Factors associated with quality of life of Brazilian older adults.

OBJECTIVE: The objective of the study was to explore factors associated with quality of life (QoL) of Brazilian community-dwelling older adults. METHODS: This was a descriptive exploratory cross-sectional study. Data were collected through a household survey. A random sample of 288 older adults from Porto Alegre, Brazil participated in the study. A demographic and health data sheet, the OARS activities of daily living (ADL) scale and the WHOQOL-BREF were administered. RESULTS AND DISCUSSION: The mean age of participants was 71.2 years (SD = 7.5) and 67.4% were female. Using multiple linear regression analysis, with overall QoL as the dependent variable, perceived health status, education level, engagement in physical activity, medical conditions, age group and use of primary health care were significant associated factors. With physical QoL as the dependent variable, significant factors included: perceived health status, medical conditions, education, physical activities and dependence in ADL; with social QoL as the dependent variable, only age group and paid work were significant. In relation to environmental QoL, education and perceived health were significant factors. CONCLUSIONS: The results illustrate the complexity of factors influencing QoL. With a better understanding of these factors, it is possible to plan appropriate health interventions.

Developing and testing instruments to measure client outcomes at the Comox Valley Nursing Center.

A Nursing Centre in Canada was initiated to demonstrate nursing practice in a primary health care context, unencumbered by conventional health care agency parameters. As one part of a multimethod evaluation, a 5 instrument client questionnaire was designed. The main instrument was developed by the researchers to measure the impact of the Centre and nurses' work from the perspective of clients. No established instrument could be found that was appropriate for the Centre's diverse client population and nature and variation in outcomes. To guide the development of the new instrument, minimally structured client interviews were conducted with 15 clients. To assess the validity and reliability of other selected instruments for the population, clients were asked to comment on the appropriateness of items. Based on findings, the Nurses' Work and Client Outcomes Questionnaire (NWCOQ) was developed, the Client Satisfaction Questionnaire and demographic questions modified, and a Cantril Self-Anchoring ladder to assess health status was supported for use. An open section was added to invite further description of clients' experiences, in particular, the unexpected, contrary or outstanding. Further pilot work was done and the refined five instrument questionnaire then was used to survey all clients who used the Centre during a seven month period. Findings from the NWCOQ revealed the nature of the nurses' work and the degree change occurred for clients on multiple health dimensions: physical, emotional, managing their situation, and group and community involvement. Clients were highly satisfied with the Centre and experienced many positive outcomes. The quantitative instruments and results were examined in relation to results from other data collection approaches and data sources. The NWCOQ has evidence of content validity and internal consistency reliability. The use of qualitative methods to develop and refine quantitative instruments for assessment of health outcomes for diverse client populations is highly recommended. This strategy is feasible even when outcome measurement timeframes are short.

Children and adolescents of parents undergoing dialysis therapy: their reported quality of life.

OBJECTIVE: The objective of this study was to describe one aspect of the reported quality of life (QOL) (according to the Aristotelian-Thomistic philosophical theory of the good life) of a selected group of children and adolescents whose parents were being treated by dialysis therapy for renal failure. DESIGN: An exploratory descriptive design was used. SAMPLE/SETTING: Twenty-five children and adolescents ranging in age from 8 to 16 years, selected on a convenience basis, participated in the study. The setting was a major renal treatment program in Western Canada. METHODS: Semi-structured interviews were held with children and adolescents privately, in their homes, once a week for two to three weeks. The interview data were subjected to content analysis. RESULTS: Generally, the children and adolescents seemed to possess the real goods necessary for a good life. However, they appeared to need more goods of the mind: (a) an intellective good--more information about how their various family members were feeling, and (b) decreased fear in relation to their parents' condition and treatments. Also, they discussed the need for carefree family vacations, an instrumental means to sensory pleasure--a bodily good. CONCLUSION: Overall, the QOL of this group of children and adolescents seemed to be good. The parents' renal disease and dialysis therapy had an impact on the children's lives in that sometimes it interfered with and sometimes it facilitated attainment of real goods. Further study is required to examine the effects on the QOL of children and adolescents regarding dialysis modality, age/gender of the child or adolescent, and stage of treatment.

Quality of life of individuals with end stage renal disease: perceptions of patients, nurses, and physicians.

