Throughout much of history, ”medical workers have basked in the clear moral light of working to ’keep people alive’ (Edlund & Tancredi, 1985).” Yet within the past decades, questions regarding the sanctity of quantity of life have arisen. Edlund suggests multiple reasons for this shift.
• Technological progress in medicine. This has been so rapid and extensive over the past 30 years that people today can be “biologically alive and socially dead.”
• Personal autonomy. As the sense of self has grown so has the belief in the right of personal decision-making.
• Cost of technology. Every country realizes that resources are not unlimited and that the cost of medical care takes large portions of the society’s resources. In some cases the expense of health care costs do not begin to match the growth of the economy to deal with those costs.
• Changes in health patterns. There are now large numbers of chronically ill people who can not be cured by even the most sophisticated technology. Medical care can no longer decrease mortality as easily.
Thus people are beginning to demand that the quality of their lives be enhanced while living with a chronic illness.
Quality of life is defined in multiple ways and means different things to different people. These various ways of defining quality of life range from vague definitions of ”whatever the individual defines it to be,” ”ability to lead a normal life” and ”self-actualization,” to more thoughtful and considered definitions such as those that emphasize fulfillment of personal goals:
”the individuals’ perceptions of their position in life, in the context of the cultural and value systems in which they live and in relation to their goals, expectations, standards and concerns.” (World Health Organization)
”the extent to which an individual is able to achieve security, self-esteem and the opportunity to use intellectual and physical capabilities in pursuit of personal goals.” (Engquist)
happiness or satisfaction:
”the degree of need satisfaction within the areas of the physical, psychological, social, activity, material and structural needs.” (Hørnquist, 1989)
”a person’s sense of well-being that stems from satisfaction or dissatisfaction with the areas of life that are important to him/her.” (Ferrans, 1990)
social utility and preference:
" utility scores (that) reflect preferences for the health states and allow morbidity and mortality improvements to be combined into a single weighted measure, quality-adjusted life years." (Revicki & Kaplan, 1993)
This last definition takes a mathematical approach to quality of life and assumes that patients and policy makers will make rational decisions that have cost-benefit consequences.
Most researchers agree that quality of life is complex and composed of multiple dimensions.
See papers by Archenholtz, Burckhardt & Segesten, Bowling (1995), Campbell and Andrews (1975), Ferrans (1996), Flanagan (1978), and Padilla et al (1990) for research and discussions on this issue. See also the book by Spilker (1996) which contains information on the breakdown of quality of life dimensions.
Although no nursing journal is dedicated to the conceptualization and measurement of quality of life, the following journals contain articles on the topic:
• Advances in Nursing Science
• Archives of Psychiatric Nursing
• Cancer Nursing
• Clinical Nursing Research
• Image
• International Journal of Nursing Studies
• Issues in Mental Health Nursing
• Journal of Advanced Nursing
• Journal of Gerontological Nursing
• Nursing Research
• Nursing Science Quarterly
• Oncology Nursing Forum
• Public Health Nursing
• Rehabilitation Nursing Research
• Research in Nursing and Health
• Scandinavian Journal of Caring Science
• Seminars in Oncology Nursing
• Western Journal of Nursing Research
One of the best ways to search for nursing articles on quality of life is with CINAHL (cumulative index of nursing and allied health literature) available at most libraries. A new source of nursing research and practice reviews is located at http://www.nursingsociety.org
This is the Sigma Theta Tau Nursing Honor Society Virginia Henderson Library site that contains information about the nursing journal, On-line Journal of Knowledge Synthesis for Nursing.
Last updated 5 September 2000