Sense of coherence and its impact on quality of life of patients with systemic lupus erythematosus

The sense of coherence (SOC) construct refers to a global orientation, which significantly determines the link between stressors, coping with disease and health. The aim of this work was to assess possible associations between SOC and quality of life (QOL) scores among women with SLE. Sixty consecutive SLE women and 88 healthy women were included in the study. QOL was assessed using the SF-36 and the WHO QOL-Bref scales. The SOC has three main sub-scales: comprehensibility, manageability and meaningfulness. Regression analyses were used to study associations between various parameters of SF-36, WHO QOL-Bref, SOC, SLEDAI, indices of end organ damage (SDI), and demographic variables. Mean SLEDAI and SDI scores were 4.5 (SD = 5.6) and 1.29 (SD = 2). SLE patients had significantly lower scores for all individual and summary sub-scales in the two QOL questionnaires compared with controls. SLE patients had significantly lower scores for the general, comprehensibility and meaningfulness sub-scales of SOC. No significant correlation was seen between SOC scores and measures of disease activity or end-organ damage. A strong linear correlation was seen between the scores of SOC, general WHO QOL-Bref, and the mental and physical component summary (MCS & PCS) scores of SF36. Age, SOC and SDI significantly affected the PCS score. SOC was the only variable independently associated with MCS. Education and SOC were significantly associated with the general WHO QOL-Bref. Age, education, SDI and SOC were independently associated with QOL of women with SLE.

From the desert: transcultural aspects of cancer nursing care in Israel

Quality of life perceptions, the meaning of cancer perception, and the meaning of illness are culture bound. Culture includes learned and shared ways of interpreting the world and interacting in society, and thereby provides all individuals with ideas about what is good or bad, desirable or undesirable, valued or devalued in life. Israel is an immigration country, and its citizens came from all over the world. It is also a meeting zone between Middle Eastern traditional culture and Western modern medicine. Cancer patients and a substantial proportion of doctors, nurses, and other health care professionals are from different ethnic backgrounds. In hospitals, clinics, and other places where health professionals live, work, or relax, there is a network of cultural factors that plays an important role in the well-being of patients. Cultural effects can considerably complicate the assessment of how an individual is likely to react to various aspects of the hospital environment, medical condition, treatment, staff, fellow patients, and so on. Ideal management includes the foresight to forestall problems that may arise and to create favorable psychosomatic effects that help patients to respond positively to treatment. To illustrate the cultural component in nursing care, four cancer patients from totally different cultural backgrounds are described: a bedouin, an Israeli-born Jew whose parents immigrated from Tunisia, and two immigrant patients, one from the United States and the other from Ethiopia. All four patients were treated by chemotherapy, radiation, or both in an oncology day-care unit at the Soroka Medical Center in Beer-Sheva. Also, a special education program for immigrant nurses is presented, as well as a new immigrant nurse from the former Soviet Union.

Measuring impact of nursing intervention on cancer patients' ability to control symptoms

Cancer patients' ability to control symptoms and to maintain reasonable quality of life is limited due to lack of knowledge, guidance, and instructions from health care providers, who usually refrain from transferring responsibility for the treatment to the patient. The present study describes a measured effect of a structured nursing intervention in which nurses were trained to apply the self-care model to 48 ambulatory cancer patients under chemo- or radiotherapy or both. The intervention included 10 structured home visits to each patient during 3 months, in which the nurse assessed symptoms and advised, guided, supported, and educated the patient in the relevant areas. The symptoms were quantitatively assessed using the Symptom Control Assessment (SCA) instrument, which was developed and validated specifically for this study. The SCA relates to 16 signs, symptoms, and complaints that encompass both the universal and the deviation-from-health needs, in addition to anxiety, body image, and sexuality. The instrument allows either the patient or the nurse to rate the severity of the complaint, the patient's independence in controlling it, the patient's perception of the familial and external help extended to him or her, and the knowledge of the symptom and its control possessed by the patient. Also, the SCA allows comparing the patient's ratings with the professional view of the visiting nurse. The SCA was proven to be a highly reliable and valid instrument. The results indicate that the intensity of the complaints decreased in the experimental group during the 3-month period while they increased in the matched control group, creating a considerable difference between the two groups on multivariate analysis of covariance (MANCOVA). On t-tests, significant improvement was found in 15 out of the 16 symptoms, including pain. The greatest reduction was found in the "psychosocial symptoms," namely anxiety, sociability, body image, and sexuality. Similarly, the patients' independence, knowledge, and perception of familial help increased in the experimental group and declined in the control group. Perhaps the most meaningful change was a significant increase in the ability of the experimental patients to assume responsibility for their own treatment as it is reflected by the increase of the independence ratings for all 16 symptoms. This is in sharp contrast to the decrease in 15 of the 16 symptoms among control patients. The results suggest that the self-care approach is effective also in improving the quality of life for unstable cancer patients by reduction of suffering and increase in controlling capabilities.