Concept analysis in nursing theory

¶ … Nursing Theory

The theory of nursing is built in a dynamic process that develops from practice and is normally reproduced through research, by development and analysis of concepts and theories. There is need to investigate further the phenomena seen in nurses' experience during practice in order to identify the attributes. The most effective way of enabling nurses to deeply examine some phenomena is by defining a concept of interest. This would enable the development of theories that are directly related to a clinical practice. There has been a tremendous improvement and push for the analysis and development of nursing concepts mainly because researchers have attempted to clarify problems that were previously considered as common sense. The increase has been necessitated by concepts that look obvious having vague terminologies, inconsistent theories, and ambiguous definitions.

Quality of life is a terminology that is frequently used in nursing practice and in health care. Looking into literature one will notice that the terminology is not well defined and there are numerous perceptions as to the meaning of quality of life. The perceptions will most often vary based on a case by case scenario. Nurses work on improving the quality of life for a patient by disease prevention, disease management, and health promotion. There are numerous issues faced by nurses regarding quality of life, especially when dealing with health care advances that are aimed at increasing the lifespan of a patient (Xu, Kane, & Shamliyan, 2013). It is the goal of nurses to improve the quality of their patients' lives, but the term is vague, and there is no enough clarity how a nurse should accomplish this task. Treatment goals and decision should be based on their effect on the patient's life, and differences on the understanding of the terminology may result in different treatment choices, goals, and outcomes (Mishra, Scherer, Snyder, Geigle, & Gotay, 2014).

It is quite difficult for nurses to make decisions based on improving their patients' quality of life is they do not know what that means. This concept analysis aims at bringing clarity to the meaning by examining various methods that quality of life is used in health care. Making a clarification would enable those involved in health care to communicate well with each other, patients, and loved ones in regards to quality of life. Treatment decisions and care goals that are related to quality of life improvement would also be clarified. Looking into literature that discuss quality of life will be the best method for accomplishing this task. From the definitions obtained from the literature, some critical attributes of the terminology would be determined, and example cases developed using the attributes. There will be the determination of antecedents and consequences that will be followed by the operational definition of the terminology. Some empirical referents will be identified and described.

Definition of Quality of Life

The Collins online dictionary defines quality of life as the extent to which a person's life is satisfying and comfortable. Another definition given for quality of life is the general well-being of a society or person that is defined in terms of health rather than wealth. Quality of life is a measure of the optimum force or energy that empowers an individual with the power to successfully cope with all the challenges they might encounter in the real world. This is the definition provided by Mosby's Medical, Nursing, & allied Health Dictionary.

A philosophical and ethical perspective definition for quality of life implies that it is the interaction between the individual and their surroundings including other people. Quality of life from a religious perspective implies that it is the spiritual wellbeing, religious issues, feelings of hope, spirituality, personal beliefs, and inner peace (Nikmat, Hawthorne, & Al-Mashoor, 2015). The World Health Organization has defined quality of life since 1970. The definition given is that quality of life is the individual's perception of their position in life within the context of culture and the value systems they live in relation to their personal beliefs, goals, expectations, standards, social relationships, and concerns. According to Mishra et al. (2014) quality of life is a multidimensional concept that covers multiple life dimensions like housing conditions, employment, education, work life balance, public services, and access to institutions and their interplay. In nursing quality of life refers to the patient's ability to enjoy their normal life activities. It is a vital consideration in medical care and medical treatments. There are some medical decisions that can greatly interfere with the patient's quality of life, and they do not offer any benefit, whereas there are other treatments that would enhance the patient's quality of life. In nursing, it is vital to find the correct balance and ensure that the patient's quality of life is well maintained at all times.

Literature Review

Quality of life a concept by itself has been analyzed by numerous researchers based in different aspects of providing quality of life to patients. Researchers have been keen to establish how well to enhance quality of life for patients especially in the ICU. From all the literature available, it is clear the main aim of analyzing quality of care is to establish the best methodologies for enhancing the patient's life. Quality of life mainly concerns with the individual's functional status and their appraisal of health as it affects their own life (Shippee, Henning-Smith, Gaugler, Held, & Kane, 2017). A majority of quality of life instruments measure the functioning of the various life aspects like physical, interpersonal, and occupational. These are all things that nurses are familiar with. Therefore, it is vital for nurses to be able to determine and measure a patient's quality of life-based on their assessment of the patient. Quality of care is not only used to measure the quality of life a patient but can also be used during clinical trials (Nikmat et al., 2015). Nurses attending conferences would be curious to establish the positive and negative side effects that drugs would have on a patient. This information is beneficial for nursing practice because it allows them to support their justification of offering or prescribing certain drugs to patients. Therefore, quality of life is not just about caring and offering support to patients, but rather it is the holistic approach taken to care for patients and ensure that the drugs they take will enhance their quality of life (Lok, Lok, & Canbaz, 2017).

Measuring quality of life is not as easy a task as some might want to make other believe. Measuring quality of life has multiple dimensions, and one has to be careful to ensure that they do not measure the wrong thing. Gauging a patient's present status and determine the patient's satisfaction with the care being received, and their perception of therapy effects are some of the methodologies that can be employed to determine quality of life (Xu et al., 2013). What does constitute the measurements for quality of life? Researchers have acknowledged that measuring a patients' perspective of their disease and the treatment they are receiving can be measured to determine quality of life. However, the main challenge is that quality of life is unique to individuals, and many modes of measurement do not account for this measurement (Mjorud, Rosvik, Rokstad, Kirkevold, & Engedal, 2014). Therefore, when nurses are measuring quality of life they might actually be measuring health status variables, and this would not give the whole picture. A patient who is continuously indicating they are suffering or in more pain after taking medications would definitely have a low quality of life. Therefore, it is vital to find the correct balance and establish the appropriate treatment regimen to enhance the patient's quality of life. Nurses have a huge challenge, and they need to be able to identify the coping levels of different patients. Quality of life should not be used to deny a patient treatment. There are drugs that have instant negative side effects, but they have been known to have long-term treatment effects. These drugs, when administered to a patient, would lower their quality of life, but in time the patient would recover and resume their normal life. It has been stated that no single questionnaire is able to capture all the uniqueness of the individual patients in their reporting on quality of care. The patient is the only one who can accurately give judgment on the quality of care they have received (Mishra et al., 2014).

