Historical …show more content…
Background Quality of life is an ancient concept, with roots in many philosophical and religious traditions.
It has been described in these arenas as living a good life and having joy or happiness in one’s life (Sandau, Bredow, & Peterson, 2013, p. 210). Quality of life began being discussed academically in the fields of sociology and psychology in the 1970s, and has since spread to areas such as business, economics, politics and healthcare (Sandau et al., 2013, p.211). The idea of quality of life in nursing care has been shaped by the philosophies of Florence Nightingale, and the World Health Organization considers psychosocial care and quality of life to be a right of individuals receiving physical health care (Sandau et al., 2013, p.211). Health-related quality of life has become an increasingly prevalent area of focus in healthcare, especially in the management of chronic and terminal …show more content…
conditions.
Major Concepts Sandau et al. (2013, p. 211) cite a lack of clarity in conceptual and operational definitions of health-related quality of life in most research articles, and comment that outcomes based on quality of life often fail to first define the terms they are using. Further, some researchers use very specific, objective measurements or limit their outcome measurements to a very narrow area, while quality of life is typically described as a broad concept that effects all areas of life (Sandau et al., 2013, p.211). Some researchers have used terms such as subjective or perceived health status to replace health-related quality of life, as these terms are associated with specific questionnaires that evaluate physical functioning and how satisfied patients are with that level of functioning (Sandau et al., 2013, p.212). One study that sought to more clearly define quality of life surveyed physicians and other healthcare professionals to discover how they defined quality of life (McKevitt, Redfern, La-Placa, & Wolfe, 2003). Common terms used in definitions included happiness, social well-being, and physical ability (McKevitt et al., 2003). Another study investigated patients’ definitions of quality of life in an intensive care setting (Brooks, 2000). Patients described quality of life as physical, social, psychological, and involving family and friends (Brooks, 2000). Health-related quality of life, and quality of life in general, is described by Sandau et al.
(2013, p. 212) as multidimensional, temporal and subjective. The multidimensional aspect of quality of life describes how it encompasses multiple aspects of a person’s life, including physical, psychological, social, spiritual, and mental (Sandau et al., 2013, p.212). Quality of life is also temporal, meaning that it changes over time as different aspects of life change or the patient’s perception of these aspects change (Sandau et al., 2013, p.212). This concept is also very subjective, and determined only by the individual. This can cause problems when quality of life is being determined by someone other than the patient themselves, as can be the case when the patient is in a compromised mental state, such as a coma or is otherwise unable to
communicate.
Application to Practice Health-related quality of life is applicable to all areas of nursing practice, as it helps increase patient satisfaction and is a lens through which nursing interventions can be measured for efficiency. It can be difficult to measure quality of life and changes, but a number of questionnaires have been developed to measure either generic quality of life or quality of life in relation to a more specific illness or set of symptoms (Sandau et al., 2013, p.217). Measuring changes in quality of life is an excellent way to determine outcomes in nursing research, especially when dealing with complex or difficult issues like chronic diseases or end of life care. Palliative care has been one area of healthcare that frequently uses quality of life measurements to evaluate the effectiveness of care and specific interventions on patients in the end stages of disease. However, published studies in this area typically do not have rigorous study designs and were mostly observational with limited subject sizes (Catania et al., 2014). Catania et al. (2014) reviewed ten studies that used quality of life interventions and found only moderate practical significance in a few areas, including symptom severity, psychosocial well-being and overall quality of life. However, since there were multiple issues with each study, the authors concluded that based on the current literature, interventions focused on quality of life should be used with caution and further research is needed to provide more support for using these interventions (Catania et al., 2014).
One study that did use an experimental design investigated the effects of palliative care on quality of life in patients with acute heart failure, and found that both quality of life and symptom burden were significantly improved in the group that received palliative care when compared to the control group (Sidebottom, Jorgenson, Richards, Kirven, & Sillah, 2015). Quality of life was improved in these patients, even though there was not a significant difference in rates of death, hospice admission, or hospital readmission (Sidebottom et al., 2015).
Brovold, Skelton, and Bergland (2013) also used an experimental design to evaluate two different exercise programs in elderly individuals after hospital discharge, most of whom had chronic health problems. A high intensity aerobic interval exercise program, including endurance, strength and balance exercises was found to be significantly associated with health-related quality of life and physical fitness when compared to a home-based exercise program (Brovold et al., 2013).
Benefits and Limitations Many benefits can be gained by using health-related quality of life theory when evaluating effectiveness of interventions. Health-related quality of life is a broad measurement, able to evaluate both overall well-being as well as more specific areas of well-being, including physical symptoms and psychosocial aspects. Quality of life allows healthcare professionals to individualize care for each patient to ensure that they are meeting their personal goals for their lives in the face of difficult situations like chronic diseases and end of life care. There are also limitations to using this theory in practice. There is very little rigorous, well designed research available, and researchers differ in how they define health-related quality of life. Also, since quality of life is a subjective measurement, it can be difficult to evaluate in those unable to communicate for themselves. It is also difficult to measure quality of life objectively, although a number of tools and measurement scales are available.
Conclusion
Health-related quality of life is a theory that is broadly applicable throughout the field of nursing, and especially useful in determining outcomes for patients with chronic diseases and those dealing with end of life issues. However, it can be difficult to define and measure, and the literature currently does not have many well-designed, rigorous studies to support the use of quality of life as a measurement of intervention effectiveness.