Ontological Views of the Quality of Life Essay (Critical Writing)

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Updated: Feb 27th, 2024

Introduction

The selected nursing concept for the analysis from different ontological views is quality of life (QoL). In nursing, QoL is an essential concept that nurses apply in the provision of healthcare services to patients, families, and communities. According to the World Health Organization (2019), QoL is a broad concept that measures the way individuals perceive their health status based on their value systems, cultural factors, beliefs, psychological conditions, physical health, environmental state, and social relationships. In this view, QoL is a composite nursing concept because it encompasses various factors that dictate the health status of individuals.

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Since QoL is dependent on perceptions of patients, it is also essential that nurses understand it to provide relevant healthcare services (Bahrami, Parker, & Blackman, 2008). The analysis of the nursing concept of QoL from different ontological perspectives highlights its philosophical basis in general health and nursing. Therefore, in the analysis of QoL, this paper examines history, development, impact on nursing practice, and epistemology from the three ontological views of post-positivism, complexity, and human science.

Post-Positivism

History

From the perspective of post-positivism, QoL was developed in the 1960s and 1970s when numerous advancements in the diagnosis of diseases emerged. Clinicians used QoL as an instrument that assesses the health status of patients and allows them to make informed decisions regarding care and treatment interventions. The primary driver of post-positivism was findings from clinical experiments, which pointed out the importance of health assessments in patients. In the 1960s, clinicians were concerned with the protection and improvement of health conditions of their patients based on medical assessments. Innovative treatments and therapies proved useful because they extended the duration of life among patients.

However, high costs of treatments and adverse effects of therapeutic procedures used in lengthening lives of patients necessitated the assessment of QoL. Subsequently, researchers focused on standardizing health factors and scoring them to measure QoL (MacKillop & Sheard, 2018). Thus, the development of instruments used in the assessment of QoL commenced in the 1970s and aided healthcare providers in making medical decisions.

In the 1980s, researchers concentrated their efforts on the development of capable research instruments, which generate valid and reliable outcomes of QoL. Nevertheless, the developed instruments generated inconsistent results of QoL, making healthcare providers experience challenges and difficulties in medical decisions. In the assessment of QoL in populations, the scale of quality-adjusted life-years (QALYs) was developed in 1980s and became dominant in the healthcare system (MacKillop & Sheard, 2018).

Despite the presence of methodological problems, nurses, physicians, clinicians, patients, and family members agreed on significant factors that dictate the measurement of QoL. In the 1990s, generic instruments were developed, while in the 2000s, disease-specific tools were established. Currently, diverse instruments of QoL permit healthcare providers to consider the varied viewpoints of patients in medical decisions.

Informed Nursing Practice

Over time, QoL has advanced in health care and has now become a central concept because it informs nursing practice. Given that the development of scales to measure QoL has demonstrated that health status of individuals is subject to numerous factors in social, psychological, spiritual, cultural, and biological arenas, nursing practice considers them as imperatives. In ensuring that their healthcare interventions are effective, nurses are obligated to evaluate outcomes (Jones, 2016).

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In nursing practice, QoL is an outcome that is measurable to enable nurses to undertake their obligations of assessing the efficacy of different interventions. The social contract that nurses have with the patients requires them to assure QoL as a performance indicator. In this view, nurses ought to practice the science of nursing by reviewing the efficacy of interventions and assessing health results.

Since QoL is a complex concept, it comprises numerous factors that determine its status in nursing practice. The assessment of QoL obliges nurses to consider individual factors, such as social, spiritual, cultural, physical, and psychological health (Jones, 2016).

In the development of scales, the inclusion of comfort, security, relationships, functional competence, privacy, enjoyment, dignity, autonomy, meaningful activities, and spiritual-wellbeing offered an accurate assessment of QoL by nurses. Moreover, consideration of the environment in which patients receive healthcare is necessary for it influences QoL. QoL varies according to the nursing environment and perceptions of patients and nurses (MacKillop & Sheard, 2018). Nurses have to adjust the measurement of nursing outcomes to match conditions of residential homes, nursing homes, or hospitals. Additionally, the integration of the perceptions of nurses and patients is integral for accurate measurement of QoL among patients.

Studies in Nursing

QoL is a significant concept in nursing because it has formed the basis of various studies. For instance, QoL has been studied in palliative settings among patients with chronic conditions. In their study, Sawatzky et al. (2018) designed a new instrument, Quality of Life and Practice Support System (QPSS), and used it in the assessment of patients under palliative care at home and hospital settings. The instrument aimed to capture different perceptions of QoL in the palliative care environment. The study used QPSS in collecting data from patients, clinicians, and family caregivers, and then integrated them to come up with an overall outcome of QoL (Sawatzky et al., 2018). The results of the study revealed that the integration of diverse viewpoints facilitates nurses to make an accurate assessment of QoL and provide customized care to patients.

