“ A female parent ‘s joy begins when new life is stirring insideaˆ¦..when a bantam bosom round is headed for really first clip and playful boots remind her that she is ne’er entirely. ”
Pregnancy and kid birth are events of great expectancy glorious minutes in adult females ‘s life. Motherhood is a great duty and it is adult female ‘s highest Crown of honor. Therefore keeping good wellness during gestation is really of import particularly in the nerve-racking life state of affairs. The few inches that the babe travels during child birth is the most unsafe distance it will go in its life clip. ( Marina, Richard, 1997 )
Pregnancy is a period of exhilaration, anticipation, some anxiousness and even fear. The brilliant experience of gestation can be seared for those unfortunate whose gestation is complicated. Pregnancy is the clip of intense physical alteration, and is associated with a great trade of emotional turbulence in many adult females. In add-on to the obvious outward physical alterations that accompany gestation, important addition in mental wellness jobs in gestation or immediate station partum period. Even in normal gestations, adult females experience elusive alterations that may change ability to carryout their usual functions and may take away from their overall quality of life. Certain fortunes like any disease associated with gestation such as medical upsets, infections, for illustration human immunodeficiency virus etc. are traumatic illustrations of how gestation can hold an impact on quality of life but other less traumatic factors increasing gestational age or household support, could besides act upon how a adult female feels during her gestation ( hueston & A ; Miller, 1998 ) .
Quality of life ( QOL ) is a multi-dimensional construct whose definition and appraisal remains controversial. Quality of life is conceptualized in footings of an absence of hurting or an ability to map in twenty-four hours to twenty-four hours life. Quality of life may be defined as subjective wellbeing. Acknowledging the subjectiveness of quality of life is a cardinal to understanding this concept. QOL reflects the difference, the spread, between the hopes and outlooks of a individual and their present experience. Human version is such that life outlooks are normally adjusted so as to lie within the kingdom of what the single perceives to be possible. This enables people who have hard life fortunes to keep a sensible QOL. ( Janssen Quality-of-life Studies, 2006 ) . Quality of life includes “ overall subjective feelings of good being that are closely related to morale, felicity and satisfaction ” . Health is one of the most of import determiners of overall quality of life, it has been suggested that quality of life unambiguously affected by specific disease procedure such as Acquired Immuno Deficiency Syndrome. ( Naveet Wig, 2009 )
The Acquired Immuno Deficiency Syndrome ( AIDS ) which is caused by the Human Immunodeficiency Virus is a RNA retrovirus that preferentially attacks T-helper lymph cells ( CD4+ cells ) every bit good as other cell type was first described in the United States of America in 1981. The first instance of HIV in India was reported in Tamil Nadu in 1986.
Key issues like quality of life come to the bow because an alarming addition of human immunodeficiency virus ( HIV ) /acquired immunodeficiency syndrome ( AIDS ) in developing states ( estimated prevalence in India=0.91 % ) and inability to afford extremely active antiretroviral therapy ( Naveet Wig,2009 ) . Today approximately 40 million people Worldwide are populating with HIV. It ‘s estimated that 50 % of those people populating with the disease are adult females has tripled from about 8 % to 27 % since 1987.
THE WORLD WIDE HIV /AIDS PANDAMIC
Harmonizing to National AIDS Control Organization ( NACO 2007 )
Worldwide HIV AIDS
Number of people populating with HIV AIDS
Adults populating with HIV AIDS
Womans populating with HIV AIDS
Estimated HIV prevalence ( % ) among prenatal clinic attendants, by age
Age group ( old ages )
HIV epidemic in India has seen some stabilisation with big prevalence now estimated at 0.31 % , compared to 0.36 % in 2006. ( Union Ministry of Health and Family Welfare, 2010 ) . It is estimated that around 2.3 million people in India are presently populating with HIV. Of these, an estimated 39 % are female and 3.5 % are kids ( National AIDS Control Organization 2008 ) . Harmonizing to Ministry of Health and Family Welfare, 2010 it said that India sing about 61.2 hundred thousand anticipating female parents go toing prenatal clinics in 2009-2010 with HIV. Harmonizing to NACO ‘s study, there are figure provinces where the HIV prevalence in prenatal adult females is 1 % and they are considered to be high prevalence provinces. The prenatal prevalence rate increased from 0.01 % to 1 % in 2007. Andhra Pradesh have prevalence rate of 1 % . In Manipur, Mizoram and Nagaland has prenatal prevalence of 0.75 % , 0.75 % , and 60 % severally. The current prevalence rate of Tamil Nadu is 0.25 % .
