Effectiveness of Teaching Program on QoL of Elderly Patients

Effectiveness of Teaching Program on QoL of Elderly Patients CHAPTER – 1 INTRODUCTION â€Å"It’s not how old you are, it’s how you are old Live your life and forget your age† Older adults recognize that they have less time in which to continue achieving their goals, so they face their challenges with resilience and determination. Gerontologists are increasingly recognizing that older adults who are aging successfully possess wisdom, which includes factual knowledge, problem- solving strategies, and the ability to manage uncertainty. Because many of the challenges of older adulthood involve health and functioning, older adults need accurate information, not only about aging, but also about interventions to promote wellness. Nurses are ideally positioned to teach older adults about health and aging and empower them to implement problem-solving strategies directed towards wellness, improved functioning, and quality of life (Blazer, Brugman, 2006). With increases in life expectancy, delayed onset of morbidity, and higher expectations for old age, interest in well-being in later life and how to achieve it has intensified. ‘Successful ageing’ has come to the fore as a goal for the ageing population. While an agreed definition of successful ageing remains elusive, there is broad agreement that core constituents include physical health and functioning, psychological wellbeing, and social functioning and participation. As the older population surges both in absolute and relative numbers, well-being in old age has also become a focus for policy-makers as a key indicator of the physical and psychological health, social integration and economic security of the older community (Bowling A, Dieppe P Dec 24). Despite the adverse changes that occur with increasing age, older people typically report high levels of well-being. Most feel younger than their actual age and maintain a sense of confidence and purpose. In the HeSSOP (Health and Social Services for Older People) surveys of older people in Ireland, conducted in 2000 and 2004, over three-quarters of community-dwelling older people scored high on morale (Garavan R, Winder R, McGee H. ; 2001, O’Hanlon A, McGee M, Barker M 2005). In fact, older people are more likely to report satisfaction with their lives than younger people (Strine TW, Chapman DP 2008). Old age, it appears, brings with it an ability to adapt to age- related changes and stresses. One study found, for example, that physical decline did not have an impact on older people’s satisfaction with life, suggesting that they regard it as a normal and relatively acceptable part of ageing (Steverink N, Westerhof GJ .2001). Moreover, older people recognize benefits in old age, such as increased wisdom and maturity, with opportunities for growth and lessening of demands upon them. Research has come to emphasize that ageing is highly specific to each individual, which implies that the pathway of old age is not predetermined. While growing older unavoidably entails losses, some individuals cope better with these losses than others. With this in mind, it aims to shed some light on the personal, material and social circumstances that influence how well people cope. â€Å"Successful ageing† refers to those cases where ageing people are free of (acute and chronic) diseases, do not suà ¯Ã‚ ¬Ã¢â€š ¬er from disability, are intellectually capable, possess high physical à ¯Ã‚ ¬Ã‚ tness and actively use these capacities to become engaged with others and with the society they live in. Concepts which have been used in gerntological research and which emphasize dià ¯Ã‚ ¬Ã¢â€š ¬erent aspects of the ageing process are healthy ageing (Ryà ¯Ã‚ ¬Ã¢â€š ¬, 2009) Gerontology has seen many dià ¯Ã‚ ¬Ã¢â€š ¬erent conceptions of active ageing. A classic deà ¯Ã‚ ¬Ã‚ nition of active ageing was presented by Rowe and Kahn (1997) who used the term successful ageing: â€Å"We deà ¯Ã‚ ¬Ã‚ ne successful ageing as including three main components: low probability of disease and disease-related disability, high cognitive and physical functional capacity, and active engagement with life† (Rowe Kahn, 1997, p. 433; Rowe Kahn, 1987). â€Å"Successful ageing† refers to those who are free of (acute and chronic) diseases and do not suffer from any disability, aged who are intellectually capable and those who possess high physical fitness and actively use these capacities and engage with others and the society they live in. Concepts which have been used in gerontological research and which emphasize different aspects of the ageing process are healthy ageing (Ryff, 2009), productive ageing (Morrow-Howell, Hinterlong, Sherraden, 2001), ageing well (Carmel, Morse, Torres-Gil, 2007). There is a strong normative element in the definition of successful ageing. Successful, healthy and productive ageing are evaluated as the more desirable as â€Å"normal† or even â€Å"pathological† ageing processes. Most people want to grow old without being affected by chronic illnesses and functional disabilities. Despite the efforts are to increase the proportion of healthy life expectancy, a substantial part of the old, and the very old population will have to face dependency and frailty. Hence, attention have to be paid to the fact that normative definitions of â€Å"active ageing† should not lead to the degradation and a discrimination against individuals and groups who do not reach the positive goal of â€Å"active ageing†. (Fernà ¡ndez-Ballesteros, 2008). The WHO deà ¯Ã‚ ¬Ã‚ nition of active ageing was more inclusive in respect to dià ¯Ã‚ ¬Ã¢â€š ¬erent ageing trajectories and the diverse groups of older people: â€Å"Active ageing is the process of optimizing opportunities for health and participation and security in order to enhance quality of life of aged people† (WHO, 2002) The Regional Implementation Strategy for the Madrid International Plan of Action on Ageing, the UNECE members