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Similar to Quality of Life in Chronic Wound Patients-Final Presentation
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Quality of Life in Chronic Wound Patients-Final Presentation
- 2. Each year 5 to 7 million chronic and/or complex wounds occur Wound care significantly affects a person’s life, many experience prolonged periods of disability, pain, discomfort, social isolation, and other aspects of daily life It is estimated that chronic ulcers affect more than six million people in the US and their incidence is expected to increase as the population ages Maria, Sebba, Borges, Juliano, Viega, & Ferreira, 2013
- 3. The purpose of this study is to investigate perceptions of quality of life in chronic wound care patients and the registered nurses who care for them in the community and out- patient settings
- 4. Research Question: Is there a significant difference between the chronic wound care patients’ perceptions of quality of life and nurses’ perceptions of chronic wound care patients’ quality of life? Hypothesis: There is an incongruence in perception between perceived QOL of patients and RNs
- 5. Convenience sampling RNs (n=58) › VNA RNs (n=48) › WMC RNs (n=10) Patients (n=26) › VNA patients (n=0) › WMC (n=26)
- 6. World Health Organization Quality of Life Brief Questionnaire (WHOQOL-BREF) 26 items taken from the WHOQOL-100 Five Domains › Physical › Psychological › Social › Environmental › Overall Total QOL Score
- 7. IRB & HSIRB approval › Health network & Moravian College Data collection setting- VNA & WMC Nurses completion of surveys Patient completion of surveys › Nurses working for the VNA distributed patient packets during their home visits › Nurses working for the WMC distributed the patient packets during patient appointments
- 8. RN Education Diploma Associate Bachelors Masters Doctorate Place of Employment VNA WMC Years of Experience as RN 0-9.9 years 10-19.9 years 20-29.9 years 30 or more years RN Demographics 55.2 25.9 12.1 5.2 1.7 82.8 17.2 46.6 27.6 13.8 12.1
- 9. Highest Education Less than high school High school/GED Some college, no degree Associate degree Bachelor's degree Master's degree Wound Diagnosis Pressure Ulcer Venous Ulcer Arterial Ulcer Diabetic Ulcer Non-healing surgical wound Other MissingLocation of Wound Foot Leg Multiple Wounds Abdomen Hip Hand Ankle Patient Demographics 50.0 19.2 15.4 7.7 3.8 23.1 19.2 15.4 15.4 11.5 11.5 3.8 34.9 26.9 11.5 11.5 3.8
- 10. M(SD) T P Overall QOL RN Patient 5.62 (1.66) 7.46 (1.17) -5.80 .001* Physical QOL RN Patient 18.73 (5.94) 24.36 (4.68) -4.18 .001* Psychological QOL RN Patient 17.50 (4.32) 23.64 (4.32) -5.92 .001* Social QOL RN Patient 9.20 (2.29) 11.04 (2.37) -3.27 .002* Environmental QOL RN Patient 24.77 (5.35) 33.23 (3.90) -7.21 .001* Total QOL RN Patient 76.18 (17.75) 99.39 (12.84) -5.64 .001* * p < .008 with Bonferroni adjustment (p < .05/6)
- 11. Small sample size RNs may not have been able to focus fully on completion of the surveys There was questionable interest on patients part in completing survey
- 12. Further education regarding QOL in the chronic wound care population WHOQOL-BREF be adopted and used in practice to better assess QOL Disseminate the results
- 13. Replicate study with larger sample size Pair RNs and patients together Research differences in perceptions of VNA RNs and WMC RNs Investigate if different types of chronic wounds affect patients' perceptions of QOL
- 14. Bahrami, M., Parker, S., & Blackman, I. (2008). Patients' quality of life: A comparison of patient and RN perceptions. Contemporary RN: A Journal for the Australian Nursing Profession, 29(1), 67-79. Department of Mental Health, (2012). Programme on mental health: WHOQOL user manual. Retrieved from World Health Organization website: http://www.who.int/mental_health/evidence/who_qol_user_manual_98.pdf De Souza, T., Borges, F., Juliano, Y., Veiga, D., & Ferreira, L. (2013). Quality of life and self- esteem of patients with chronic ulcers. Acta Paulista De Enfermagem, 26(3), 283-288 Lau, J., Tatsioni, A., Balk, E., Chew, P., Kupelnick, B., Wang, C., & O'Donnell, T. Department of Health and Human Resources, Agency for Healthcare Research and Quality. (2005). Usual care in the management of chronic wounds: A review of the recent