Academic journal article Scholarly Inquiry for Nursing Practice

Development of a Conceptual Model of Quality of Life

Academic journal article Scholarly Inquiry for Nursing Practice

Development of a Conceptual Model of Quality of Life

Article excerpt

Quality of life is a critically important concept for health care that has been developed predominantly in the past three decades. Conceptual clarity is extremely important, because differences in meaning can lead to profound differences in outcomes for research, clinical practice, and allocation of health care resources. This paper describes the development of the Ferrans conceptual model of quality of life. The model was developed based on the adoption of an individualistic ideology, which recognizes that quality of life depends on the unique experience of life for each person. Individuals are the only proper judge of their quality of life, because people differ in what they value. Consistent with this ideology, quality of life was defined in terms of satisfaction with the aspects of life that are important to the individual. The model was developed using qualitative methodology. Factor analysis of patient data was used to cluster related elements into domains of quality of life. The resulting model identifies four domains of quality of life: health and functioning, psychological/spiritual, social and economic, and family. Subsequent cross-cultural work with African Americans and Mexican Americans has provided evidence that the elements of the model appropriately reflect quality of life for segments of the population not sampled in the original work. The Ferrans and Powers Quality of Life Index was developed based on this model.

Quality of life (QOL) has become a critically important concept for health care in recent years. Quality of life considerations are significant in decisions to stop life-sustaining treatment and in debates regarding physician-assisted suicide. In clinical practice and clinical trials, QOL indicators are used to evaluate treatment in terms of human costs and benefits. QOL has also been used to make decisions regarding allocation of health care services, such as in Oregon's new health care system which has been viewed as a potential model for the nation. In this system, anticipated QOL outcomes were used to decide which treatments would be provided and denied to Oregon's poor (Hadorn, 1991). In addition, QOL has been proposed as a criterion for evaluating the quality of health care in a permanent national medical data base accessible to patients, payers, and providers (Elwood, 1988).

The literature reveals a wide variety of meanings for quality of life, defined explicitly or operationally (Ferrans, 1990a, 1992). Conceptual clarity is extremely important, because differences in meaning can lead to profound differences in outcomes for research, clinical practice, and allocation of health care resources. Concept analysis techniques using Wilson-based methods, predominantly those of Walker and Avant (1988), have been applied to QOL to help provide clarity (Kleinpell, 1991; Meeberg, 1993; Oleson, 1990b). A multiplicity of meanings can be identified from the literature using these techniques. The task breaks down, however, at the step of determining defining attributes. Because many definitions are mutually exclusive in their conceptual approach, they cannot be synthesized into a coherent whole. Hupcey and her colleagues (in this issue) pointed out that Wilson-based approaches have produced results that lack cohesion and explanatory power. Morse and colleagues (in this issue) then suggest that other approaches to concept analysis, such as critical analysis of the literature, qualitative methodologies, and quantitative methodologies may produce results that are more comprehensive and useful to nursing. Our work over the past 14 years in QOL provides an example of concept development using a variety of approaches. In addition to critical literature analysis and qualitative methodologies, we found that quantitative approaches can contribute meaningful information to concept development. Using these methodologies we developed a conceptual model of quality of life (Figure 1 and Table 1). This model provided the basis for the development of an instrument to measure QOL, which was our ultimate goal in this effort. …

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