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Quality of Life: Concept Analysis

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DOI: 10.36348/sjnhc.2023.v06i01.003

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 Saudi Journal of Nursing and Health Care
Abbreviated Key Title: Saudi J Nurs Health Care
ISSN 2616-7921 (Print) |ISSN 2616-6186 (Online)
Scholars Middle East Publishers, Dubai, United Arab Emirates
Journal homepage: https://saudijournals.com

Original Research Article

Quality of Life: Concept Analysis

Ibrahim Aqtam1*, Ahmad Ayed2, Kefah Zaben3
1
Ibn Sina College for Health Professions, Department of Nursing, Nablus University for Vocational and Technical Education, Nablus,
Palestine
2
Clinical Training Coordinator, School of Nursing, Arab American University, Jenin, Palestine
3
Clinical Training Coordinator, School of Nursing, Al-Quds University, Jerusalem, Palestine

DOI: 10.36348/sjnhc.2023.v06i01.003 | Received: 01.12.2022 | Accepted: 12.01.2023 | Published: 17.01.2023

*Corresponding author: Ibrahim Aqtam

Ibn Sina College for Health Professions, Department of Nursing, Nablus University for Vocational and Technical Education, Nablus,
Palestine

Abstract
Background: Quality of life (QOL) is a concept commonly used within healthcare but lacks consensus. A concept that
has been commonly associated with adherence, morbidity, and health outcomes. Objectives: The aim of this paper is to
clarify the concept of QOL and identify the conceptualizations behind it and to provide some insights to QOL research.
Design: Concept analysis according to Walker and Avant, consist of eight steps: select concept, determine purpose,
identify uses, determine defining attributes, identify model case, identify additional cases, identify antecedents and
consequences, and define empirical referents. Results: The fact that quality of life is subjective, and the most crucial
lesson advanced practice nurses should learn from this investigation. However, in the absence of subjective evaluations
of quality of life, objective evaluations can be done by people who were close to the patient and may understand what
they would have appreciated. Though many of the characteristics of quality of life are measured, it is crucial to keep in
mind that each person's priorities ultimately define what is important to them. When deciding on care goals and treatment
plans, these must be made in collaboration with the patient so that the patient can determine what he/she values and what
would improve his/her quality of life. Conclusion: The practitioner needs to put aside his/her personal opinions on what
would improve the quality of life and instead listen to the patient’s wishes and goals. Quality of life is ultimately what an
individual says it is, and when that is heard and respected, the highest and most individualized quality of care can be
provided.
Keywords: Quality of life, cancer, palliative care, support, nursing.
Copyright © 2023 The Author(s): This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International
License (CC BY-NC 4.0) which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original
author and source are credited.

understanding what that phrase really means, how can

INTRODUCTION advanced practice nurses make judgments that will
The term quality of life (QOL) is overused in improve the quality of patients' lives?
the fields of medicine and nursing. However, there
aren't many descriptions of this phrase. A patient's life The goal of this concept analysis is to raise
quality is improved by advanced practice nurses awareness of the idea and encourage its application in
through disease management, disease prevention, and nursing and medical practice. The concept analysis
health promotion. Advance practice nurses who work principles created by Walker & Avant (1995) are used.
with medical innovations that extend life spans are It is hoped that this analysis will spark discussion and
challenged with issues of quality of life [1]. The aim of lead to more nursing research on what quality of life
advance practice nurses is to enhance the quality of means in the context of healthcare. Quality of life is
patients' lives, however because of the term's high determined to be quite complex.
degree of ambiguity, it is unclear how this should be
done [2]. The impact on the patient's quality of life is
taken into consideration when choosing a course of METHODS
therapy and setting care goals. Different treatment WE searched PubMed, COCRHEAN, and
goals, decisions, and outcomes might be brought on by CIHNAL using the keywords “QOL concept analysis”,
differences in how people define quality of life. Without and “QOL in children, adult, elderly with chronic

