1. 'Loss of self': a psychosocial study of the quality of life of adults with diabetic ulceration 報告者 : 洪華憶 95-05-031

2. Abstract At present, recognition of the importance of psychological factors in the care of individuals with diabetes is still in its infancy. At present, recognition of the importance of psychological factors in the care of individuals with diabetes is still in its infancy. Understanding of the specific psychological factors relating diabetic foot ulceration is embryonic. Understanding of the specific psychological factors relating diabetic foot ulceration is embryonic.

3. Introduction A growing awareness of the importance of psychological and social influences on health and illness has led to the development of a biopsychosocial framework [1] for research and intervention. A growing awareness of the importance of psychological and social influences on health and illness has led to the development of a biopsychosocial framework [1] for research and intervention.[1] This integrative mode [1] has served as a basic framework for academic and clinical research in many areas, including assessment of patients' health- related quality of life (HRQoL), as the inseparable nature of physical, psychological and social factors are taken into account [2] This integrative mode [1] has served as a basic framework for academic and clinical research in many areas, including assessment of patients' health- related quality of life (HRQoL), as the inseparable nature of physical, psychological and social factors are taken into account [2][1][2][1][2]

4. Introduction Research has demonstrated that doctors who are still largely trained in the medical model [9] are often unwilling and unable to adopt a biopsychosocial approach to patient care Research has demonstrated that doctors who are still largely trained in the medical model [9] are often unwilling and unable to adopt a biopsychosocial approach to patient care[9] Research in individuals with diabetes has suggested that HRQoL is affected by a range of factors including effective metabolic control and positive mental health Research in individuals with diabetes has suggested that HRQoL is affected by a range of factors including effective metabolic control and positive mental health

5. Introduction This negation of psychological and social factors is despite the increasing recognition by those involved in the health care of people with diabetes that many patients experience major, long-term psychological and social difficulties This negation of psychological and social factors is despite the increasing recognition by those involved in the health care of people with diabetes that many patients experience major, long-term psychological and social difficulties Holistic patient care requires attention to physical, psychological and social areas of life Holistic patient care requires attention to physical, psychological and social areas of life

6. Introduction research has suggested that psychological and social factors are highly influential in determining patients' health-related behaviour [14]. research has suggested that psychological and social factors are highly influential in determining patients' health-related behaviour [14]. [14]

7. Findings Living a restricted life Living a restricted life Many participants reported that diabetic foot ulceration had had a major impact on their freedom to live life as they did before. Many participants reported that diabetic foot ulceration had had a major impact on their freedom to live life as they did before. Existing in social isolation Existing in social isolation Most of the participants reported negative effects of foot ulceration on social roles and activities. Restricted mobility, pain and lack of employment all contributed to a growing sense of social isolation. Most of the participants reported negative effects of foot ulceration on social roles and activities. Restricted mobility, pain and lack of employment all contributed to a growing sense of social isolation.

8. Findings Experiencing discredited definitions of self Experiencing discredited definitions of self Most of the participants in the study reported experiencing discredited definitions of their sense of self as a direct result of foot ulceration Most of the participants in the study reported experiencing discredited definitions of their sense of self as a direct result of foot ulceration. Becoming a burden. Becoming a burden

9. Implications for professional practice First, a holistic approach is needed to assess an individual's total experience of living with diabetes as opposed to focussing solely on physical care. First, a holistic approach is needed to assess an individual's total experience of living with diabetes as opposed to focussing solely on physical care. A second issue for professional practice is that of education. An accurate understanding of the experiences of each individual would help to inform both teaching strategies and the nature of education provided by professionals A second issue for professional practice is that of education. An accurate understanding of the experiences of each individual would help to inform both teaching strategies and the nature of education provided by professionals

10. Implications for professional practice A final issue for professional practice is that of encouraging those with diabetes to attend foot clinics, preferably before they develop ulcers. A final issue for professional practice is that of encouraging those with diabetes to attend foot clinics, preferably before they develop ulcers.

11. Conclusion The paper has argued that psychosocial factors have major implications for the quality of life of individuals living with diabetic foot ulceration. As a consequence, effective intervention and care strategies need to take account of these factors. The paper has argued that psychosocial factors have major implications for the quality of life of individuals living with diabetic foot ulceration. As a consequence, effective intervention and care strategies need to take account of these factors.