Psychosocial Nursing Intervention For Improving Quality Of .

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Psychosocial Nursing Intervention forImproving Quality of Life of patient withMultiple SclerosisThesisSubmitted for Partial Fulfillment of the Requirement of doctorateDegree in Nursing Science (Psychiatric/Mental Health Nursing)Supervised By:Dr. Zeinab Abd-Elhameid LoutfiProf. of Psychiatric Mental/Health NursingFaculty of NursingAin Shams UniversityDr. Ghada Mohamed MouradAssist. Prof. of Psychiatric/Mental Health NursingFaculty of NursingAin Shams UniversityFaculty of NursingAin Shams University2015

Psychosocial Nursing Intervention forImproving Quality of Life of patient withMultiple SclerosisThesisSubmitted for Partial Fulfillment of the Requirement of doctorateDegree in Nursing Science (Psychiatric/Mental Health Nursing)ByFatma Mohammed Ibrahim MorsyAssistant Lecturer in Psychiatric/Mental Health NursingDepartmentFaculty of Nursing - Ain Shams UniversityFaculty of NursingAin Shams University2015

ACKNOWLEDGEMENTFirst of all and foremost, thanks to ALLAH, who gaveme the strength and ability to complete this work.I would like to express my deep thanks and appreciationto supervisor Prof.Dr. Zeinab Loutfi, Professor ofPsychiatric/Mental Health Nursing, Faculty of Nursing, AinShams University for her supervision, personal enthusiasm,fruitful guidance, and valuable advices throughout theconduction of this study.I would like to express my deep thanks, indebtedness,and greatfull gratitude to Dr. Ghada Mourad, AssistantProfessor of Psychiatric/Mental Health Nursing, Faculty ofNursing, Ain Shams University for her close supervision,continuous advice, constant encouragement, moral support,and valuable help to the completion of this study.Last but not least, I would like to express my gratitude tomy husband, family, all my colleagues in the faculty, friends,patients and all persons who were directly or indirectlyinvolved in my study and have one way or another helped inmaking this study a success.The Candidate

This work is dedicated to the most importantpersons in my life To The Soul of My Father, to My Mother,My Husband, My Daughters and All MyFamily Members For Their Warmest Love,Support, Encouragement, Patience, andUnderstanding Which Made This StudyCome to Light.Thankyoualot

Table of ContentContentsChapterI. IntroductionPage1II. Aim of the study5III. Literature review6 Overview of Multiple Sclerosis6 The Burden of Multiple Sclerosis on Patients’Quality of Life16I. Quality of life in the light of Multiple Sclerosis16II. Patients reaction to diagnosis with MS20III. Bio-psychosocial impact of multiple sclerosis24 Role of Liaison Mental Health Nurse in MultipleSclerosisBio-psychosocial interventionsIV. Subjects and methodsV.Results414489118VI. Discussion163VII. Conclusion186VIII. Recommendations187IX. Summary190X. ReferencesAppendicesArabic summary197

List of TablesList of TablesIn Literature ReviewNoTable titlePage1Predictors of Poor QOL in MS.992Comparison of the traditional nursing andwellness nursing processes.43In ResultsNoTable titlePage1Frequency distribution socio-demographiccharacteristics of patient with MS.1192History of illness of patient with MS.1223Frequency distribution of bio-psychosocialcomplains patient with MS.1244Comparison between pre- and postintervention regarding knowledge of patientwith MS.1265Comparison between pre- and postintervention regarding physical health of patientwith MS.1036Comparison between pre- and post-interventionregarding role limitations due to physicalproblems of patient with MS.1327Comparison between pre- and postintervention regarding role limitations due toemotional problems of patient with MS.134

List of TablesList of Tables cont.8Comparison between pre- and postintervention regarding health perception ofpatient with MS.1369Comparison between pre- and postintervention regarding pain of patient with MS.13910Comparison between pre- and postintervention regarding emotional well-being ofpatient with MS.14311Comparison between pre- and postintervention regarding energy of patient withMS.14212Comparison between pre- and postintervention regarding social function of patientwith MS.14413Comparison between pre- and postintervention regarding cognitive function ofpatient with MS.14614Comparison between pre- and postintervention regarding health distress of patientwith MS.14815Comparison between pre- and postintervention regarding sexual function ofpatient with MS.10316Comparison between pre- and postintervention regarding change in health ofpatient with MS.15217Comparison between pre- and postintervention regarding overall quality of life ofpatient with MS.152

List of TablesList of Tables cont.18Comparison between pre- andinterventionregardingMSQOLcomposites of patient with MS.posthealth15019Comparison between pre- and postintervention regarding total overall quality oflife of patient with eristics of patient with MS and acteristics of patient with MS and totalknowledge pre- and post- psychosocial nursingintervention.16922Correlation between total knowledge of patientwith MS and MSQOL health composites preand post- intervention.162