Citation: Ibrahim Aqtam, Ahmad Ayed, Kefah Zaben (2023). Quality of Life: Concept Analysis. Saudi J Nurs Health 10
Care, 6(1): 10-15.
 Ibrahim Aqtam et al., Saudi J Nurs Health Care, Jan, 2023; 6(1): 10-15
conditions”. I included 19 articles; seven articles were and structural areas is how Hörnquist defines quality of
concept analysis papers written by nurses, and four life [12]. The subjective assessment of a good and
were written by a psychologist. Three articles were satisfactory quality of life is how some people define
qualitative research of QOL in patients and caregivers QOL [13]. Others assert that the fulfillment of a
with chronic diseases, and the remaining five articles person's ideals, objectives, and desires through the
were quantitative studies of QOL in children and adult realization of their abilities or lifestyle constitutes the
with ESRD conducted by nephrologists, 3 of them were quality of life [14]. In addition, Patrick and Erickson
conducted in Middle east countries. define quality of life as "The value assigned to duration
of life as modified by impairment, functional status,
BACKGROUND perception, and opportunity influenced by disease,
Definitions and uses of QOL injury, treatment, and policy" [15] in their assessment of
Numerous sources have defined quality of life health-related quality of life for clinical decision
in several ways. Quality of life is described as "a broad making. Additionally, Wood-Dauphinée et al. defined
multidimensional concept that incorporates subjective quality of life as "the reflecting of an individual's
judgments of good and negative elements of life" by the overall view and happiness with how things are in their
Center for Disease Control and Prevention (CDC) [3]. life" (para. 16) in a subjective manner. Understanding
The World Health Organization (WHO) defines quality this idea requires acknowledging the subjectivity of
of life as "a person's view of their place in life in QOL [16].
relation to their objectives, expectations, standards, and
concerns in the context of the culture and value systems QOL illustrates the discrepancy between a
in which they live. It is a wide notion that is intricately person's hopes and expectations and their actual
influenced by a person's functional status, social experience. As a result of human adaptation, life
relationships, personal views, and interactions with key expectations are typically modified to fit within the
elements of their environment. [4]. Quality of life is bounds of what the individual believes is achievable.
described as "the level of living, or degree of This makes it possible for those with challenging life
enjoyment, comfort, etc., enjoyed by an individual or situations to keep up a respectable QOL [17]. Grewal et
group in any period or area" by the Oxford English al., add that relationships with family and friends, one's
Dictionary. [5]. Quality of life is defined as "a measure own health, the health of those close to you,
of the optimal energy or force that endows a person independence, emotional and psychological health,
with the power to successfully cope with the whole religion and spirituality, finances and standard of living,
range of obstacles encountered in the real world" by social and leisure activities, one's home and
Mosby's Medical Nursing & Allied Health Dictionary surroundings, enjoyment, security, and control are other
[6]. aspects of one's quality of life [18].

Quality of life was described by Barcaccia as According to Courtenay et al., [19], personal
"the overall health of people and communities”, work satisfaction, income, neighborhood schools, the
highlighting both the bad and the good aspects of state of the area's arts and cultural amenities, air quality,
existence. It evaluates factors that affect life and racial tolerance are all factors that influence quality
satisfaction, such as physical health, family, finances, of life. Sugiyama et al., address how neighborhood
employment, wealth, and the environment "[7]. open spaces, their comfort and safety, social interaction,
According to Jennings, "the word quality of life tends to social activities, and regular physical activity are all
imply that life is not intrinsically worthy of respect but related to quality of life [20]. When addressing the
might have greater or lesser value according on its quality of life associated with health, Albert et al. make
circumstances" [8]. This is consistent with a distinction. He describes functional status, mental
philosophical and ethical viewpoints. health, emotional wellness, social engagement, and
symptom states as aspects of health-related quality of
Quality of life is described by WHOQOL life. Ambulance, mobility, body care and movement,
Group as "spiritual wellbeing, spirituality, religious communication, alertness behavior, emotional behavior,
issues, sentiments of hope, personal views, religiosity, social contact, sleep and rest, eating, job, home
and inner peace" from a religious perspective [9]. management, and recreation are all considered to be
According to Haas, it is "a comprehensive examination aspects of health-related quality of life [21].
of a person's current living situations in the context of Additionally, Bowling described the broad range of
their culture and values [10]." The primary component domains that make up health-related quality of life,
of quality of life is a subjective experience of wellbeing including emotional well-being, psychological well-
that includes aspects of the physical, psychological, being (measured with indicators of anxiety or
social, and spiritual selves. When people are unable to depression), physical well-being, and social well-being
subjectively measure their quality of life, objective (examples include indicators of social network,
indicators may serve as a substitute or supplement in obtained social support, community integration, etc.)
some cases [11]. The degree of need and satisfaction in [22].
the physical, psychological, social, activity, material,