literature. Retrieved from Tufts- New England Medical Center website: http://www.cms.gov/Medicare/Coverage/DeterminationProcess/downloads/id37TA.pdf Macdonald, J. M., & Ryan, T. J. (2010). Global impact of the chronic wound lymphoedema. In J. Macdonald & M. Geyer (Eds.), Wound and lymphoedema management (1 ed., Vol. 1, pp. 13- 15). Geneva, Switzerland: World Health Organization Press. Retrieved from http://whqlibdoc.who.int/publications/2010/9789241599139_eng.pdf Maddox, D. (2012). Effects of venous leg ulceration on patients' quality of life. Nursing Standard,26(38), 42-49. Shukla, V., Shukla, D., Tripathi, A., Agrawal, S., Tiwary, S., & Prakash, V. (2008). Results of a one-day, descriptive study of quality of life in patients with chronic wounds. Ostomy Wound Management, 54(5), 43-49. Skevington, S. M., & McCrate, F. M. (2012). Expecting a good quality of life in health: Assessing people with diverse diseases and conditions using the WHOQOL-BREF. Health Expectations, 15(1), 49-62. doi: 10.1111/j.1369-7625.2010.00650.x
Editor's Notes
- Each year 5 to 7 million chronic and/or complex wounds occur. Wound care significantly affects a person’s life, many experience prolonged periods of disability, pain, discomfort, social isolation, and other aspects of daily life. It is estimated that chronic ulcers affect more than six million people in the US and their incidence is expected to increase as the population ages. The Department of Health and Human Services defines a chronic wound as, "Wounds that do not heal completely after receiving standard medical treatment for 30 days.“ Less emphasis has been placed on understanding how living with the wound affects the patient. It is clear that, despite this lack of emphasis, wounds can have a negative effect on quality of life (QOL). The World Health Organization (WHO) defines QOL as "An individual's perceptions of their position in life, in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns"
- The purpose of this study is to investigate perceptions of quality of life in chronic wound care patients and the registered nurses who care for them in the community and out-patient settings.
- Hypothesis: There is an incongruence in perception between perceived QOL of patients and RNs
- for this study consisted of patients who have chronic wounds and RNs who care for patients with chronic wounds Nurses Licensed RN in the state of Pennsylvania Employed at either the VNA or Wound Management Center Willing to participate Patients: Any type of wound for at least one month or longer English speaking Ability to read at a 5th grade level Utilize wound care services from either St. Luke’s VNA or Wound Management Centers Willing to participate
- The survey utilized in this study was the World Health Organization Quality of Life Brief Survey. This survey is a subset of 26 items taken from the WHQOL-BREF-100. According to the user manual written by the World Health Organization report that Cronbach Alpha scores for total QOL was .84, which demonstrates good internal consistency. In the current study, I was also able to calculate Cronbach Alpha scores for total QOL for both my RN and patient populations. For the RNs I calculated a Cronbach Alpha level of .959 and for my patients I calculated a Cronbach Alpha of .900. Both of these scores also demonstrate good internal consistency. Physical Health- consisted of 7 questions: (3,4,10,15,16,17, and 18)-just notes Psychological- consisted of 6 questions: (5,6,7,11,19, and 26)-just notes Social- consisted of 3 questions: (20, 21, and 22)- just notes Environmental- consisted of 8 questions: (8, 9, 12, 13, 14, 23, 24, and 25)-just notes Total QOL score- consisted of all 26 questions
- Data collection took place at a visiting nurse agency (VNA) and a wound management center (WMC) during team meetings The nurses completed the survey based on their understanding of wound care patients’ quality of life. After they participated they were then asked to help in the collection of data for the patients. Nurses who were employed with the VNA distributed patient packets during their home visits, and nurses who were employed with the WMC distributed patient packets during patient appointments. Surveys were color coded to distinguish between VNA nurses, WMC nurses, VNA patients, and WMC patients.