In modern history of appraisal of quality of life come to research field in the early 1960 ‘s and wellness related quality of life appraisal go popular a decennary subsequently ( flargan 1982 as cited by Zhanc 1992 ) . Health related quality of life focal points specially on quality of life as it relates to wellness. The major facets of wellness related quality of life include physical, societal, emotional, and cognitive operation, mobility and ego attention.
Health care is an of import facet in the primary attention of adult females with HIV. Pregnant adult females with HIV will go on to necessitate competent compassionate and comprehensive antenatal attention, medical services in consistent with holistic nursing attack.
SIGNIFICANCE AND NEED FOR THE STUDY
Pregnancy is a clip of intense physical alteration, and is associated with a great trade of emotional turbulence in many adult females. Pregnancy constitutes a clip of important life alteration necessitating major psychological accommodations, frequently associated with anxiousness and emphasis ( Da Costa et al. , 1999 ) . A lacking psychosocial and emotional accommodation during gestation constitutes a hazard factor for the female parent. The relationship between societal support, psychological emphasis and gestation result is complex ( Hoffman and Hatch, 1996 ; Sheehan, 1998 ) . The psychosocial resources, peculiarly societal stableness and societal engagement supplying psychological and instrumental support, are protective by buffering the impact of life emphasis on emotional wellbeing of the female parent ( Glazier et al. , 2004 ) .
Even in normal gestations, adult females experience elusive alterations that may change their ability to transport out their usual functions and may take away from their overall quality of life. Certain fortunes, such as inordinate sickness and emesis, other medical upsets and infections like hepatitis, HIV are dramatic illustrations of how gestation can hold an impact on quality of life, but other less dramatic factors, such as increasing gestational age or household support, could besides act upon how a adult female feels during her gestation ( Hueston & A ; A Kasik-Miller, 1998 )
Harmonizing to Polly Clayden HIV positive adult females having either no ART or AZT prophylaxis showed that gestation either somewhat increased the hazard of HIV disease patterned advance or had no effects.
HIV remains a complex disease that has prolonged physical and psychosocial effects for individuals diagnosed with the disease, their loved 1s, and their health professionals. The emphasiss and losingss associated with HIV disease are profound and are frequently compounded by social stigmatisation ( Cochran & A ; Mays, 1991 ) . Persons with HIV disease face multiple challenges in their day-to-day life forms every bit good as in their interaction with wellness attention systems. The success with which they meet these challenges influences both the patterned advance of the disease and the quality of their lives. This probe sought to place behaviours and forms that enable individuals with HIV disease to accomplish a higher health-related quality of life in malice of a long, unpredictable progressive downhill class. ( Murdaugh & A ; Carolyn,1998 )
HIV amendss the nervousnesss and encephalon, the nervous system. It besides attacks and destroys the organic structure ‘s natural defense mechanism system against disease-the immune system. Specifically, HIV destroys the CD4 cells of the immune system. Without adequate of these particular cells, the organic structure has trouble contending off infections. When the immune system becomes so weakened by the assailing virus that certain dangerous infections set in, and if the CD4 cell count is low in the individual ‘s blood, the individual is said to hold AIDS. While it is true that an HIV infection has no remedy, intervention is available today that can assist people bask an improved quality of life and unrecorded thirster. Treatment can besides assist decrease the hazard of go throughing the virus to an unborn kid ( sogc 2010 ) . The HIV infections has become one of the most serious epidemics worldwide, with important impact on mortality, morbidity, overall quality of life, and the usage of wellness attention services ( Adriana Carvalhal ; 2010 ) .
With the recent progresss in clinical trials and interventions for those enduring from HIV/AIDS, the endurance of these patients has been increased and their quality of life has become an of import focal point for research workers and health care suppliers. ( Nojomi, Anbary & A ; Ranjbar, 2008 )
In the developed universe, with the accent on richness and with the increasing length of service of populations, there is a general involvement in how to accomplish the `goodness ‘ of life, sometimes called life satisfaction or quality of life. The saliency of quality of life across subjects has resulted in the recent outgrowth of generic quality of life questionnaires ( Evans and Cope 1993 ) , and quality of life questionnaires for usage in wellness attention rating, ( Bowling, 1999 ) .