QoL has also been applied in a randomized controlled study to evaluate the influence of nurse practitioner-led care on QoL of patients with atrial fibrillation. Smigorowsky, Norris, McMurtry, and Tsuyuki (2017) argue the provision of practitioner-led care improves access to care and augment the quality of care, leading to enhanced QoL among patients with atrial fibrillation. Comparison of the standard care and the nurse practitioner-led care allowed the analysis of QoL as an outcome of interest in the study.

Based on their QoL survey, Smigorowsky et al. (2017) established that patients who underwent nurse practitioner-led care experienced a higher level of satisfaction than those who received standard care. Thus, the study suggests the use of nurse practitioner-led care in the improvement of QoL in patients with atrial fibrillation.

Human Science

History

The evolution of human science has seen healthcare providers amass knowledge concerning what constitutes QoL among patients. From the ontological perspective of human science, QoL has evolved in line with the growth and expansion of knowledge. The concept of QoL stems from the definition of health by the World Health Organization in 1947. According to the definition, health constitutes “a state of complete physical, mental, and social well-being, and not merely the absence of disease and infirmity” (para. 1) (World Health Organization, 2019). The incorporation of the term ‘well-being’ signifies the health conditions of individuals concerning QoL. The broadened definition of health incorporated the aspect of human science in the delivery of nursing care. In essence, holistic approaches to health are critical to the improvement of QoL.

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Advancements in treatment interventions in the 1960s and 1970s increased the demand for nursing care. Consequently, healthcare providers recommended the use of multidisciplinary approached as interventions of improving QoL among patients, particularly those with chronic conditions. Disease-specific interventions were designed to ensure that they have optimum effectiveness and generate superb QoL.

Medical professionals, sociologists, psychologists, and environmentalists formulated theories that elucidate the occurrence of diseases, as well as interventions required to enhance QoL. In the modern world, multidisciplinary has become the cornerstone of healthcare delivery because it allows nurses, physicians, laboratory technicians, caregivers, and patients to collaborate in their efforts to assure QoL.

Informed Nursing Practice

From the perspective of human science, QoL has informed and advanced nursing practice significantly. Nurses collaborate with other healthcare professionals in the delivery of care and ensuring that optimal health outcomes are achieved. Von Kodolitsch et al. (2016) hold that geneticists, surgeons, cardiologists, radiologists, pathologists, neurologists, pediatricians, gynecologists, and nurses collaborate in hospital settings to bring about a robust multidisciplinary team in the provision of care. The attainment of QoL is the goal of a multidisciplinary team, which utilizes extensive knowledge and diverse skills of nursing practice. In nursing, the multidisciplinary team does not only benefit patients by improving their QoL, but it also ensures optimal achievement of nursing interventions and promotes efficient utilization of limited resources.

Since human science perceives healthcare from a holistic point of view, it informs the use of the interdisciplinary approach in nursing practice. The interdisciplinary approach allows the use of diverse strategies, skills, and interventions in the provision of care to patients and improving their QoL. According to Von Kodolitsch et al. (2016), the multidisciplinary approach to the treatment of diseases does not only empowers nurses but also boosts QoL in patients with chronic disorders.

Debilitating effects of chronic conditions weaken patients and deprive them of their abilities to lead meaningful lives. Zadeh, Eshelman, Setla, and Sadatsafavi (2017) advise nurses to collaborate with clinical management, support staff, administration, physicians, and other healthcare professionals in the provision of holistic medical care. Through the interdisciplinary strategy, healthcare providers pool their skills, experience, and knowledge and utilize them in the provision of comprehensive care to patients. The interdisciplinary approach has informed nursing practice since nurses apply it as a strategy of improving therapeutic efficacy and QoL.

Studies in Nursing

Based on the ontology of human science, nurses have undertaken numerous studies to examine QoL. For instance, a study was performed to identify the role of the multidisciplinary approach in the improvement of QoL among patients with Marfan syndrome. Since Marfan is a chronic disorder that affects connective tissues and threatens the lives of patients, the multidisciplinary approach is necessary to alleviate the progression of diseases and enhance QoL (Von Kodolitsch et al., 2016). The optimization of therapeutic interventions is dependent on the extent to which healthcare providers work as a collaborative team.