© 2023 | Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 11
 Ibrahim Aqtam et al., Saudi J Nurs Health Care, Jan, 2023; 6(1): 10-15
Meeberg concludes by describing quality of subjective assessment of her life, Mariam finds that she
life as being subjective and individualized, with the is content in many areas, including her emotional well-
critical components of a sense of well-being, happiness, being, social fulfillment, financial stability, and physical
living conditions, life satisfaction, an acceptable state of health. It is significant to notice that Mariam places
physical, mental, social, and emotional health, or an importance on these factors for her life pleasure. The
objective assessment by another person that the living subjective evaluation might be multidimensional or one
conditions of that individual are adequate and not life dimensional based on what is essential to everyone. Not
threatening [23]. Additionally, quality of life has been all dimensions need to be included, However,
characterized as being subjective, multidimensional, depending on what is significant to everyone, the
and changeable [24, 25]. subjective evaluation may be multidimensional or one-
dimensional. Given that it changes, this is dynamic.
Critical attributes: Although Mariam is content with her life right now, her
The critical attributes are the "features of the circumstances and her level of pleasure may alter in the
concept that recur again" are the crucial characteristics future.
[26]. Subjective contentment, multidimensionality, and
dynamicness are essential characteristics of quality of Borderline Case
life. It is a purely arbitrary assessment of life Borderline cases contain some of the critical
satisfaction. When descriptors like perception, context, attributes of the concept being examined, but not all of
interpretation, and individualized are included in them [26]. Here is an illustration of a questionable case
definitions of the term, this subjective component of for the idea of quality of life. A year ago, Jabr, a 57-
quality of life is evident. Each person's is distinct and year-old man, lost his wife to cancer. He has five
depends on their assessment and evaluation of their grandchildren totaling three children. He lives on his
circumstances. If a subjective judgment is not own property and will retire the following year. He
accessible, it can nevertheless be evaluated objectively. participates in social events through his temple and is an
Being multidimensional, satisfaction encompasses a active member there. He himself has not experienced
range of life's physical, psychological, spiritual, and any health issues and continues to be highly active,
social realms. Activities of daily life, functional status, walking several kilometers every morning. Although
exercise, physical health, cognitive function, sexual Jabr is content with his life, the loss of his wife has left
function, sleep and rest, and comfort are all included in him depressed. This case represents most of the critical
the definitions of the physical domains. The definitions' attributes of quality of life. Jabr has evaluated his
terms for fulfillment, feeling, pleasure, enjoyment, situation subjectively, and despite being content and
security, control, independence, and satisfaction all fall appearing to have a wonderful life on the surface, he is
under the psychological umbrella. The spiritual realm not happy. It is multifaceted because he is evaluating
comprises characteristics from definitions like holiness, various aspects of his life and concluding that his
religion, or spirituality, meaning, inner tranquility, and marriage to his wife is what matters most to him. Due to
morale. Relationships with people, productivity at work, the breakup of his marriage, he is not entirely happy
money, role performance, leisure, social engagement, with his life. This is dynamic since his satisfaction has
personal resources, and surroundings are all altered recently because of losing his wife and may
characteristics that fall under the social domain. change in the future as he gets used to life without her.
Additionally dynamic, it changes through time and on a All facets of quality of life are present in this scenario
continuum based on factors such as life circumstances, except for satisfaction.
disease state, developmental stage, etc.
Related Case
Model case Related cases are cases that are “related to the
A "'real life' example of the concept's use that concept being studied, but that do not contain the
encompasses all the necessary features of the concept" critical attributes” [26]. While watching the news,
[26] is what is referred to as a "model case." The Jamila comes across a segment about an old guy who
example instance given below exemplifies the idea of recently won a sizable sum of money in the lottery. She
quality of life. Mariam, a 44-year-old mother of two, believes that because he is well-off financially, he
has a devoted husband and understanding friends. She would always be content in life. On the surface, this
recently completed the mortgage on her home and has individual is leading a high-quality life, however many
already started saving for her children's retirement and essential elements are absent in this case. Instead of a
college expenses. She recently received a promotion at subjective assessment of that person's level of
work that came with a pay increase, ensuring her happiness, it is the observation of someone who is
financial stability. Mariam experiences contentment and unaware of that person's priorities that he or she must be
fulfillment as she thinks back on her life. Her health, content. It is not multidimensional because it just
family, friends, and financial security all meet her considers the individual's financial security and ignores
standards. She believes that life is generally pretty good any other factors that can affect their quality of life.
and that she is loved and supported. This situation Since it presupposes that the gentleman would always
exemplifies every important aspect of life quality. In her

