الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 196 |  |  |
| | | from | 196 | | |
Abstract
SUMMARY
Patients with chronic wounds suffering from reduction in their QOL and various factors have been implicated to decrease it, including: activities of daily living, fatigue, sleep disturbances, restricted mobility, pain, wound infections, and social isolation. The requirements and consequences of having a chronic wound have an enormous impact on the patient’s social life. The loss of independence associated with functional decline can lead to changes in overall health and well-being, altered eating habits, depression and a gradual reduction in daily routine (Wongkongkam, 2006 & Karakayali et al, 2009).
Aim of the Study
This study aimed to assess the factors affecting quality of life in patients with chronic wounds (diabetic foot and venous leg ulcers).
Subjects and Methods:
Design
A descriptive exploratory design was utilized to meet the aim of this study.
Setting
The present study was conducted at the surgical outpatients, clinics and inpatients, departments (general & vascular), in El-Demerdash Hospital which is affiliated to Ain Shams University.
Subjects
A purposive sample of 225 adults patients, from both sexes with chronic wounds (DFUs &VLUs) were recruited, from the above mentioned settings. They were selected according to the number of patients with DFU and VLUS within the year 2009/2010 in El-Demerdash Surgical Hospital according to the statistical department affiliated to the setting.
Tools of data collection:
Data were collected using the following tools:
Patients’ interviewing questionnaire sheet.
A simple Arabic questionnaire to identify the factors affecting quality of life in patients with chronic wounds (DFUs &VLUs). It was developed and filled in by the researcher after reviewing by the supervisors utilizing the most recent and relevant literature. It included the following parts:
(A) Socio-demographic data sheet: It included age, sex, number of children, level of education, occupation, income, marital status, body weight and length, housing status and smoking.
(B) Clinical data sheet: It was used to obtain patients’ diagnosis, past and present medical history, signs and symptoms, complications, investigations, wound types, treatment pattern and duration .
Wounds assessment sheet:
It was used to assess the following items: site, and size of wounds, exudates, odour, infection, and pain, surrounding skin, edema, dressing frequency and healing condition. It was adapted from (Grey et al, 2006).
Wound condition was assessed according to the following categorization: Good=3 degrees, average= 2 degrees and poor= 1 degree.
Factors affecting quality of life assessment sheet: It included the following:
- Physical factors: (pain, discomfort, fatigue, activates of daily living, changes in (sleeping, resting, eating and skin). exercise, caring, walking, household duties, work, treatment, bandages compressor, wound size, duration, health condition, moving, and environment (34 items).
- Social factors: personal relationships, culture, social support work effects, burden on the family, insufficient income, social isolation, handicap, independent and marital relations changes (14 items).
- Psychological factors: suffering, self-esteem, body image & appearance, satisfaction, family reaction, self-confidence, shame, embarrassment, sadness, sorrow, angry, nervous, fear and anxious (15 items).
- Spiritual factors: vision for the future, difficult coping, no goals in life, hopelessness on recovery, always complaint, depressed feeling, God punishment and un-satisfaction feeling (9 items).
The negative effect of factors affecting QOL was determined according to the following: low effect= 1 degree, moderate effect =2 degrees and high effect = 3 degrees.
Results:
The iportant findings that were obtained from the study can be summarized as follows:
Socio-demographic characteristics of patients understudy revealed that the mean age was (59.4 ± 1.9). As regards educational level, about two thirds (66.2%) of them were illiterate, while minority (7.1%) of them were university graduates.
More than half of the studied patients (50.7%) had severe pain and majority of them (85.3%) had pain during wound dressing.
More than three fifths of the studied patients had a high negative effect regarding ADLs on their QOL as follows: transferring/walking (67.1%), work (64.4%) and exercises (63.1%).
Physical factors represent the highest negative effect on QOL (mean=154.4±24.9), followed by spiritual factors (mean=149.8±54.5), then Psychological and social factors (mean=135.4±26.2 & 115.5±53.8 respectively).
Level of negative factors affecting patients, QOL was high (mean =133.4±17.5), followed by moderate negative effect (mean=78.6±11.2), then low negative effect (mean =9.7±3.7).
Majority of the studied patients had offensive wound odour and irregular wound edges (85.8% & 84.4% respectively).
There were Statistically significant relations between QOL domains (physical, psychological, social, & spiritual) and patients’ age, knowledge, educational level, income, pain, wound type, duration and complications.
CONCLUSION
Based on the findings of the present study, it can be concluded that:
There were many factors affecting on quality of life in patients with chronic wounds (Diabetic foot and Venous leg ulcers) including: physical, psychological, social and spiritual. Moreover , significant relations were found between these factors and patients’ characteristics (age, knowledge, education-al level, income) , added to pain severity, wound type, duration and complications.
RECOMMENDATIONS
The following recommendations are inferred from the study:
An educational program should be held periodically for such groups of patients with chronic wounds.
Patients are in need to a simplified illustrated and comprehensive Arabic booklet including information about chronic wounds and its therapeutic regimen.
Continuous assessment of quality of life domains in patients with chronic wounds (DFUs and VLUs) is highly recommended.
Longitudinal studies are needed for patients with chronic wounds (DFUs and VLUs).
Further studies are needed to focus on studying other factors affecting quality of life in patients with chronic wounds (DFUs and VLUs).