Be the first to like this. No Downloads. Views Total views. Actions Shares. Embeds 0 No embeds. No notes for slide. If you want to download this book, click link in the last page 5. You just clipped your first slide! Clipping is a handy way to collect important slides you want to go back to later. Now customize the name of a clipboard to store your clips. Illness and suffering constitute an existential experience that changes the hierarchy of values, instills a different perspective on the surrounding reality, provokes changes in life plans, and affects the feeling of solitude and social isolation.
The QoL with the disease is determined by factors such as clinical condition and physical functioning, mental condition, social situation, and somatic responses. It is described as health-related quality of life HRQoL. Diseases of osteoarticular system affect a significant percentage of people in Poland, many of whom suffer from adjudicated level of disability. According to the WHO, OA is the fourth leading cause of physical disability and one of the most serious hazards of civilization. Pathological changes caused by the disease are irreversible; they are the reason for physical disability and very often require highly specialized, invasive therapeutic intervention.
The disease considerably decreases the QoL of people suffering from it compared with the healthy population, as OA, in its progressive, chronic course, hinders, and sometimes even hampers, fulfilling basic roles in the society, including functioning in the family or at work, 6 , 7 which also leads to isolation and deepens depression. Another factor that determines the worsening of the QoL in patients with OA is older age. These limitations lead to loss of mobility and worsening of performance, as well as to poorer QoL. RA is another rheumatic disease that differs in etiopathogenetic terms and clinical treatment; it is a heterogenic, inflammatory joint disease, characterized by a chronic progressing inflammatory process of the synovial membrane, leading to distraction of articular and circumarticular tissues.
In spite of treatment, the disease is chronic, with relapses, which causes progressive destruction and deformation of joints, and disability. As a result of articular changes, about one-third of patients manifest permanent disability. The disease affects mainly young people aged between 30 and 50 years. Women are affected four times more often than men. RA is classified as a disease of connective tissue, which has a significant impact on the deteriorating of HRQoL, along with the duration of the disease.
Thus, nowadays, in the treatment of chronically ill patients, evaluation of their QoL is also taken into account, taking notice of factors that are dependent age, sex, education, professional status, family situation, individual capabilities of the patient, the potential to adapt, and the degree of the obtained social support and independent from the medical condition feeling of pain, chronic fatigue syndrome, side effects of drugs, organ complications, and the level of physical fitness.
The authors of this study present the following research thesis to study the influence of socio-demographic factors, as well as the process in which functional condition and pain, typical for rheumatic diseases, affect the QoL and hinder medical condition:. Researchers hypothesize that rheumatic diseases involve significant consequences in terms of physical, mental, and social functioning.
It can be presumed that educating patients and providing support for coping with the disease, especially in reducing pain and improving physical performance, can greatly improve the QoL of the patients with chronic rheumatic disease. The study group consisted of patients diagnosed with OA of the hip, knee, and spine. The criterion for exclusion from the study was the existence of other overlapping diseases of bone and joint, including inflammatory joint diseases. Patients filled in the questionnaire on their own, with opportunity provided to seek an explanation for any incomprehensible questions.
The questionnaire also included eight subscales physical functioning [PF], social functioning [SF], deficiency in fulfilling social roles for physical reasons [RP], pain [BP], general health [GH], vitality [VT], mental health [MH], and deficiency in fulfilling social roles for psychical reasons [RE] , in which rating system was between 0 and points; higher scores equal better functioning. The HAQ-DI is a validated generic measure of physical functioning combining eight domains dressing and grooming, arising, eating, walking, hygiene, reach, grip, and other activities.
Responses to each item ranged from 0 no difficulty to 3 unable to do. Intensity of pain Pain VAS 0— was interpreted in three ranges: 0—35 — low level; 36—65 — average; and 66— — high level of pain sensation. All data were analyzed using PQStat v. The null hypothesis was tested of no correlation between QoL and patient pain problem and disability. The effects of sex, age, disease duration, and educational background were tested across all measures. Taking age into account, patients were divided into three groups: 40—60 years Average age standard deviation [SD] was As shown in Table 1 , majority of patients Majority of patients Analyzing the level of education, The vast majority The average duration of illness was 5.
More than half of the patients Average age SD was With respect to age, majority were patients up to 60 years of age comparable to OA group. The education levels of the study group was commensurate to that of the OA group. The majority The average duration of disease was higher than that of the OA group and amounted to 6. Average level of pain in the OA group was Analysis of individual components of QoL according to SF shows that each patient, as shown in Table 2 , assessed the lowest limitations in social roles for RP. Sphere of mental functioning among males with rheumatic disease was higher than females.
QoL in both the study groups was assessed the highest among patients aged 40—60 years Table 3. The analysis also showed that physical functioning was assessed higher among patients with OA Diseases of the osteoarticular system pose serious clinical, social, and economic problems.
They affect a great percentage of people, majority of whom had an adjudicated level of disability. Disability, apart from clinical effects, entails a number of other consequences, both social and economic, and contributes to decrease in the QoL. Cuperus et al 14 in the assessment of QoL, also indicated that in patients with OA there is a lower evaluation of QoL in the physical sphere compared with the mental sphere.