© 2023 | Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 12
 Ibrahim Aqtam et al., Saudi J Nurs Health Care, Jan, 2023; 6(1): 10-15
enjoy a high quality of life because of one experience, it Disease management and modifications to medical
is not dynamic. practice are potential consequences as well [28]. In the
face of disease or age [21], it can also lead to an
Contrary Case increase in empowerment [25] or resiliency [29]. It
Contrary cases are examples of “not the might also lead to improved coping [30], acceptance of
concept” [26]. Nadine, a woman in her 83s, has cancer life's circumstances [25], or reparation for
that is terminal. For almost three months, she has been biopsychosocial losses [29]. It may lead to the
in the hospital. She is unable to decide what she needs preservation of an individual's dignity and respect for
for care since she is disoriented. She is unable to eat for their uniqueness and choices [27]. Cost containment
herself and is incontinent. She frequently groans or cries may also be a result.
out for aid while declaring her desire to pass away.
Insisting that his mother would want everything done Operational Definition
for her, Nadine’s son, who has power of attorney, A person's subjective assessment of their level
refuses to let his mother take pain medication since it of satisfaction with their changing living circumstances,
makes her too sleepy. Nadine receives a feeding tube, which may include several dimensional aspects of their
and she undergoes multiple intubations and weaning physical, psychological, spiritual, and social well-being,
procedures. The son claims he wants the medical staff is known as their quality of life.
to take all necessary measures to preserve his mother's
life. The essential elements of quality of life are not Empirical Referents
present in this situation. Nadine is just concerned with Empirical referents are “classes or categories
the fact that she is alive and has not subjectively of actual phenomena that by their existence or presence
evaluated her living condition or her level of life demonstrate the occurrence of the concept itself” [26].
satisfaction. Care is not multidimensional since it is An individual's subjective interpretation of life
focused on keeping Nadine alive rather than satisfaction would serve as an empirical referent for
determining her needs or level of pleasure in relation to quality of life because the essential characteristics of
the numerous facets of her life. quality of life contain a subjective component [25].
When quality of life can be assessed, that is the best
Antecedents scenario. Patients' ratings of their quality of life, as well
Antecedents are the “events or incidents that as their sentiments of contentment, happiness, or well-
must occur prior to the occurrence of the concept" [26]. being, are the best indicators of whether quality of life
Since life itself must exist before quality of life can is present [21, 23]. The World Health Organization
occur, having life itself is a significant prerequisite to (WHO) created the "WHOQOL" tool to measure
quality of life [10]. The quality of life of something quality of life. A 28-item questionnaire that includes
without life cannot be discussed. Several sources questions about physical, functional, psychological,
contend that cognitive capacity [10] or state of social, and satisfaction aspects makes up the system
awareness [23] serve as additional antecedents. The [27]. When subjective remarks are not accessible,
capacity to assess, appraise, and evaluate life as well as various tools have been created to determine the
the capacity to make decisions are suggested as incidence of quality of life. Even though they do not, by
prerequisites to quality of life [16]. Even when other virtue of their presence, indicate the occurrence of the
people judge, appraise, and evaluate life, they must also concept, these are important instruments that, in the
possess the cognitive capacity to do so. The ability to absence of an individual's subjective judgment of their
evaluate one's quality of life cognitively and life itself own quality of life, provide a close approximation of
are the two main precursors to quality of life. the concept. These life-quality questions might be posed
to proxy informants such family members who are
Consequences deemed to be well acquainted with the subject [27].
The consequences are “those events or There are other observations that can be made to
incidents that occur as a result of the occurrence of the ascertain a person's quality of life, such as behavioral
concept” [26]. It is challenging to talk about the effects observations, information about their physical, social,
of a quality of life since they involve a level of quality and care environments, and their capacity to set and
of life or a shift in status of quality of life, which can be achieve goals, express unhappiness, start and respond to
either positive or bad. Happiness, a sense of wellbeing, change, and establish and maintain satisfying
self-esteem, and pride [20], as well as life satisfaction relationships [25]. Inadequate living conditions [25],
[20], can all improve or decrease because of it. It may severe suffering [10], and abuse-related data can all be
lead to better physical and mental health [24]. As a used to evaluate the absence of quality of life. It is
result of the transformation, one may decide to alter crucial to remember that these things do not imply that
their circumstances [10], change their everyday the quality of life has reduced or vanished altogether.
activities [21], or have a different perspective on life. It People may not consider some of these issues to lower
may lead to the availability of personal choices, chances their quality of life because it is an individual,
for engaging in self-care activities [27], and the subjective assessment of their own condition. For
accomplishment of significant life functions [18]. instance, they might discover purpose in their pain,

© 2023 | Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 13
 Ibrahim Aqtam et al., Saudi J Nurs Health Care, Jan, 2023; 6(1): 10-15
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