Quality of Life in Nursing: A Concept Analysis

Introduction

Nursing theory is built through a dynamic process that develops from practice and is reproduced through research, by the development and analysis of concepts and theories. There is a need to further investigate phenomena observed in nurses' experience during practice in order to identify key attributes. The most effective way of enabling nurses to examine certain phenomena deeply is by defining a concept of interest. This approach enables the development of theories that are directly related to clinical practice. There has been a tremendous push for the analysis and development of nursing concepts, largely because researchers have attempted to clarify problems previously regarded as common sense. That push has been driven by the recognition that seemingly obvious concepts often carry vague terminologies, inconsistent theories, and ambiguous definitions.

Quality of life is a term frequently used in nursing practice and in health care. A review of the literature reveals that the terminology is not well defined and that numerous perceptions exist regarding its meaning — perceptions that often vary on a case-by-case basis. Nurses work on improving the quality of life for patients through disease prevention, disease management, and health promotion. Numerous issues arise for nurses regarding quality of life, especially when dealing with health care advances aimed at increasing a patient's lifespan (Xu, Kane, & Shamliyan, 2013). It is the goal of nurses to improve the quality of their patients' lives, but the term remains vague, and there is insufficient clarity about how a nurse should accomplish this task. Treatment goals and decisions should be based on their effect on the patient's life, and differences in 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 aimed at improving their patients' quality of life if they do not know what the term means. This concept analysis aims to bring clarity to the meaning by examining various ways quality of life is used in health care. Such clarification would enable those involved in health care to communicate effectively with each other, with patients, and with loved ones regarding quality of life. Treatment decisions and care goals related to quality of life improvement would also be better understood. A review of literature discussing quality of life is the most appropriate method for accomplishing this task. From the definitions obtained through the literature, critical attributes of the terminology will be identified and example cases developed using those attributes. Antecedents and consequences will then be determined, followed by the operational definition of the terminology, and 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. An additional definition frames quality of life as the general well-being of a society or person, defined in terms of health rather than wealth. Mosby's Medical, Nursing, & Allied Health Dictionary defines quality of life as a measure of the optimum force or energy that empowers an individual with the capacity to successfully cope with all the challenges they might encounter in the real world.

From a philosophical and ethical perspective, quality of life implies the interaction between the individual and their surroundings, including other people. From a religious perspective, quality of life encompasses spiritual well-being, religious concerns, 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 as the individual's perception of their position in life within the context of the culture and value systems in which 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, including 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 treatment. Some medical decisions can greatly interfere with a patient's quality of life without offering any benefit, whereas other treatments may genuinely enhance it. In nursing, it is essential 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 as a concept has been analyzed by numerous researchers across different aspects of patient care. Researchers have been particularly keen to establish how best to enhance quality of life for patients, especially in the ICU. From the available literature, it is clear that the primary aim of analyzing quality of care is to establish the best methodologies for enhancing the patient's life. Quality of life mainly concerns 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 various life aspects such as physical, interpersonal, and occupational domains — all areas with which nurses are familiar. 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 life measures are not only used to assess individual patients but can also be applied during clinical trials (Nikmat et al., 2015). Nurses attending conferences would naturally be curious about the positive and negative side effects that drugs may have on a patient. This information is beneficial for nursing practice because it supports the justification for offering or prescribing certain drugs to patients. Therefore, quality of life is not simply about caring and offering emotional support to patients; it is the holistic approach taken to care for patients and ensure that the treatments they receive will enhance their quality of life (Lok, Lok, & Canbaz, 2017).

Measuring quality of life is not as straightforward a task as it may appear. It has multiple dimensions, and one must be careful not to measure the wrong thing. Gauging a patient's present status, determining the patient's satisfaction with the care being received, and assessing their perception of therapy effects are some methodologies that can be used to determine quality of life (Xu et al., 2013). Researchers have acknowledged that measuring a patient's perspective of their disease and treatment can contribute to a quality-of-life assessment. However, the main challenge is that quality of life is unique to each individual, and many measurement tools do not account for this individuality (Mjorud, Rosvik, Rokstad, Kirkevold, & Engedal, 2014). As a result, nurses measuring quality of life may inadvertently be measuring health-status variables rather than capturing the full picture.

A patient who continually reports suffering or increased pain after taking medications will almost certainly have a diminished quality of life. It is therefore vital to find the correct balance and establish an appropriate treatment regimen to enhance the patient's quality of life. Nurses face a significant challenge in identifying the coping levels of different patients. Quality of life should not be used as a justification for denying treatment. Some drugs produce immediate negative side effects yet are known to have long-term therapeutic benefits. When administered, such drugs may temporarily lower a patient's quality of life, but over time the patient may recover and resume normal activities. It has been noted that no single questionnaire is able to capture all the unique characteristics of individual patients in their reporting on quality of care. Ultimately, the patient is the only one who can accurately judge the quality of care they have received (Mishra et al., 2014).

Determining quality of life is difficult, in large part because of the many dimensions a nurse must analyze. The care offered by nurses may be effective, yet the patient may still feel that their quality of life is low due to the disease or their condition. Therefore, when attempting to establish quality of life, it is vital to understand both the patient's mental state before the condition and their current mental state. When a patient is heavily burdened by their condition, they may find it difficult to cope with any proposed medical treatment. In such a scenario, psychiatric assessment may be advisable, and it may have a positive effect on the patient's overall outcome.

Conclusion

The term quality of life is used frequently in health care, yet it is not clearly defined. This concept analysis has brought some clarity to the terminology, particularly for usage in clinical practice. A review of the literature confirms that the term cannot be reduced to a single objective definition. However, by analyzing the literature, identifying critical attributes, and creating illustrative cases, greater clarity has been achieved. For nurses, the subjective nature of quality of life is vital in daily practice and patient care. Without subjective analysis, it would be difficult to determine quality of life for a patient (Shippee et al., 2017). Quality of life may encompass many dimensions, and a nurse must be able to distinguish among them. Individualizing quality of care is essential, as it allows for proper analysis and evaluation and ultimately supports more informed, patient-centered treatment decisions.

References

Lok, N., Lok, S., & Canbaz, M. (2017). The effect of physical activity on depressive symptoms and quality of life among elderly nursing home residents: Randomized controlled trial. Archives of Gerontology and Geriatrics, 70, 92–98.

Mishra, S. I., Scherer, R. W., Snyder, C., Geigle, P., & Gotay, C. (2014). Are exercise programs effective for improving health-related quality of life among cancer survivors? A systematic review and meta-analysis. Paper presented at the Oncology Nursing Forum.

Mjorud, M., Rosvik, J., Rokstad, A. M. M., Kirkevold, M., & Engedal, K. (2014). Variables associated with change in quality of life among persons with dementia in nursing homes: A 10-month follow-up study. PLoS ONE, 9(12), e115248.

Nikmat, A. W., Hawthorne, G., & Al-Mashoor, S. H. (2015). The comparison of quality of life among people with mild dementia in nursing home and home care: A preliminary report. Dementia, 14(1), 114–125.

Shippee, T. P., Henning-Smith, C., Gaugler, J. E., Held, R., & Kane, R. L. (2017). Family satisfaction with nursing home care: The role of facility characteristics and resident quality-of-life scores. Research on Aging, 39(3), 418–442.

Xu, D., Kane, R. L., & Shamliyan, T. A. (2013). Effect of nursing home characteristics on residents' quality of life: A systematic review. Archives of Gerontology and Geriatrics, 57(2), 127–142.