The purpose of this paper is to explore the concept of health related quality of life (HRQoL) by studying a client situation in my clinical practice. My client’s name and hospital location will be kept confidential. I will be describing my client situation, discussing my rationale for choosing the concept and interpreting what quality of life means to my client. I will also identify specific nursing interventions that may facilitate adaption to their experience, and how this learning experience will positively influence my future nursing practice. Description of the Client Situation
In week two of my clinical practice, I received a 56-year-old male client who had undergone a total left knee replacement surgery due to osteoarthritis – a “slowly progressive noninflammatory disorder of the diarthrodial (synovial) joints.” (Roberts, 2010)
The total knee replacement required inserting a prosthetic joint in replacement. Hockey may have been the cause of his secondary osteoarthritis because strenuous exercise that involves quick stops, pivoting and repetitive physical activities overuses the knees, causes cartilage deterioration and has been associated with higher risks of knee osteoarthritis (Roberts, 2010).
My client stated that he was bothered by osteoarthritis and it affected his daily life activities, social life and work. Rationale for the Choice of the Concept HRQoL is the overall satisfaction that people have with their health. My client had pain and frustration for not being able to move around before surgery.
He stated this has caused great inconvenience for social engagements and family relationships and he held low self-esteem and was not very happy. I chose to study this patient to learn more about the impacts of his illness on his quality of life. I hope it can offer some insights on the concept of HRQoL on osteoarthritic patients.
According to an article from Solomon et al, “Measurement of HRQoL is based on an assessment of physical and mental health, including such factors as physical and emotional function, symptoms, and disease processes” (2010, p.837). In my case, I used observation, interview and examination methods for assessment and evaluation.
Understanding and Interpretation of the Client’s Illness Experience Gill and Feinstein stated within Ibrahim et al that the best method of determining a client’s perception regarding QOL is to directly ask them to rate it. (2002) I asked him a global quality of life question: “How would you rate your overall quality of life prior to your surgery?”
He rated it as fairly poor because he was not able to enjoy quality time with his family or take time to enjoy himself and play sports. I also asked him to evaluate the extent of his osteoarthritic disability affecting his daily life with a scale from 1 to 14, with 1 being not affected at all and 14 being severely disabling.
He answered 9 out of 14 due to pain and inability to maximize his joint movements. This is consistent with the literature because “osteoarthrosis of the knee results in pain, loss of function and a reduced quality of life.” (Hawker et al, 1998, p.164) However, Rat et al has found that there is a greater improvement after knee replacement procedure in clients with poor baseline pain or physical function. (2010) which gives great hope for recovery.
When asked about his instrumental support, “Could you use more help than you receive?” He said: “ I have adequate finances and my wife and [adult] daughters are very helpful.” When asked “Do you have many close friends and relatives you see often?” He said that he had many loving family members and supportive friends and is very grateful. Ethogen et al reported that greater social companionship was related to better “physical function, mental health, role emotional, social functioning and vitality” in his study of clients with knee osteoarthritis. (2004, p.321)
I asked my client whether he had any other health problems. He replied that he only had mild asthma, which is stable.
Having no major co-morbidities increases his quality of life because “co-morbidities… and the presence of a painful location other than the [left knee] location contributed to low QOL” (Rat et al. 2010, p.58). When asked about his psychological wellbeing, he told me that he had depression from being away from his job because he could not stand for long periods of time at his ‘machinery and manufacturing’ job.
This is consistent with literature as Solomon et al noted that “greater ADL (activities of daily living) disability and depressed mood were associated with poorer QoL” (2010, p.841). My client and I both concluded that although he has good social support and finances, his pain, limited mobility, losing his job and further compounded by depression has all affected his quality of life negatively before his surgery. Factors Related to the Identified Concept
Attributes of improved quality of life following a knee replacement surgery are “improvements in joint mechanics (such as range of motion and stability)” (Hawker et al, 1998, p.164), pain relief and improvement in performing activities of daily living. Personal satisfaction and good self-rated health are also antecedents to good quality of health (Solomon et al, 2010). Also receiving discharge teaching such as having an exercise plan and how to minimize or effectively treat post-operative pain will reduce post-op complication anxiety, reduce length of stay and improve client satisfaction. (Wellisch et al, 2012).
In addition, my client was very satisfied with the surgery outcome and said “I’m actually very surprised at how smoothly it went.” He feels that he can now function without being bothered with pain. He listened attentively to his doctors’ and physiotherapist’s advice and says he will follow their instructions.
Analysis of the Client Situation There are a number of nursing interventions which facilitate patients’ adaptation to their knee replacement surgery; and increase their quality of life. These are physiotherapy, pharmacological pain management, and effective post-operative teachings. Assisting the client with his physiotherapy enables him to increase his range of motion to perform activities of daily living (Hewitt & Shakespeare, 2001) and providing effective pharmacological pain management will further increase his personal satisfaction (Wellisch et al, 2012).
Additional interventions include providing non-pharmacological pain management such as guided imagery and music therapy reduce adverse reactions to medications, improve emotional well-being, physical health and social functioning (Roth & Susan, 2004). Another intervention is to provide emotional support.
He has a supportive family, but felt that he was always on the receiving end, but he can be supported to gained back confidence so that he can also be the source of contribution to others. Also, teaching about maintaining family ties, developing social relationships, participating in the community and exercising to maximize personal growth and satisfaction will also increase his quality of life (Felce & Perry, 1995). Discussion
Through analyzing my client’s clinical experience and reviewing some of the related literature, I have gained more knowledge required to skillfully assess a client’s quality of life. It will definitely help me to effectively observe my clients, ask related questions, understand and interpret the illness experience and identify factors that contribute to quality of life.
I will be able to look for any antecedents to poor quality or good quality of life that a client may have. I will have a deeper appreciation for the multidimensional factors that influence my client’s quality of life including “physical health, personal circumstances (wealth, living conditions, etc.), social relationships, functional activities and pursuits, and wider societal and economic influences” (Felce & Perry, 1995, p.54).
I also want to provide holistic nursing interventions to increase quality of life that include physical, emotional, physiological and spiritual support. Conclusion In summary, my client had low quality of life satisfaction prior to his knee replacement surgery due to pain and decreased mobility. This interfered with his quality family time, his enjoyment of social engagements, and loss of his work role which lead to depression from social isolation. After his surgery, his self-rated health and personal satisfaction was greatly improved.
Nursing interventions include providing holistic care, post-operative teaching on pain management and exercises to increase range of motion. From researching quality of life, I learned that the most effective way of assessing one’s quality of life is for them to self-rate it.
I also learned more about the attributes of good quality of life which include good physical health, sufficient instrumental support, strong family and friend relationships and many other multidimensional factors. I will take this information with me for my future nursing practices as quality of life is an effective indicator of personal satisfaction and self-esteem that can be measured in everyone.