and the planning of care for dying patients. [ABSTRACT FROM AUTHOR]