In relation to wellness, wellness position is progressively referred to as quality of life, and, so as to contract down its operationalization in research surveies, quality of life is progressively referred to as wellness related quality of life. Health- subjective wellness position, is patient based, but focuses more on the impact of a sensed wellness province on the ability to populate a fulfilling life ( Bullinger et al. 1993 ) . Health position, functional position, and quality of life are three constructs frequently used interchangeably to mention to the same sphere of wellness. The wellness sphere ranges from negatively valued facets of life, including decease, to the more positively valued facets such as function map or felicity. The boundaries of definition normally depend on why one is measuring wellness every bit good as the peculiar concerns of patients, clinicians, and research workers. We use the term health-related quality of life ( HRQL ) because widely valued facets of life exist that are non by and large considered as wellness, including income, freedom, and quality of the environment. Although low or unstable income, the deficiency of freedom, or a low-quality environment may adversely impact wellness, these jobs are frequently distant from a wellness or medical concern. Clinicians focus on HRQL, although when a patient is sick or diseased, about all facets of life can go wellness related.
HRQL is of import for mensurating the impact of chronic disease. Physiologic measures supply information to clinicians but are of limited involvement to patients ; they frequently correlate ill with functional capacity and wellbeing, the countries in which patients are most interested and familiar. In patients with chronic bosom and lung disease, exercising capacity in the research lab is merely weakly related to exert capacity in day-to-day life. Another ground to mensurate HRQL is the normally ascertained phenomena that two patients with the same clinical standards frequently have dramatically different responses. For illustration, two patients with the same scope of gesture and even similar evaluations of back hurting may hold different function map and emotional wellbeing. Although some patients may go on to work without major depression, others may discontinue their occupations and have major depression.
These considerations explain why patients, clinicians, and wellness attention decision makers are all keenly interested in the effects of medical intercessions on HRQL. Administrators are peculiarly interested in HRQL because the instance mix of patients affects use and outgo forms, because increasing attempts exist to integrate HRQLs as steps of the quality of attention and of clinical effectivity, and because remunerators are get downing to utilize HRQL information in reimbursement determinations.
Has and colegues reported lower physical operation and poorer perceptual experiences of wellness among adult females in the 2nd and 3rd trimesters compared with their prepregnancy province. ( Vijayalakshmi,2003 ) . Cichocki ( 2004 ) conducted a survey that focuses on how the effects of HIV/AIDS have significantly increased among HIV positive pregnant adult females at Nairobi. The survey concluded that the survey of adult females and HIV continues to be missing wellness related quality of life
Examination of wellness related quality of life in pregnant adult females with HIV can help in the comparing of how HIV positive pregnant adult females and HIV negative pregnant adult females are affected and helps in be aftering to better the wellness related quality of life.
The research worker during her clinical visits found that pregnant adult females who are infected with HIV have many emotional, physical, societal, and psychological jobs. They need much attention in those spheres. With respect to above factors the research worker want to carry on the undermentioned survey.
STATEMENT OF THE PROBLEM
A comparative survey to measure the Health Related Quality Of Life ( HR-QOL ) of HIV positive and HIV negative pregnant adult females who are go toing Government Rajaji Hospital, Madurai.
The aims of the survey were to:
assess the related quality of life of HIV positive pregnant adult females
assess the wellness related quality of life of HIV negative pregnant adult females
compare the degrees of wellness related quality of life of HIV positive with HR-QOL of HIV negative pregnant adult females
To happen out the correlativity between overall HR-QOL and its bomber spheres ( such as physical operation, function restrictions due to physical wellness, function restrictions due to emotional jobs, energy /fatigue, emotional well being, societal operation, bodily hurting, and general wellness perceptual experiences ) among HIV positive pregnant adult females.
happen out the association between wellness related quality of life of HIV positive pregnant adult females and their selected demographic variables such as age, instruction, business, income, faith, support system, matrimonial position, old ages of diagnosing, CD4 count and para.
happen out the association between wellness related quality of life of HIV positive and HIV negative pregnant adult females and selected demographic variables such as age, instruction, business, income, faith, support system, matrimonial position, and para.
Hypothesis will be tested at the 0.05 degree of significance
There will be a important association between wellness related quality of life of HIV positive pregnant adult females and age, instruction, business, income, faith, support system, matrimonial position, continuance of gestation old ages of diagnosing, CD4 count and para.
There will be a important association between wellness related quality of life of HIV negative pregnant adult females and age, instruction, business, income, faith, support system, matrimonial position, and para.
The average wellness related quality of life mark of HIV negative female parent will be higher than the average wellness related quality of life of HIV positive female parents.