- RN EDUCATION: These are the demographics I collected for the nurses. 55.2% (32 RNs) held a bachelor’s degree, 25.9% (15 RNs) held a diploma degree, 12.1% (7 RNs) held an Associate degree, 5.2% (3 RNs) held a Masters degree and 1.7% (1 RN) held a Doctorate degree. RN PLACE OF EMPLOYMENT: In the next pie chart a majority of the RNs 82.8% (48 RNs) were employed at the VNA and 17.2% (10 RNs) were employed at the wound management center YEARS OF EXPERIENCE: In the last pie chart a majority of the nurses who participated in this study had between 0-9.9 years experience which as 46.6% (27 RNs) second were the RNs who had 30 or more years of experience which was 27.6% (16 RNs) third were the RNs who had 10-19.9 years at 13.8% (8 RNs) and last were the RNs who had 20-29.9 years at 12.1% (7 RNs).
- HIGHEST EDUCATION: These are my demographics that I collected for the patients. A majority of the patient population in this study 50% (13) of the reported that their highest level of education was either a high school degree or a GED. The second most common highest education level was some college with no degree 19.2% (5). 3.8% (1)- Associate and Bachelor degree 15.4% (4) -less than high school 7.7% (2) -masters degree (Just notes) WOUND DIAGNOSIS: A majority of the patient population in this study reported that they had a wound diagnosis of ‘Other’ 23.1%. The second most common wound diagnosis was non-healing surgical wound 19.2% (5). 11.5% (3)- PU 11.5% (3)-Venous 3.8% (1)-Arterial 15.4% (4)-Diabetic 15.4% (4)-Missing (Just notes) LOCATION OF WOUND: A majority of the patients reported that they had a chronic wound located on their leg 34.6% (9) the second most popular location was the food at 26.9% (7). 11.5% (3)- both multiple wounds and abdomen 3.8% (1)-Hip, Hand, Heel, and Ankle (Just notes)
- Independent t-Tests were computed on: Physical, psychological, social, environmental, overall, and total QOL scores The WHOQOL-BREF was an interval level of measurement. The two populations that were measured were the RNs and the clients which was a nominal level of measurement. Interval scales are numerical scales in which intervals have the same interpretation throughout. Nominal scales are scales that refer to categorically discrete data. As you can see all six results are statistically significant because they are all less than .008 which was the value calculated for the Bonferroni adjustment. Therefore, the hypothesis for this study which stated that there is an incongruence between perceived QOL of patients and RNs can be accepted.
- Small sample size A convenience sample of 58 RNs and 26 patients with chronic wounds. Sample size did not meet power-G*Power Type I error can be associated with these results Unequal sample size RNs may not have been able to focus fully on completion of the surveys Completion of survey during meeting Felt rushed to complete the survey Responsibilities of job created time limitations There was questionable interest on patients part in completing survey low response rate patients may have other health conditions
- The results of this descriptive study indicate a need for further education regarding QOL in the chronic wound care population. One way to rectify this problem would be to provide QOL education for all RNs who frequently interact with patients with chronic wounds. This would be beneficial for nursing practice because a lack of education and knowledge among RNs about QOL could also indicate a lack of education and knowledge among nursing students. Educating RNs early on will increase the likelihood that changes in practice will take place. An additional way this research can be incorporated into nursing practice would be to adopt the WHOQOL-BREF use it in practice to better assess QOL. This would allow the patient's plan of care to address QOL that is individualized to meet that patient's specific needs.
- Pair RNs and patients together and assess how they perceive QOL- This design was originally created by Bahrami et al. (2008). They paired oncology patients to the RNs who took care of them during their hospital stay to directly determine how accurately RNs perceive specific patients’ QOL. Research differences in perceptions of VNA RNs who visit the home environment, as opposed to WMC RNs who just hear about the patient's home environment from their patients' perspectives. Investigate if different types of chronic wounds affect patients’ perceptions of QOL.