OBJECTIVE: The objectives of this study were to describe the perceptions of physicians, nurses, and patients regarding the quality of life (QOL) of individuals with end stage renal disease (ESRD), to identify differences in ratings of QOL, and to identify predictors of perceptions of QOL for each group. DESIGN: A cross-sectional, descriptive comparative design was used. Three measures of QOL, the Self-Anchoring Striving Scale, Index of Well-Being, and Time Trade-Off were used. SAMPLE/SETTING: The subjects included 215 patients with ESRD (including dialysis and transplant), and 42 nurses and 7 physicians who cared for them. All were from a major tertiary care hospital renal program in western Canada. METHODS: Patients were interviewed and asked to complete questionnaires relating to quality of life, health status, functional status, outlook, support, medical, and demographic characteristics. Three measures of QOL, the Self-Anchoring Striving Scale, Index of Well-Being, and the Time Trade-Off were used. Primary physicians and nurses were asked to complete the same questionnaires within one week of the patients. RESULTS: It was found that there were significant differences in the ratings among the groups. The nurses' ratings of patients' QOL were significantly lower than were patients (T2 = 21.89, df = 5, 377, p < .001). Physicians' mean ratings were higher than patients' ratings (T2 = 14.24, df = 5, 338, p < .05). Correlations among patients', nurses', and physicians' ratings of QOL ranged between .19 and .49. It was also found that different variables explained the perceptions of each group regarding the patients' QOL. CONCLUSIONS: In this study, nurses, physicians, and patients rated the QOL of individual patients differently, and different factors explained the perceptions of QOL of each group. Although findings of the study are not generalizable, it may be advisable for nurses to be aware that patients and physicians may not share their perceptions of patients' QOL.

Creating caring organization cultures in dialysis units.

Organization culture refers to the ways in which work groups have evolved to consider and address issues that face them. In this article, the concept of a caring organization culture is described. Elements to consider in creating a caring organization culture include: values of the group, qualities of a caring leader, management style, decision-making processes, planning for the change, taking action, and reflection/evaluation/accountability. Although change to organization culture is difficult, it is possible if there is a commitment to the change.

Quality of life of candidates for and recipients of heart transplants.

OBJECTIVE: To describe the quality of life (QOL) of candidates for and recipients of heart transplants over a five-year period. DESIGN: Descriptive, longitudinal. SETTING: Canadian university-affiliated tertiary care medical centre. PATIENTS: Sixty-five candidates for heart transplantation; after one year, six candidates were still awaiting transplantation; 42 patients received transplants and were included in the study six months post-transplant. OUTCOME MEASURES: Three measures of QOL were used: the Index of Well-Being, Cantril's Self-Anchoring Striving Scale and the "time-trade-off technique'. INTERVENTION: Data were collected before transplantation, six months post-transplantation, one year post-transplantation and annually for the next four years; for individuals who did not receive transplants, data were collected six months and one year after the first interview. MAIN RESULTS: QOL scores were considerably higher after than before transplantation, and compared favourably with norms for the general population. For 11 individuals who did not receive transplants, QOL remained low. QOL for heart transplant recipients was remarkably stable over the five-year study period. The major predictors of QOL for candidates awaiting transplantation were health status, outlook and ability to work. After transplantation, the major predictors of QOL were outlook, health status and employment status. CONCLUSIONS: There is evidence to suggest that QOL improves after heart transplantation, and that improvement is relatively stable over time. Further work is needed to identify the factors that could result in improvements in QOL.

Knowledge and attitudes of physicians regarding organ donation.

The objectives of this study were to describe Canadian physicians' knowledge, attitudes, commitment, and professional involvement relating to organ donation, and to identify factors related to personal commitment and professional involvement. A cross-sectional survey design was used. Mailed questionnaires were sent to 2,400 randomly selected physicians practising in Canada. A total of 831 physicians (34.6 per cent) responded. Over 95 per cent of the physicians who responded supported organ donation in principle, but only 63 per cent had signed organ donor cards. Physicians responded correctly on average to 68.3 per cent of the questions testing knowledge. Many respondents incorrectly answered questions on brain-death legislation and religious barriers to organ donation. Many physicians indicated their reluctance to approach relatives of potential organ donors. The predictors of their personal commitment to organ donation included positive attitudes, younger age, and female gender. In relation to professional involvement in organ donation, more knowledge, positive attitudes, younger age, male gender, and higher numbers of hospital beds were important predictors.

Knowledge and attitudes of critical care nurses regarding organ donation.

The purpose of this study was to describe the knowledge, attitudes, personal commitment, and professional involvement of Canadian critical care nurses in organ donation. This was part of a larger study of 4900 Canadian nurses and physicians. 50% of nurses receiving questionnaires responded. Of the 147 critical care nurses who responded to the survey, over 92% supported organ donation in principle. However, only 65.3% had completed organ donor cards. Nurses responded correctly to 71.2% of the questions testing knowledge. Attitudes regarding organ donation tended to be positive, but 85% of nurses indicated reluctance to approach potential organ donors. Critical care nurses scored higher than other groups of nurses on the knowledge, attitude, and professional involvement in organ donation subscales.

Organ donation: what do nurses know and believe?