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This demonstrates the progression of inflammation in the course of RA-associated symptoms pain, swelling, morning stiffness of the joints and progressive deformity of the joints, leading to disability. Rheumatic diseases are a group of illnesses that affect females more than males. The results of our research led us to the conclusion that there is an important interdependence between mental functioning and sex.
Males, with both OA and RA, rated mental sphere higher than females. In the group of males with OA, at the same time, a higher evaluation of QoL in their physical sphere was observed compared to females.
Fighting the Good Fight with Insurers | Rheumatoid Arthritis (RA) - Rheumatology Nurses Society
Age is also a crucial predicator in rheumatic diseases. Diagnosis of OA is made more often in the older age group, mainly between 55—65 years of age, whereas RA is diagnosed at an younger age 40—50 years. Other reports, comparable to the results of our research, have also indicated the impact of age on the QoL and general social functioning among people with OA and RA. Rheumatic diseases tend to be recurrent and chronic; therefore, duration of illness is a crucial factor influencing QoL of patients with OA and RA.
The SOAR template provides health-care professionals with advice on the assessment process and referral guidance. Assessment of needs OA - The template sets out some of the initial basic aspects required to provide a comprehensive strategy to enhance patient self-management Newman et al, The needs assessment must be tailored according to specific factors relevant to that person, their disease, social and psychological needs, as well the provision of care and education available to them.
Much can be achieved to enable individuals with OA to cope with their disease effectively and manage their pain control. This is reflected in the work of Lorig et al , who developed patient education programmes that now form the basis of work to develop expert patient and self-management programmes DoH, ; Encouraging such principles has significant advantages for both patients and the NHS Box 1. RA - Assessment should include disease-specific issues as well as physical function, social and psychological factors.
Patients with active RA should be seen regularly by a specialist rheumatology team. Research examining the views of individuals with RA demonstrate a strong need for continuity of care by knowledgeable practitioners Ryan et al, This is partly reflected by the wish for continuity of care in chronic disease but may also highlight the limited amount of knowledgeable support for patients within the primary care setting Dequeker et al, RA is a complex disease with additional risk factors that require skilled management and a sound understanding of the disease and the need to control the disease process using disease-modifying drugs DMARDs.
Further biologic therapies are becoming available.
Patient education Patients with RA face many issues that affect their ability to cope with daily life Ryan et al, They are also at increased risk of infection, drug side-effects, blood disorders and other co-morbidities Weisman et al, Table 1 lists some of the issues to address. There is a wealth of research on patient education in arthritis, showing greater levels of patient satisfaction, concordance and improved self-efficacy Hill et al, ; Reilly and Bird, Some reviews have questioned whether the overall benefit to health care and the individual are sustained, but the emphasis is on ensuring that outcome measures accurately reflect potential benefits to individuals and overall health economics Riemsma et al, Patient-education programmes are not a static one-stop package.
It is also likely that patient expertise will reduce risk and improve concordance Carter and Taylor, Pain management Patients with OA and RA experience a significant amount of pain and this affects quality of life Covic et al, Pain is a complex mechanism affected by physical and psychological issues. It should be assessed and managed using a holistic approach. Pain assessment should be structured, looking at therapeutic and non-therapeutic relief strategies. Although pain is a subjective experience a number of tools can help practitioners to understand what a patient is experiencing Burckhardt, Many OA patients with relatively mild disease can achieve satisfactory pain control using simple analgesia and non-pharmacological approaches.
Many are likely to require frequent or occasional use of non-steroidal anti-inflammatory drugs NSAIDs to relieve inflammatory pain.
Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy
Patients with RA have more complex problems and, generally, more frequent episodes of pain and stiffness requiring high doses of anti-inflammatory drugs as well as simple or compound analgesia. This approach has the potential to reduce risk from drug side-effects and improve self-efficacy and concordance, although research in this area on OA and RA patients is limited. A general increase in pain, stiffness and fatigue can highlight increased disease activity. Pain can also be exacerbated by a number of factors:. Access to services Developing nursing roles - Nurses have an important role in improving health-care delivery, particularly with the advent of primary care trusts, nurse prescribing and extended roles DoH, ; This is particularly relevant in chronic disease management, where the safety and efficacy of nurses working in extended roles has been demonstrated in a range of settings Kinnersley et al, The greatest benefits are achieved if nurses extend their expertise while maintaining the integral aspects of the therapeutic relationship Castledine, It is likely that chronic disease management will be an integral part of extended nursing roles.
Nursing assessment models could include patient information and education, helpline support, pain or symptom management, review of medications including polypharmacy and additional risk, for example osteoporosis or gastrointestinal bleeds and blood monitoring. Some examples include:. Conclusion Nurses have a key role in influencing future care delivery. The SOAR template provides a framework to guide practitioners towards improving care. This paper aims to inspire nurses to look at proactive and innovative approaches to care.
It highlights the benefit that nurses and other members of the team can provide to patients with RA and OA in all care settings. Patient-centred care is rewarding and has the potential to improve a number of key health-related problems for patients with OA and RA.
Arthritis Research Campaign. Chesterfield, Derbyshire: ARC.
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