express their commitment to enhance the social, economic, political and cultural participation of the older people and also to promote the integration of older people by encouraging their active involvement in the community and by fostering intergenerational relations (UNECE, 2002). Old age often bring decreasing functional capacity and health problems which may affect the individual’s sense of wellbeing.The goal of health for the elderly in the society may not be free from diseases but the possibility of having a good life despite of illness are in decreasing capacities (Lawton, 1991; Nordenfelt, 1991b; Sarvimaki and Stenbock-Hult, 2000). The Quality of life of the people in a developed country with chronic health condition will have a lower impact rather than the patients with the same disease in a low income country where the resources to ameliorate the disability may be scarce. The subjective and the contextual nature of Quality of life inform the World Health Organization’s definition as: â€Å"an individual’s perception of his/her position in life in the context of the culture and value systems in which he/she lives, and in relation to his/her goals, expectations, standards and concerns† (The WHO QUALITY OF LIFE Group, 1995). Thus Quality of life reflects a extended view of subjective wellbeing and life’s satisfaction that encompasses physical and mental health, material wellbeing, interpersonal relationship within and without the family, personal development, work and activities within the communities, and fulfillment and active recreation (Niemi et al., 1988). There is an important consideration in studying the factors associated with the Quality of life of the elder persons is the multi-dimensional nature of the construct and the possibility that determines from one dimension may be different from those of the other dimension. (Patel et al., 2007). NEED OF THE STUDY Little is known about factors that determine the Quality of Life of the elderly persons living in the developing societies and who are undergoing rapid social changes. Quality of life has become increasingly important as an outcome in medical research. The influence of health status is often emphasized, but other dimensions are important. In order to improve quality of life, there is a need to know what people themselves consider important to their perception of quality of life. The studies that are conducted among the groups of elderly persons have shown that Quality of life and the subjective evaluation of the life satisfaction are determined by several factors (Jakobson et al., 2007). Other than the demographic features such as age and financially status, the health, including social support functional disability and networks are often found to be important in the elderly person’s assessment of their Quality of life. (Bowling, 1994;Low and Molzahn, 2007;Richard et al., 2005 ). Other than functional impairments and the health problems to which most of the elderly persons are vulnerable (Clark and Siebens, 1993), old age may also predispose to some social and economic problems. The ccess to health care is severely limited both by manpower and paucity of health facilities and by out-of-pocket payment arrangement. Traditional family support is decreasing and social network is dwindling as migration and urbanization take the young members of the family away. Social changes are also affecting the position of the elderly in the society and leading to a reduction in their social status and influence in the community (Gureje and Oyewole, 2006). All of these factors affect the Quality of life of elderly. (Hickey et al., 2005) Quality of life is the central concepts in the ageing research. Two different traditions can be distinguished in this respect: Concepts which define quality of life in terms of objective living conditions, and concepts which define quality of life in terms of subjective evaluation (Noll, 2010). Similar distinctions have been made in the context of social gerontology. Objective quality of life can be measured by the extent to which the elderly has access and command over the relevant resources like income, health, social networks, and competencies that serve the individuals to pursue their goals and direct their living conditions. Hence, objective quality of life is high in those cases where the health is good, income is high, social networks are reliable and large and the competencies as achieved by the educational status are high. Objective quality of life can be measured by the external observers (Erikson, 1974). Subjective quality of life, in contrast, emphasizes an individual’s perceptions and evaluations. Individuals compare their (objective) living situation according to different internal standards and values. That means the elderly people with different aspiration levels may evaluate the same objective situation differently. Subjective quality of life depends upon the individual person – and lies in the â€Å"eye of the beholder† (Campbell, Converse Rodgers, 1976). Hence, high subjective quality of life can be defined as subjective well-being (high life satisfaction on, strong positive emotions like happiness, and low negative emotions like sadness). Quality of life has become increasingly important as an outcome in medical research. The influence of health status is often emphasized, but other dimensions are important. In order to improve quality of life, there is a need to know what people themselves consider important to their perception of quality of life. The study was of 141 randomly selected people aged from 67 to 99 years that formed a control sample for a study of suicide among older people. They were interviewed in person about their health, socio-demographic background and, using an open-ended question, what they considered to constitute quality of life. Their answers were grouped into eight categories. In addition, they were asked to choose from a ‘show card’ three items that they regarded as important to quality of life. Functional ability was the most frequently selected domain, followed by physical health, social relations and being able to continue to live in ones present home. It was found that socia l relations, functional ability and activities influence the quality of life of elderly people as much as health status. ( Katarina Wilhelmson ,Christina Andersson, et al., 2004) Since 1970s cardiovascular disease is the leading cause of deaths worldwide, cardiovascular mortality rates have been declined in many high-income countries Age is an important risk factor in developing cardiovascular diseases, though it usually affects the older adults. It is estimated that 87 percent of people who die of coronary heart disease are 60 and older. â€Å"It’s important that this vulnerable group of people doesn’t get overlooked so that they are properly assessed and they receive the best treatments to improve their quality of life.† Newcastle University,British Heart Foundation, (Professor Bernard Keavney, July 25, 2012) A study wasrecently carried out376heart scans calledechocardiogramson 87- 89 year olds in their homes. The results revealed that around a quarter hadundiagnosed heart problemsand are missing out on treatments, which could improve their symptoms and theirquality of life. (Newcastle University,British Heart Foundation, Professor Bernard Keavney, July 25, 2012) The purpose of the present study is to identify the effectiveness of structured teaching program on awareness of quality of life among elderly patients with cardiac disorders, at GKNM Hospital, Coimbatore. The researcher strongly believes that, the result of the proposed study can be used to enhance nursing initiatives, and to establish a teaching strategy for elderly patients attending cardiac and cardio thoracic opd’s at GKNM Hospital and thereby improve their quality of life. STATEMENT OF THE PROBLEM A Study to Assess the Effectiveness of Structured Teaching Program on the Awareness of Quality Of Life among Elderly Cardiac Patients at G.K.N.M Hospital, Coimbatore. OBJECTIVES To assess the quality of life of elderly cardiac patients To assess the effectiveness of structured teaching program To find the association between the pre- test level of scores and selected demographic variables OPERATIONAL DEFINITIONS Effectiveness: It refers to the outcome of the planned teaching program in terms of awareness gained Structured Teaching Program: It refers to the systematic information provided to the elderly cardiac patients regarding quality of life. Awareness: It is the state or ability to perceive, to feel, and sense data confirmed by an observer. Quality of life: It is the personal satisfaction with the cultural or intellectual conditions under which a person lives. Elderly cardiac patients: Patients above 60 years of age and having cardiac disorders. HYPOTHESIS H0: There will be no significant difference between the pre-test and the post-test awareness scores of elderly cardiac patients regarding quality of life. H1: There will be significant association between the demographic variables and the pre-test awareness scores of elderly cardiac patients regarding quality of life. ASSUMPTIONS The elderly patients will not have adequate awareness regarding Quality Of Life. The structured teaching program will enhance the quality of life of elderly cardiac patients.

Should Euthanasia be Legalised Essay -- Papers

Should Euthanasia be Legalised This essay will explore several different and varied opinions about whether or not euthanasia should be legalised. Euthanasia is the Greek word for easy death, but is often referred to as mercy killing. There are two main forms of euthanasia. Voluntary euthanasia is when a terminally ill patient expresses the wish to be euthenised. Active euthanasia is when a Doctor decides that it is in the best interest of the patient to be euthenised. All forms of euthanasia are illegal in Great Britain; however in Holland, Switzerland, Oregon in the U.S and the northern territories of Australia, voluntary and assisted euthanasia has been legalised in recent years. Firstly most Religious groups are opposed to euthanasia, because it is seen as murder. Christians and Jews in particularly are against euthanasia because in 'the ten commandments' it is written that 'you must not kill'. In the Torah and the Bible it also reads that humans are created in the image of God and in the Bible it also reads that Jesus died to save us. Christians and Jews base their views on euthanasia on these things in particular because they believe that only God has the right to decide when to end a life. On the other hand the Roman Catholic Church is of the Christian faith but they do have a slightly different opinion. Although they are very pro-life, they do not believe in pro-longing life by treatment which will prolong suffering. However the government is concerned that if euthanasia were legalised then the amount of suicides in our country will rise considerably. This has not been entirely proven in the few countries that have ... ... of himself administering a lethal injection to a terminally ill man who wished to die. In conclusion I believe that voluntary euthanasia should be legalised because if you have a very poor quality of life then you should be able to have the right to end it. I agree with the Roman Catholic opinion that there is no need to prolong life by treatment which will only prolong the suffering. I also think that only Doctors should be allowed to assist with euthanasia, otherwise euthanasia may be used lightly when it is not necessarily the only option. Until euthanasia is legalised there will continue to be unnecessary arrests of people who thought that they were helping, by euthenising terminally ill people who had little or no chance of ever recovering from their illness, and may have had to suffer for a great deal longer.

