A concept analysis of quality of life
Introduction
Much has been written about quality of life (QOL) over the past few decades. Initially, the concept was applied in the field of sociology, but today it is commonly applied to other disciplines, popular movies and even music. The healthcare literature commonly refers to the concept as “health-related QOL” (Derrett et al., 1999, Gill and Feinstein, 1994). The use of the concept is fundamental in healthcare, in that it recognizes the effects of illness (Schweitzer et al., 1995), evaluates treatments (Rotstein et al., 2000), and facilitates resource decisions (Ager, 2002). Smith et al. (2002) argue that nursing care can be improved when the nurse has a sound knowledge of issues associated with QOL. Although it is a frequently-used concept, it is sometimes not clearly defined and hence poorly understood (Gill and Feinstein, 1994, King et al., 1997, Meeberg, 1993).
This paper has four main purposes. First, a concept analysis guided by Walker and Avant’s (1995) framework is presented. Second, a literature review examines the current use of the concept and its critical attributes. Third, to further explain the concept, cases are described and the concept’s antecedents and consequences identified. Lastly, empirical referents that indicate the presence of the concept are explored.
The literature review was based on electronic searches, hand searches and search engines associated with relevant journals. The MEDLINE, CINAHL, Cochrane Collaboration, ERIC, and PsycINFO databases were searched with the phrase ‘QOL’. Search limits included articles from the past year, English articles with abstracts, and studies pertaining to humans. An additional search utilized the key words ‘QOL and acute pain’. No time limitation was placed on the second search. Article reference lists were reviewed to identify classic articles that weren’t revealed in the previous searches due to the imposed limitations. Articles were eliminated that were repeated, did not address the concept, or were not obtainable in a timely manner. Overall, a total of 65 articles were reviewed.
Section snippets
Dictionary and thesaurus definitions
The Canadian Oxford Dictionary (1998, p. 827) defines life as a condition in which there is “a capacity for growth, functional activity, and continual change”, “human condition; existence”. Quality is defined as “the standard of something when compared to other things like it” (Canadian Oxford Dictionary, 1998, p. 1180). This definition indicates that either positive or negative features are revealed but usually it refers to superior standards. Thesaurus definitions also provide additional
Use of concept
QOL is not a new concept. It was identified in Greek philosophy (McCorkle and Cooley, 1998) and Aristotle reflected on QOL when he examined happiness (Ferrans, 1990, Ferrans, 1996). Lindholt et al. (2002) discuss existential QOL and recognize the roles that influential leaders such as Kerkegaard, Sartre, Maslow, Frankl, and Antonovsky played when they referred to the inner state of one’s life.
These perceptions of QOL continued throughout history. Following World War II, economic growth and
Characteristics of QOL
QOL is viewed as multidimensional (Cimete et al., 2003, Efficace and Marrone, 2002, Ferrans and Powers, 1992, Foreman and Kleinpell, 1990, Hacker, 2003, Jalowiec, 1990, Kaasa and Loge, 2003, Wilson et al., 2001, WHOQOL Group, 1995). Jalowiec agrees and identifies the multidimensional aspect of QOL and the interrelatedness of the dimensions.
Culture and spirituality influence people’s perceptions of their QOL. According to Marshall (1990), Collinge et al. (2002) and the WHO (2004) people’s roles
Domains of QOL
A large proportion of QOL literature is from an oncology perspective (see Hacker, 2003). In her research with cancer patients, Hacker identifies the three domains of QOL as: physical, psychological, and social. Schweitzer et al. (1995) in their work with chronic fatigue syndrome patients agree while Ferrell et al. (1995) and Ferrell et al. (1998) add spiritual well-being. In contrast, other researchers add cognitive functioning (Wilson et al., 2001) or the mental capacity to evaluate one’s own
QOL and pain
Pain negatively affects QOL (Bartman et al., 1998, Ferrell et al., 1991, Hopman-Rock et al., 1997, Jakobsson et al., 2003, Wilkie et al., 2000). Melzack et al. (1987) agree that pain has a profound effect on the patient. For example, Bartman et al. (1998) refer to the chronic pain of claudication while Ferrell et al. (1991) discuss the effect of cancer pain on QOL.
The majority of the literature focuses on QOL and cancer or chronic pain and significantly less has been written regarding acute
Critical attributes
Critical attributes are repeated in the literature and further define the concept. Three critical attributes of OQL are that: (1) individuals make a subjective appraisal of their own lives, (2) individuals identify their satisfaction with their lives as it pertains to the physical, psychological, and social domains of their life, and (3) objective measures may supplement people’s subjective evaluations of the QOL.
Individuals’ health and functioning are reflected in the physical domain. The
Cases
Walker and Avant (1995) recommend the use of cases such as model, borderline, related, invented and contrary to further illustrate the concept. These cases may or may not contain the critical attributes that have been described above. It is through the use of these cases that we can further understand the concept of QOL.
Antecedents and consequences
The most obvious antecedent (precursor) of QOL is that life must be present (Meeberg, 1993). Emphasis is on the subjective dimension of QOL. There is dispute over the appraisal of QOL in disabled persons; however, that debate is not the focus of this paper.
The consequences of QOL occur after the concept is present. If individuals evaluate their QOL as high, they are probably happy and satisfied. Additional outcomes can be physical and psychological health. Keith and Schalock (1994) also
Empirical referents
Empirical referents indicate that the concept is present (Walker and Avant, 1995). A number of instruments have been developed to measure QOL and this could reflect the ambiguity of the concept (Kaasa and Loge, 2003). Grant et al. (1990) assert that the way QOL is defined determines specific items that must be included in the assessment tool.
There are websites such as the Mapi Research Institute that are devoted solely to QOL instruments. This is an excellent starting point for the orthopaedic
Conclusion
Conducting a concept analysis is a valuable exercise. It enhances the understanding of a concept by examining its current usage and its critical attributes. Cases, antecedents, and consequences provide further insight into the concept. And lastly, the empirical referents attempt to identify when the concept is present.
The concept of QOL is particularly significant for orthopaedic nurses. Cohen et al. (1996) emphasize that “QOL always matters to the patient” (p. 576). If we can be responsive to
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