It is clear that determining quality of life is difficult mainly because of the different aspects that a nurse has to analyze in order to establish a patient's quality of life (Mishra et al., 2014). The care offered by nurses might be effective, but the patient might still feel they have a low quality of life that is brought about by the disease or their condition. Therefore, when attempting to establish quality of life, it is vital to understand the mental frame of the patient before the condition and their current mental state. It is the nurse's duty to ensure that a patient who is heavily burdened by the condition they are suffering would find it hard to cope with any medical treatment proposed. In such a scenario, it would be advisable to propose psychiatric analysis, and this might have the positive effect on the patient's overall outcome.

Critical Attributes

The critical attributes associated with quality of life are multidimensional, subjective satisfaction, and dynamic. Quality of life is a subjective evaluation of a patient's life satisfaction. The subjective nature of quality of life is seen in its definition when descriptive words like context, perception, interpretation, and individualized are employed. Quality of life is distinctive to each patient, and it is based on their evaluation and assessment of their current situation. Patient satisfaction is multidimensional in that it includes a variety of psychological, physical, social, and spiritual domain of life (Shippee et al., 2017). Physical domains will include attributes like daily living, exercise, cognitive function, sleep, rest, and comfort. Psychological domain will include attributes from definitions like emotion, happiness, fulfillment, security, enjoyment, independence, and satisfaction. Social domain includes attributes like relationships with others, income, productivity, recreation, role performance, social engagement, environment, and personal resources. The spiritual domain will include attributes like inner peace, meaning, religion, and sanctity. Quality of life is dynamic in that is changing all the time depending on the patient's life circumstances, development state, and disease state.

Antecedent and Consequence

Antecedents are defined as the events that must take place before the concept occurs. For quality of life, the major antecedent is having life itself, because life must be present before the occurrence of quality of life. It is not possible to discuss quality of life for something or someone who does not have life. There are several sources that have indicated that another antecedent of quality of life is cognitive ability or the state of consciousness. This means the ability of an individual to assess, evaluate, and appraise life, and the ability to make decisions (Shippee et al., 2017). When measuring of quality of life by others, they also need to have cognitive abilities for appraising, assessing, and evaluating life. Therefore, the two antecedents of quality of life can be said to be life itself, and the cognitive ability for assessing quality of life.

Consequences are defined as the events that occur as a result of the concept occurring. It is not easy to discuss the consequences of quality of life, but the consequences of quality of life can be said they have to do with the degree of change in status of quality of life both positive and negative. It could be an increase or decrease in life satisfaction, happiness, self-esteem, feeling of well-being, and pride. Lok et al. (2017) posits that quality of life could result in improved psychological and physical health. It can result in the opportunities for participating in self-care, provision for individual choices, and achievement of important life functions. Disease management, changes in practice choices, and changes in treatment could be other consequences of quality of life. There is a possibility to increase empowerment, especially in the face of aging or illness. Quality of life could also result in improved coping, or acceptance of life's circumstances (Xu et al., 2013). Cost containment is another consequence of quality of life.

Empirical Referents

The classes or categories of the phenomena that by their presence demonstrate the occurrence of the concept are referred to as empirical referents. It has been noted that the critical attributes of quality of life have a subjective component. Therefore, the empirical referents for quality of life will be the individual subjective analysis of life satisfaction. The best way for determining quality of life would be if the patients could rate their own quality of life, satisfaction, feelings, or well-being (Nikmat et al., 2015). There are several tools that have been created to assist in determining the patient's quality of life or the occurrence of quality of life. The tools are a way for measuring the patient's perception of their quality of life. Observations can also be made to gauge the patient's quality of life that will include observing their behavior, and information on their social, physical, and care environments. There are situations where the patient might find meaning in their suffering, and this might increase their quality of life. This is referred to as acceptance, and it does play a vital role in quality of care. Quality of life is individualized, and the absence of one aspect should not mean there is decreased quality of care (Mishra et al., 2014). Therefore, it is beneficial to note that the best measure for quality of life is the individual themselves based on their subjective assessment.

Model Cases

James is a 37-year-old father of two children who has a loving wife and supportive friends. He has just finished paying off his house and has set aside some money for his children's college and his retirement. James recently got promoted in his job, and this came with a raise, so he is financially secure. when reflecting on his life, James feels he is satisfied and happy. He is satisfied with his family, friends, health, and financial stability. He feels he is loved and supported and he thinks life is generally very good. However, a week ago James was involved in an accident that threatened his life, but he is very lucky to be alive. The accident resulted in James fracturing his leg, and this will mean he has to use crutches for at least six months before his leg fully heals. The quality of life for James has changed, and this is affecting how he currently feels about his life. He is no longer the happy, social guy he used to be and he is keeping more and more to himself. He feels sad, and he is not happy with his current situation. Everyone else feels he is very lucky to have come out of the accident with only his leg being injured, but he does not see it that way.