“The King of Torts” by John Grisham

Clay Carter is a public defender doing boring, low-paid, through which every beginning lawyer is to go through. Carter has been there for too long, and this job does not bode anything to Carter†¦ up to the point, when he takes up the case of Tequila Watson, a 20-year-old youth who has committed a murder seemingly without any reasons†¦ Up to the point, when Carter realizes that beneath a hackneyed case there is a real case, which is difficult and dangerous, boding a huge amount of money. This case can become the start of a dazzling legal career – if Carter takes the risk and stakes his all†¦This is the entanglement of the legal suspense thriller â€Å"The King of Torts† (2003) by John Grisham. The novel has a fast-pace and dynamic plot, which takes Carter from the mundane post of public defendant to the pecuniary cream of the society. John Grisham, a former lawyer and now a successful novelist, is known for his penetrating insights into the American legal system, made in his numerous earlier novels like â€Å"A Time to Kill†(1989) and â€Å"Runaway Jury† (1996).This time Grisham takes on the â€Å"torts†, lawyers who lead suits against large corporations in the name of many people, who suffered from the actions or products of this company; the attorney receives a considerable percent from all payouts of all plaintiffs and his payout can be measured in billions. As Clay Carter engages into the case of Tequila Watson, he discovers an enormous conspiracy, where the big pharmaceutical company is involved. Tempted by the mysterious stranger Max, he plunges into tort business and is soon dubbed â€Å"king of torts† for his success.He starts leading a luxurious life, living in a luxurious house and driving a black Porsche; however, everything has its price. The price of success for Carter is his moral and professional principles, which he eagerly sells in exchange for fame and fortune.In this novel, Grisham makes a grim commentary on the American legal system, which has turned into a machine for earning money for attorneys. Apart from the exciting plot, the most gripping suspense lies in the attitude of the reader to the protagonist. Carter is evidently degrading, but will the reader find â€Å"extenuating circumstances† to justify him or at least to understand his downfall? This is a question, which you can answer only after turning the last page of this gripping thriller.ReferencesGrisham, J. (2003). The King of Torts. New York: Doubleday.

Dr. Jekyll Mr. Hydes Trauma - Free Essay Example

Sample details Pages: 4 Words: 1262 Downloads: 1 Date added: 2019/02/06 Category Literature Essay Level High school Tags: Dr Jekyll and Mr Hyde Essay Did you like this example? Dissociative identity disorder is usually a reaction to trauma as a way to help a person avoid bad memories. When people face traumatic experiences, they have a choice to cope in a healthy or unhealthy way. Sometimes in extreme cases, they believe that having another identity could help them cope by escaping their current reality. For example, Dr. Jekyll has created a different personality, Hyde, that he uses to escape his reality and create a new one. Through Mr. Hyde, Dr. Jekyll displays a Dissociative identity disorder due to a traumatic experience that happened in his past. Dr. Jekyll displays signs of an abused childhood by having a second personality, Mr. Hyde. Jekyll uses Hyde to forget and run away from the pain. It is shown that, â€Å"Among childhood trauma types, only physical abuse and physical neglect predicted dissociation [identity].† (Sar et al. 1). He is saying that the reason to dissociative identity is not only childhood trauma, but abuse as well. Childhood trauma can cause dissociative identity by allowing the kid to escape to a different reality, due to the creation of another personality. In about 90% of dissociative identity cases there is a history of child abuse. Don’t waste time! Our writers will create an original "Dr. Jekyll Mr. Hydes Trauma" essay for you Create order Dissociative identity is another way for people and kids get away from the world and create a new and better one. Some signs of dissociative identity is having nightmares, zoning out, and memory problems. Jekyll shows these signs throughout the book by waking up without realizing what he did. For example when he killed Carew in the alleyway. Dr. Jekyll stated, while talking to Mr. Utterson, â€Å"I know you have seen him†¦and I fear he was rude.