List of FiguresList of FiguresNoFigures TitlePageIn Review1. Cross Section of the Brain and Spinal Cord.72. Main symptoms of multiple sclerosis.83. World prevalence of multiple sclerosis.134. Types of multiple sclerosis.125. Relation between fatigue and mobility.26In Results1. Gender distribution of patients with MS.1232. Age groups distribution among patients with MS.1233.Educational level and age groups distributionamong patients with MS.1294.Commitment to treatment distribution amongpatients with MS.1205.Comparison between pre- and post- interventionregarding knowledge of patient with MS.128Comparison between pre- and post- psychosocial6. nursing intervention regarding total knowledgeof patients with multiple sclerosis.128

List of FiguresList of Figures cont.Comparison between pre- and post- psychosocial7. nursing intervention regarding physical health ofpatients with multiple sclerosis.139Comparison between pre- and post- psychosocialnursing intervention regarding role limitations8.due to physical problems of patients withmultiple sclerosis.132Comparison between pre- and post- psychosocialnursing intervention regarding role limitations9.due to emotional problems of patients withmultiple sclerosis.134Comparison between pre- and post- psychosocial10. nursing intervention regarding health perceptionof patients with multiple sclerosis.136Comparison between pre- and post- psychosocial11. nursing intervention regarding pain of patientswith multiple sclerosis.138Comparison between pre- and post- psychosocial12. nursing intervention regarding emotional wellbeing of patients with multiple sclerosis.143Comparison between pre- and post- psychosocial13. nursing intervention regarding energy of patientswith multiple sclerosis.142Comparison between pre- and post- psychosocial14. nursing intervention regarding social function ofpatients with multiple sclerosis.144Comparison between pre- and post- psychosocial15. nursing intervention regarding cognitive functionof patients with multiple sclerosis.146

List of FiguresList of Figures cont.Comparison between pre- and post- psychosocial16. nursing intervention regarding health distress ofpatients with multiple sclerosis.148Comparison between pre- and post- psychosocial17. nursing intervention regarding sexual function ofpatients with multiple sclerosis.103Comparison between pre- and post- psychosocial18. nursing intervention regarding change in healthof patients with multiple sclerosis.152Comparison between pre- and post- psychosocial19. nursing intervention regarding overall quality oflife of patients with multiple sclerosis.150Comparison between pre- and post- psychosocialnursing intervention regarding physical health20.composite and mental health composite of life ofpatients with multiple sclerosis.150Comparison between pre- and post- intervention21. regarding total overall quality of life of patientwith MS.157

List of abbreviationsList of abbreviationsADLs:Activities of Daily LivingCIS:Clinically Isolated SyndromesCNS:Central Nervous SystemDMTs:Disease-Modifying TreatmentsFDA:Food and Drug AdministrationGU:GenitourinaryHRQOL:Health Related Quality Of LifeLMHN:Liaison Mental Health NurseMRI:Magnetic Resonance ImagingMS:Multiple SclerosisMSQOL-54Multiple Sclerosis Quality of Life-54OTC:Over The Counter medicationsPPMS:Primary Progressive Multiple SclerosisPRMS:Progressive-Relapsing Multiple SclerosisPST:Problem-Solving Therapy

List of abbreviationsList of abbreviations cont.QOL:Quality Of LifeRRMS:Relapsing-Remitting Multiple SclerosisSO:Significant Other(S)SPMS:Secondary Progressive Multiple SclerosisUTI:Urinary Tract InfectionWHO:World Health Organization

AbstractABSTRACTMultiple sclerosis (MS) is the most common chronic, nontraumatic neurological disorder afflicting young people during theirpeak productive ages. This study was aiming to assess the effect ofpsychosocial nursing intervention on quality of life of patient withmultiple sclerosis. It was conducted on 50 cases with MS in ElDemerdash day care unit. Data were collected using: 1) Interviewingquestionnaire containing the following parts A) Socio-demographicsheet. B) History of illness, C) Patient’s knowledge regarding multiplesclerosis. 2) Multiple Sclerosis Quality of Life (MSQOL-54)instrument. The result of this study showed that, there are highlystatistically significant differences found between pre- and postintervention regarding knowledge about disease of patient withmultiple sclerosis (P .000). Additionally, there are highly statisticallysignificant difference found between pre- and post- interventionregarding physical health composite and mental health composite ofpatient with multiple sclerosis (P .000) respectively. As well as, thereis a highly statistically significant difference found between pre-andpost-intervention regarding total overall quality of life of patient withmultiple sclerosis, (P .002).Results concluded that theimplementation of psychosocial nursing intervention has a positiveeffect on quality of life of patient with multiple sclerosis. Based on theresults, it is recommended to incorporate non-drug therapy(psychosocial intervention) along with pharmacological therapies inMS management to improve quality of life of patients with -----------------------------------------Key wordsMultiple sclerosis – Quality of life- Psychosocial nursing intervention

Sclerosis 4 1 Bio-psychosocial interventions 4 IV. Subjects and methods 89 V. Results 118 VI. 1Discussion 63 VII. 18Conclusion 6 VIII. 18Recommendations 7 IX. 1Summary 90 X. References 197 Appendices Arabic summary . List of Tables List of Tables In Literature Review No Table title Page 1 Predictors of Poor QOL in MS. 9 2 Comparison of the traditional nursing and wellness nursing