Quality of life
Quality of Life as person ‘s perceptual experience of their place in life in the context of the civilization and value systems in which they live and in relation to their ends, outlooks, criterions and concerns. ( WHO,1997 )
Health related quality of life
It refers to a individual or group ‘s sensed physical and mental wellness of HIV positive and HIV negative pregnant adult females, as measured by medical results short form-36
HIV positive pregnant adult females
It refers to the prenatal adult females go toing authorities Rajaji infirmary, who are infected with human immune lack virus and whose positive position is confirmed by doctor as per National AIDS Control Organization protocol.
HIV negative pregnant adult females: –
It refers to adult females who are pregnant and free of human immunodeficiency virus.
HIV is a menace to wellness related quality of life
Control of physical symptoms associated with HIV contributes to better wellness related quality of life of pregnant adult females with HIV.
Handiness of societal support enhances the quality of life with HIV positive pregnant adult females.
Nurses can play an of import function in bettering wellness related quality of life of HIV positive pregnant adult females.
The survey is limited to pregnant adult females who are go toing prenatal outpatient section at authorities Rajaji infirmary Madurai.
Study period is limited to 6 hebdomads.
The survey happening will uncover the bing wellness related quality of life HIV positive pregnant adult females in comparing with HIV negative pregnant adult females. The survey findings will uncover wellness related quality of life HIV negative pregnant adult females and HIV positive pregnant adult females.
The survey findings will assist the nursing forces to plan the attention, support and instruction harmonizing to the demands and jobs of HIV positive pregnant adult females. This will assist the wellness squad to make awareness sing wellness related quality of life and steps to in addition wellness related quality of life of HIV positive pregnant adult females.
CONCEPTUAL FRAME WORK
This survey is based on Ferrell quality of life theoretical account. Health related quality of life is the extent to which one ‘s usual or expected physical, emotional and societal wellbeing are affected by a medical status or its intervention. It is the grade to which a individual enjoys the of import possibilities of her life, possibilities result from the chances and restrictions each individual has in her life and reflect the interaction of interpersonal and intrapersonal factors. In this survey the research worker Ferrell quality of life theoretical account to compare the wellness related quality of life HIV positive and HIV negative pregnant adult females.
HIV can impact all 8 spheres of wellness related quality of life. Here, HIV can act upon all the spheres of HR-QOL i.e. physical operation, function restrictions due to physical wellness, function restrictions due to emotional jobs, energy, emotional well being, societal operation, bodily hurting and general wellness. In this survey physical sphere, the factors considered are activities of day-to-day life, self attention and mobility. Under the function restrictions due to physical wellness sphere, factors considered are jobs in day-to-day activities due to physical wellness and able to execute good with physical jobs. Under the function restrictions due to emotional jobs domain, the factors considered are activities of day-to-day life hindered with emotional jobs. Under the energy sphere, the factors considered are tiredness, involvement in making activities of day-to-day life and energetic at work. Under the emotional well being sphere, the factors considered are sleep, remainder, composure and peaceableness and felicity. Under the societal operation sphere, the factors considered are sing friends and physical job which hinders with societal assemblages. Under the bodily hurting sphere, the factors considered are pain and hurting interfering with physical wellness. Under the general wellness sphere, factors considered are perceptual experience of their wellness and disease patterned advance.
The factors impacting wellness related quality of life of pregnant adult females are demographic factors such as age, instruction, business, income, faith, matrimonial position and societal support and clinical factors such as para, continuance of gestation. HIV has terrible impact on gestation so that the wellness related quality of life of HIV positive pregnant adult females besides altered.
All the 8 spheres are interrelated ; alteration in one sphere can impact the other sphere. Satisfaction in all spheres leads to high HR-QOL and low satisfaction leads to low HR-QOL. Low or high HR-QOL is influenced by assorted spheres such as physical operation, function restrictions due to physical wellness, function restrictions due to emotional jobs, energy, emotional well being, societal operation, bodily hurting and general wellness. Therefore an apprehension of external conditions and act uponing factors is indispensable for nursing intercessions to heighten the personal satisfaction with life.
Age, instruction, business, income, faith, matrimonial position and societal support
HIV NEGATIVE PREGNANT WOMEN
HIV POSITIVE PREGNANT WOMEN
Sleep and remainder, composure and peaceableness Happiness
PHYSICAL FUNCTIONING Activities of day-to-day life, self attention, mobility
Pain, intervention of hurting with activities of day-to-day life
HEALTH RELATED QUALITY OF LIFE
Fatigue, Interest in making energetic in work
Parity, continuance of gestation,
High or low
Health related quality of life
Percept of wellness and disease patterned advance
Visiting friends, go toing societal assemblage, hindernce of hurting
Parity, continuance of gestation, CD4 count, continuance of disease and HIV phase Health
Modified ferrals qol theoretical account