Date of Award

2012

Embargo Period

8-1-2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Nursing

First Advisor

Teresa J. Kelechi

Second Advisor

Gayenell S. Magwood

Third Advisor

Martina Mueller

Fourth Advisor

Julie Hilsenbeck

Abstract

Background: The number of patients in the United States living with chronic conditions is increasing as patients are surviving conditions that were previously fatal. This increase in survival has resulted in a shift in the disease burden in the United States from infectious to chronic diseases. Many patients with chronic conditions experience associated symptoms that impact their health-related quality of life more significantly than those without associated symptoms. To enable patients to achieve what they determine to be an acceptable state of wellbeing, health care providers must first be aware of the factors and the relationships among the factors that impact the perceptions patients have of their health-related quality of life. To comprehensively assess their patients, health care providers must incorporate their objective perspectives with the subjective perspectives of their patients. A comprehensive assessment will enhance the ability of health care providers to develop treatment plans that enable patients to achieve the state of well-being they desire. Beyond traditional health-related quality of life instruments, an instrument is needed to assess patients' perceptions of the impact symptoms associated with a chronic condition have on their health-related quality of life. The impact of symptoms associated with chronic conditions is the focus of this dissertation. Objective: The objective was first to conduct a review of the literature to define chronic wound pain, the focus of the study in this dissertation., as chronic wound pain is often under-assessed and under-treated as a result of inadequate knowledge related to this type of pain. The second objective was to develop a conceptual map illustrating the factors and the relationship among the factors that shape patients" perceptions of their health-related quality of life. The next objective was to develop a subjective health-related quality of life assessment instrument and to test the reliability and validity of the newly developed instrument among patients experiencing pain associated with chronic wounds. Results: The concept of chronic wound pain was explored and included defining this type of pain and identifying its prevalence, pathophysiology, and dimensions. The Chronic Illness Disease States - Symptom Intrusiveness Model was developed to demonstrate the factors that contribute to patients' perceptions of their health-related quality of life and the Symptom Intrusiveness Rating Scale was developed as a method to subjectively assess patients' perceptions of their health-related quality of li£e. Validity and reliability testing of the new instrument was conducted among patients with chronic wound pain. Patients with chronic symptoms confirmed in cognitive pretesting that the items on the instrument were interpreted as intended. Experts in the field of health-related quality of life confirmed that the statements on the instrument were all relevant. Test retest confirmed reliability of the Symptom Intrusiveness Rating Scale when conducting retest 2 to 4 days after the initial survey. However, conducting a retest study 2 weeks after the initial survey was found not to be a feasible method of testing reliability in a patient population admitted to an acute care facility. Conclusion: A subjective assessment can be quantified by utilizing the newly developed Symptom Intrusiveness Rating Scale, an instrument that focuses on the impact symptoms associated with chronic conditions have on patients' health-related quality of life. A comprehensive assessment will enhance a health care provider's ability to develop treatment plans that will improve the potential for patients to achieve their desired state of well being. Future research will focus on testing the validity and reliability of Sy IRS in studies with larger sample sizes and participants with varied chronic symptoms.

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