Concept Analysis: Healthcare Related Quality of Life

Tarren Evans, RN BSN

APSU/RODP

NURS 5000

March 21, 2015

Quality of Life Concept Introduction
The phrase “health care related quality of life” (HRQOL) or “quality of life” (QOL) is often used in healthcare. The perceptions of the meaning can vary depending on who is explaining it. The reason for this selected topic is to research other disciplines and see if indeed significant variations in the meaning exist. The purpose of this concept analysis is to define, research, and analyze if the dissimilarities improve or hinder a patient’s plan of care. This paper will examine the significance of a concept to advance understanding (McEwen, 2014).
Literature Review
Can quality of life be defined to have a uniformed definition? The first known research on quality of life was published in 1957 that surveyed mental health adults in the USA. The Oxford English Dictionary (2010) defines QOL as “the standard of health, comfort, and happiness experienced by an individual or group”. There are several influences that can alter the definition of QOL. The acronym “HRQOL” is a narrowed term when characteristics relating to an individual’s health status are likely to be affected (Sandau, 2014). The literature review discussed some domains that render the effects on the perception of this concept. A collaborative study done by doctors and nurse practitioners discussed that physical, social, emotional, cognitive, and spiritual well-being of an individual are the main components for measuring QOL for patients with left ventricular assisted devices (LVAD) (Sandau, 2014). In the review of social sciences, Lawton’s (1997) article defined QOL as a multidimensional judgment, by both interpersonal and social-normative criteria, of the independent-domain structure of the person. In clinical medicine, the term quality of life is hard to define. QOL can be defined as a state of gratification, quality of life reveals a valued discernment: the experience of life and living, as a whole or in some aspect, is evaluated to be better, good, bad, or worse (Jonsen, 2010). There are several questions that need to be addressed prior to determining the QOL. These questions resonate like what are the expectations, with or without treatment, for a return to a normal life, and what are the physical, cognitive, and social deficits might the patient experience even if treatment succeeds (Jonsen, 2010)? Will any medical intervention improve QOL back to normalcy? Will the intervention of a feeding tube placement improve a QOL? These questions linger in the hospital setting amongst medical staff and depending on who is involved (i.e., family members, power of attorney, parents, medical personnel) may determine a positive or negative outcome for the patient. In reviewing psychology literature, screening tools are used to predict how the patient outcome could be based on validity and reliability of an individual (Cruz, 2009). The World Health Organization Quality of Life Instrument (WHOQOL) was used to determine depressive symptoms of a patient with coronary artery disease and the severity of how he/she views QOL (Cruz, 2009). From a nursing prospective, quality of life can vary based on the diagnosis. A patient that needs back surgery to improve acute/chronic pain versus a patient that needs a feeding tube due to failure to thrive are two different scenarios that ask the same question. The term QOL is used when substantial elements will significantly affect his/her day-to-day life. Religious viewpoints suggest ethical concerns and QOL coincide with each other and in palliative care that one cannot be discussed without the other (White, 2013).
Antecedents
An antecedent is “a cause that must precede an effort” (McEwen, 2014). The primary antecedent for QOL is “life” itself. In order to evaluate quality of life, an individual must have life experiences and value something in life to determine the measurement. A significant change in health/life that can alter QOL must occur. The decision made regarding quality of life must be significant enough to question this concept. Taylor (2008) proposed that an antecedent to quality of life is the ability to assess, appraise, evaluate life, and the ability to make a determination. Some may argue that a sound cognitive ability must be present in order to determine QOL (Taylor, 2008).
Attributes
There are several scenarios for the term “quality of life” when being addressed in a hospital setting. In reviewing the research, cardiac patients are often reevaluated or questioned whether the benefit of managing care aggressively is beneficial. An effective management plan, spirituality for coping, and subjective satisfaction are critical attributes to HRQOL.
Effective management of care is essential in a patient’s improvement during treatment. The Album (2007) article explained that establishing a collaborative relationship with multidisciplinary teams involved might ensure optimal outcomes. The other aspect of that is allowing the patient to participate in the treatment plan and being ultimately responsible for maximizing his/her own care. Spirituality accredits to embracing a positive perspective on life and may subsequently improve the overall well-being of the patient. Katerndahl (2008) determined that spirituality could provide a sense of tranquility and a reason for sustaining an individual’s life purpose. Lastly, subjective satisfaction is the optimistic way of evaluating an individual’s self-worth. It is a measurement of life satisfaction and happiness despite the circumstances.
Consequences
Consequences are the incidents that result following the phenomenon of a concept (Walker & Avant, 2010). The consequences for QOL can be positive or negative. In healthcare, nothing is guaranteed and the decision decided upon may not be the outcome an individual hoped for. QOL can be measured as a bridge to maintain functionality of a patients’ wellbeing (Alum, 2007). A positive outcome of a patient that had cardiac bypass surgery, he/she will lessen the chance of having severe chest pain or possibly a Myocardial Infarction due to stenosed arteries. A negative consequence for QOL could be a heart failure patient that has other co-morbidities that will prevent he/she from receiving a heart transplant. The doctor considers the surgery high risk and sustains that he/she QOL can only be a home Primacor infusion to maintain the cardiac function of the heart for the remainder of life. The result in acceptance of life’s circumstances (Taylor, 2008) and improved coping (O’Connell, 2007) are consequential examples. Psychology research states depression can also be a consequence of QOL (Alum, 2007). The thought of having date stamped on an individual’s lifespan could cause emotional turmoil.