In elucidating the mechanism of the multidisciplinary approach, Von Kodolitsch et al. (2016) categorized healthcare providers into coordinators, core members, and auxiliary support. Furthermore, a multidisciplinary team cooperates with the quality management sector, quality assurance, clinical risk management, and patients for continuous monitoring of diseases. Therefore, the study recommends nurses to engage a multidisciplinary team as a strategy of enhancing therapeutic outcomes and promoting QoL among patients with Marfan syndrome.

Nurses have also studied the role of interdisciplinary in promoting QoL among diverse patients. For example, as patients with terminal illnesses need end-of-life care, QoL determines their survivorship. In their study, Zadeh et al. (2017) scrutinized the role of interdisciplinary perspectives as robust strategies of improving QoL among patients receiving end-of-life care in both hospital and home environments. Variations in individual perception of QoL influence strategies employed in the provision of end-of-life care.

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Zadeh et al. (2017) identified policies, caregiver practices, symptom management, healthcare provider experience, family members, and patients as some of the essential strategies of improving QoL among patients in end-of-life care. The diversity of strategies signifies that QoL is a complex healthcare concept, which requires the interdisciplinary approach by all healthcare providers. In this perspective, the study suggests the adoption of the interdisciplinary approach in the provision of nursing care to heighten QoL in patients undergoing end-of-life care.

Complexity Thinking

History

The emergence of nursing theories in the early- and mid-parts of the 20 century led to the elucidation of QoL from the perspective of complexity thinking. In the 1930s, the formulation of the systems theory indicated that human relationships are not only organized but also structured in their environment to exhibit causal relationships (Arnold & Boggs, 2019). The systems theory postulates that individuals do not exist in isolation but live in an environment with complex interactions.

In the mid of the 20th century, Hildegard Peplau formulated a theory, which holds that the relationship between patients and nurses plays a significant role in the attainment of QoL (Hagerty, Samuels, Norcini-Pala, & Gigliotti, 2017). Joyce Travelbee came up with the interpersonal theory in 1966 to highlight how effective interaction between nurses and patients enhances QoL (Shelton, 2016). Thus, the interaction of factors surrounding patients has a marked influence on their QoL.

In the 1970s, behavioral system analysis provided the basis of explaining the interrelationships between people in society and their environment. The application of behavioral system analysis shifted from the management field to healthcare arena. The analysis of forces that affects patients shows that their behaviors of change in response to their environmental conditions, which act as external forces that the system of QoL. The nature of physical, psychological, social, spiritual, and natural environment determine the way individuals attains QoL (Anderson, 2016). The increasing case of medical errors in the 1980s and 1990s necessitated the application of systems theory in healthcare.

The complexity of healthcare systems and human needs contributed significantly to the occurrence of medical errors. Anderson (2016) requires the consideration of interactions between individual attributes and organizational conditions as factors that determine the occurrence of medical errors and QoL. Currently, healthcare systems and hospitals utilize systems theory in improving healthcare outcomes and promoting QoL among patients.

Informed Nursing practice

QoL has evolved as new knowledge emerged in the field of nursing. As humans do not live in isolation, the ontology of complexity thinking holds that causal relationships elucidate QoL. In essence, humans live in systems that are subject to numerous forces that stabilize and destabilize their health conditions. Systems theory has informed nursing practice because it provides a framework that integrates different disciplines of healthcare and support collaboration in the delivery of medical care (Arnold & Boggs, 2019).

In line with the ontology of complexity thinking, the interpersonal theoretical model of Hildegard Peplau elucidates that effective relationships between nurses and patients should go through the critical phases of orientation, delivery of care, and termination (Hagerty et al., 2017). The phase of orientation allows patients to adapt treatment environment, while the phase of delivery of care provides for the treatment. The termination phase occurs when patients have attained significant QoL from debilitating conditions sickness.

The assessment of systems theory shows that it has improved the provision of nursing care, promoted collaboration, and reduced the occurrence of medical errors. The delivery of care is a collaborative effort of physicians, nurses, caregivers, and family members (Anderson, 2016). To provide quality care and achieve the highest possible QoL, nurses ought to factor in the needs and experiences of patients, available resources, and medical advice from physicians and specialists. Based on the concept of causal relationship, Jacqueline Fawcett modelled the metaparadigm of nursing as interactions between the domains of health, environment, medical care, and patients (Bender, 2018). Hence, the metaparadigm informs the nursing curriculum and build nursing capacity to deliver quality care, leading to enhanced QoL in patients.

Studies in Nursing

QoL based the ontology of complexity thinking has been studied in nursing through the analysis of the model of causal relationships. For example, in their study, Hariyono and Soewandi (2016) applied Hildegard Peplau’s theory to ascertain the effect of the nurse-patient relationship on QoL and family uncertainly. In the provision of nursing care, nurses can develop positive relationships with patients and alleviate their pain, fear, anxiety, distress, and depression.