†(Stevenson, 13). Under the context, it seems that he does not remember meeting him. That’s shows that he does not remember what happens whenever he is Mr. Hyde, which is a prime example of dissociative identity disorder. Another traumatic experience that could happen is a close family member dying, or a mentor dying. They use their second personality to escape the pain of losing someone they loved. It is most common that because of a loss of a loved one, people generally create a different personality to disband the pain in their original world. Some signs are a loss of identity as related to individual distinct personality states, and loss of time, sense of self and consciousness. In the book, it shows lots of times where Dr. Jekyll wakes up, not remembering what happened when he was Hyde. For instance, in the book Jekyll turns into Hyde by accident at a park, â€Å" I looked down; my clothes hung formlessly on my shrunken limbs†¦I was once more Edward Hyde† (Stevenson 51). This shows that he realizes that he changes, but not what he does, and example of this, â€Å"Dr. Jekyll was a double personality because he remembered the process of transformation (what today we would call dissocia tion), but not what he did while he was Mr. Hyde.† (Waiess Vol. 93, Iss. 3,). Also now Jekyll can switch to Hyde with just thoughts instead of potions, which shows how someone with Distinctive Personality disorder can escape to there other reality with just a thought and idea instead of a trigger of some sort. It becomes easier to escape if they lost a loved one, by remembering who the deceased was to them. Just the thought of that person can send someone into a deep depression, which they will heal by switching personalities and becoming a different person. When a person switches to another personality, they usually feel completely different and not normal. In the book, Jekyll describes this as, â€Å" †¦ something indescribably new and, from its very novelty, incredibly sweet. I felt younger, lighter, happier in body†¦Ã¢â‚¬  (Stevenson 44). This shows that whenever he transformed into Hyde he felt, â€Å" happier in body† (Stevenson 44) which proves that when he was Jekyll, he felt pain and depression, most likely because of a traumatic ch ildhood past. Jekyll was suffering with a weight of a traumatic childhood either from a close family member dying or something else that changed his life, and he used Hyde to escape all those feelings. When he was Hyde he felt free and happy, but he realized that Hyde always had hatred in his mind. He realized that it was a mistake to use Hyde to run away from his past, so he began to stay as Jekyll and not change. This caused a deep depression and he could not last long, he needed to change to Hyde to have the feeling of being happy and free again. Most people need to switch to their different personality to stay away from suicidal thoughts and actions. A different way Jekyll can be diagnosed with Distinctive personality disorder is by being alone and not having much social interactions with other people when they were a child. When someone is alone their whole childhood life, it creates an image and gets them thinking why. They start asking if something is wrong with them and will live the rest of their life thinking that they are awkward and weird to others. In the book, Jekyll was sitting inside alone stating that he was, â€Å" Very low. It will not last long, thank God.† (Stevenson 25). This was right after he stopped becoming Hyde. It was a cause and effect of the childhood trauma. Because Jekyll stopped becoming Hyde, he became very depressed and didn’t want to see anyone or go outside. In the book, Jekyll does not live with anyone except waiters, servant, and maids. He does not have a lover or any family that live with him. Jekyll even wanted to be left alone for a long time, â€Å"‘The doctor is confined to the house’ Poole said, ‘and saw no one’† (Stevenson 22). His want to be alone shows that he never had that much social interactions when he was a child. If he did then he would not be able to stay alone in his room without seeing his friends. He would be so used to having people and friends to talk to that he would be uncomfortable by being alone in a room. As a child he would learn that it is weird not having friends to interact with, so that would cause him to always want to be around friends his whole life. But, it is the opposite with Jekyll. He had a traumatic childhood due to a decrease in social interactions with other kids. The effect of his childhood, caused him to create a different personality, Mr. Hyde, which would take out all the anger he had on the inside and bring it to the outside world. Throughout the whole book, the idea of dissociative identity disorder is the constant theme. Jekyll is always showing signs of dissociative identity disorder in the book. Stevenson was very successful on giving the message of the book. The readers could really understand what he has trying to say under the words and pages. Dissociative identity disorder has been a very interesting and questionable topic to get information on. Lots of people suffer from this disease. They usually do not have people to love on them and care for them, only because the people think they are crazy. People with Disabilities are usually left alone and outcastes by the whole world, that is why we should embrace them instead of allowing them to feel left out. Every human, whether they have something psychologically wrong or are physically deformed, should be treated no different than those that appear normal. Everyone is different and weird in their own way.