Model Case A model case is a depiction that all of the defining attributes of the concept that yield the best example of the use of concept in a realistic situation (Walker & Avant 2010). Vivian M. is a 52-year-old wife and mother of three wonderful kids. She has loving a husband who adores her and a host of supportive friends. Vivian has a great job as a graphic designer and recently got promoted. She saves all her money for retirement in which she will be able to retire earlier than most people in her profession. Her husband is financially secure and covers all the bills. Vivian is able to put away more money for her children’s college fund and that brings her joy every time she thinks about it. Vivian is heavily involved in her church and enjoys helping others. She is healthy and loving all aspects of life. She has borderline hypertension but manages it well with diet and exercise. Vivian grasps a sense of satisfaction and contentment in life. She has support from family and friends, she is financially stable, and in good health. This case exhibits all critical attributes of quality of life. Vivian makes a subjective analysis of her life and is satisfied with it on many levels including being religiously satisfied, emotionally content, socially fulfilled, having financial security, and is healthy. These dimensions are crucial to Vivian’s life gratification. Depending on what is important to each individual, the subjective analysis can be multidimensional or one-dimensional. Vivian is currently satisfied with her life but these circumstances and her satisfaction could change in the near future.
Related Case Related cases are “are instances that represent a different but similar concept (Chinn, 2011, p.170). Darren H. and Micah T. are neighbors and attended the same high school. The two hung out in different circles and never really conversed other than an occasional “hello” in passing. Darren got into a horrible car accident after high school graduation. He was in the hospital for several months but fully recovered and was back to his baseline before the accident. It turns out that he was not at fault in the car crash and is due to be rewarded a large amount of money for his pain and suffering. Micah thinks of what he could do with all the money if he received it and how lucky Darren must feel. He states, “He is set for life and has nothing to worry about”. This scenario seems like Darren will have a prosperous life and will not have to worry about money. There are no critical attributes in this scenario. The subjective analysis of Darren is not explained. Micah cannot identify what makes Darren satisfied with life. Although Darren may now have financial security that may not be of significant importance of how he views quality of life. Micah also does not know how Darren values his faith.
Contrary Case
Contrary cases are “those cases that are certainly not instances of the concept (Chinn, 2011, p.170). CJ is a 34-year-old male that has cocaine induced heart failure. He is in and out the hospital due to his non-compliance for managing his heart failure. He continues his unhealthy diet, drinking, smoking, and still occasionally does recreational drugs. While in the hospital, he coded in the ICU while talking to the medical team. The code team resuscitated him and got him back but he never regained consciousness. He was literally talking to his doctors regarding his code status. He wanted to sign a DNR and his girlfriend was against it. His family also wanted everything done for him. He never stated why he wanted to sign a DNR. After the code, they determined that CJ was brain dead and nothing more could be done for him. The family insisted on a feeding tube and refused to sign a DNR. The patient was transferred out to the ICU to a medical-surgical unit for palliative care. The family went to the ethical board and won the right to continue on with the patients care. A feeding tube was placed and the family wanted every measure done to keep CJ alive. This case is has no critical attributes of quality of life. CJ did not subjectively assess his life satisfaction. The care was based on what the family wanted instead of the patient’s need based on quality of life.
Empirical Referents Empirical referents are “classes or categories of actual phenomena that by their existence or presence demonstrate the occurrence of the concept itself” (Walker & Avant, 2010). The critical attributes of QOL have instinctive components. An empirical referent for QOL would be a subjective analysis of life’s fulfillment (Taylor, 2008). The self-analysis of a patient is the best way to improve his/her QOL. The World Health Organization evolved an instrument to evaluate quality of life called “WHOQOL”. It consisted of several questions that included functional, physical, psychological, social, and satisfying factors that determine QOL (Kane 2003).
Observations can also be made to decide QOL when the subjective analysis of the patient cannot be obtained. QOL could be measured by care environments and surroundings (Kane, 2003). The ability to reach goals, convey feelings of dissatisfaction, start and respond to change, and advance and maintain satisfactory relationships (Taylor, 2008) could also be observed. The absence of QOL can also be through an observation of inadequate living conditions to sustain life or evidence of abuse can occur (Taylor, 2008). QOL is such an individual based assessment that some factors may not be included in his/her evaluation. Self-analysis is key in any scenario.
Implications for Nursing Quality of life is situational based and can have many different elements included in deciding what is best for an individual. In nursing, a neutral standpoint is always important to have while life-changing decisions are being made. The role of a nurse can change from support system to advocate to managing all disciplines involved. Quality of life is a self-assessment of critical components that include spiritual, social, physical, and psychological facets that resonate vital in an individual’s value system.
In cardiology nursing, this concept is constantly discussed. Effective medical management is key. It is the assurance that the patient has a solid support system for coping and encouraging utilization of the support system if he/she needs it. Provoking thought in an individual about self-assessment of quality of life and evaluate his/her satisfaction.
Conclusion
The term “Quality of Life” in healthcare can mean have different defining elements depending on who is referencing it. In reviewing the literature, it is hard to narrow down a concise definition. The ultimate goal is to maximize effective medical management of care for a patient addressing quality of life. Critical attributes are essential in determining QOL. An individual should have a value system that can differ depending on what is valued in his/her life. The changing definition does not hinder a patient’s plan of care because it is individualized in most cases. The final analysis is that Quality of Life is a self-assessment of meaningful values that can differ depending on one’s belief system.

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