At the end of 1994, 2,226 Canadians were waiting for organ transplants. Some of these people will die waiting for transplants; others will live with significant impairments in quality of life. Yet it has been estimated that if organ donations were obtained from just half of potential donors, enough transplantable organs would be available for all potential recipients. Why is there such a shortage of organs available for transplantation? The simple answer is that organ donations take place in only 10 to 14 per cent of brain deaths (the major potential source of transplantable tissue). But the more complex answer refers to the multitude of cultural, psychological, economic and practical factors that limit donations and transplantations.

Quality of life of patients with end stage renal disease: a structural equation model.

In this study, the perceived quality of life (QOL) of 215 patients with and stage renal disease (ESRD) was examined. A LISREL model describing the patients' perceptions of their QOL was tested and, after some revisions, was found to be consistent with the data (chi 2 = 33.76, df = 25, p = 0.113). QOL was measured by: the Self-Anchoring Striving Scale, the Index of Well-Being, and the Time Trade-Off Technique. The model includes the patients medical characteristics, their health status, functional status, support and outlook. Outlook, functional status and treatment modality had significant direct effects on QOL. Support influenced QOL through the mediating variable, outlook. This study suggests that a theoretical reexamination of the measurement structure of QOL is warranted.

Changing to a caring paradigm for teaching and learning.

Nephrology nurses have tended to use behavioral strategies to teach people about their diseases and treatments. However, in this article, nurses are encouraged to shift to a caring paradigm for teaching individuals with end stage renal disease. The key concepts in this paradigm include: caring, phenomenology, multiple realities, empowerment, and health promotion. Specific suggestions for planning teaching and learning activities, and evaluating learning in the new paradigm are provided.

Attitudes of dialysis patients and caregivers regarding advance directives.

OBJECTIVE: The objective of this study was to describe and compare the attitudes of dialysis patients, their relatives/friends, primary nephrologists, and nurses regarding advance directives. DESIGN: A descriptive comparative design was used. SAMPLE/SETTING: A total of 50 dialysis patients from a large teaching hospital in western Canada participated in the study. For every patient who responded, a relative/friend, physician, and nurse completed the questionnaire. METHODS: The questionnaires were designed for the purposes of the study. These questionnaires were mailed to dialysis patients, who were asked to identify a relative/friend to complete a similar questionnaire. Nurses and physicians also completed questionnaires. RESULTS: Overall, 84% of patients indicated that they believed that it was important to leave a living will, but only 18% of these patients had actually left an advance directive. However, 52% of patients and relatives/friends believed that major treatment decisions should be left to the physician, a perception that was not shared by physicians and nurses. CONCLUSIONS: It appears that patients, family/friends, nurses, and physicians in this study had differing perceptions regarding advance directives. It is important that health care professionals realize that these differences may exist and that further research should address strategies to increase our understanding of patient decisions in this area.

An evaluation of the nephrology nursing research literature: 1979-1989.

The purposes of this project were: to describe the research designs, areas of study, and major dependent variables of nephrology nursing research conducted between 1979 and 1989; and to evaluate the quality of this research. Of the 284 publications included, 34.9% of the research designs were descriptive; 45.4% analytical observational; 4.9% methodological; 14.1% experimental; and 0.7% historical. Content analysis was conducted to classify the area of study and dependent variables. Nurse experts assessed the quality of the research studies using Georgopoulos' (1975) Quality Index.

Quality of life after organ transplantation.

Organ transplants are being conducted with increasing frequency. It is generally known that these procedures increase length of life, but less is known about the quality of that life. In this paper, the literature pertaining to quality of life of patients with kidney, pancreas, heart, heart-lung, liver and bone marrow transplants is reviewed. On the basis of this review, it seems that quality of life after kidney and heart transplantation is very good, when compared to the pretransplant state. However, more research is required to examine quality of life of recipients of other types of transplantation. There are many issues that pertain to measurement of quality of life that remain to be addressed. These include: definitions of quality of life, dimensions of quality of life, expectations of quality of life and clinical assessment of quality of life.

The reported quality of life of selected home hemodialysis patients.

The quality of life (QoL) of 10 home hemodialysis (HHD) patients was studied using the Aristotelian-Thomistic philosophical theory of the good life. According to this theory, seven types of real goods are required to have a good life. Semistructured interviews were used to determine whether the patients possessed these goods. Also, card sort tasks were used to obtain the patients' ranking of these goods in terms of the importance of the goods and time spent acquiring them. It was found that the subjects were seriously deprived of some of the real goods required to have a good life, including health, vigor, pleasurable feelings, freedom of action, and free time. Goods of personal association and goods of the body were of greatest importance to the subjects. It appears that this theory has some utility in assessing QoL of patients on HHD.