Hariyono and Soewandi (2016) found out that interpersonal relationships that nurses develop through acceptance, communication, and alliance are statistically significant predictors of QoL as indicated by the uncertainty of surgery. Typically, unresolved uncertainty decreases QoL of family members and their patients because it increases stress, anxiety, and depression.

Since systems theory models critical elements in relationships that determine QoL, studies have employed it in nursing studies. Ahmadi and Sadeghi (2017) utilized the model of Betty Neuman systems, which a form of systems theory, in the analysis of nursing care given to patients with multiple sclerosis. As an autoimmune disease, multiple sclerosis causes neurological disability and reduces QoL among patients.

From the perspective of systems models, psychological, physiological, physical, social, and spiritual elements interact in a patient as a system with internal and external forces. Using the Neuman model, Ahmadi and Sadeghi established that stressors of patients with multiple sclerosis exist on extra-personal, inter-personal, and intra-personal levels. In this view, the study advises nurses to employ the model in the provision of medical services to patients with multiple sclerosis.

Conclusion

QoL is a critical concept in nursing since it indicates the overall wellbeing of patients in various settings. The analysis of QoL from the ontological views of post-positivism, complexity, and human science revealed important epistemological tenets of nursing. The analysis of QoL from the viewpoint of post-positivism concentrated on the development of instruments and scales, which assess the health conditions of patients. From the perspective of human science, the analysis demonstrated that the multidisciplinary approach to nursing care is integral in the improvement of QoL. Complexity thinking indicated that causal relationships and interactions between personal factors, healthcare professionals, and environment determine the level of QoL among patients. Ultimately, the analyses reveal that QoL is a complex nursing concept that is subject to different ontological approaches.

References

Ahmadi, Z., & Sadeghi, T. (2017). Application of the Betty Neuman systems model in the nursing care of patients/clients with multiple sclerosis. Multiple Sclerosis Journal: Experimental, Translational, and Clinical, 3(3), 1-8. Web.

Anderson B. R. (2016). Improving health care by embracing systems theory. The Journal of Thoracic and Cardiovascular Surgery, 152(2), 593-594. Web.

Arnold, E. C., & Boggs, K. U. (2019). Interpersonal relationships: Professional communication skills for nurses. New York, NY: Elsevier Health Sciences.

Bahrami, M., Parker, S., & Blackman, I. (2008). Patients’ quality of life: A comparison of patient and nurse perceptions. Contemporary Nurse, 29(1), 67-79. Web.

Hagerty, T. A., Samuels, W., Norcini-Pala, A., & Gigliotti, E. (2017). Peplau’s theory of interpersonal relations: An alternate factor structure for patient experience data? Nursing Science Quarterly, 30(2), 160-167. Web.

Hariyono, T., & Soewandi, A. Y. (2016). The influence of nurse’s interpersonal relationship on perioperative patient’s family uncertainty based on Hildegard Peplau’s theory. Journal of Applied Science and Research, 4(2), 56-66.

Jones, T. (2016). Outcome measurement in nursing: Imperatives, ideals, history, and challenges. The Online Journal of Issues in Nursing, 21(2), 1-13. Web.

MacKillop, E., & Sheard, S. (2018). Quantifying life: Understanding the history of quality-adjusted life-years (QALYs). Social Science & Medicine, 211(1), 359-366. Web.

Sawatzky, R., Laforest, E., Schick-Makaroff, K., Stajduhar, K., Reimer-Kirkham, S., Krawczyk, M., … Cohen, S. R. (2018). Design and introduction of a quality of life assessment and practice support system: Perspectives from palliative care settings. Journal of Patient-Reported Outcomes, 2(36), 1-13. Web.

Shelton G. (2016). Appraising Travelbee’s Human-to-Human Relationship Model. Journal of the Advanced Practitioner in Oncology, 7(6), 657-661.

Smigorowsky, M. J., Norris, C.M., McMurtry, M. S., & Tsuyuki, R. T. (2017). Measuring the effect of nurse practitioner (NP)-led care on health-related quality of life in adult patients with atrial fibrillation: Study protocol for a randomized controlled trial. Trials, 18(1), 1-8. Web.

Von Kodolitsch, Y., Rybczynski, M., Vogler, M., Mir, T. S., Schüler, H., Kutsche, K., … Pyeritz, R. E. (2016). The role of the multidisciplinary health care team in the management of patients with Marfan syndrome. Journal of Multidisciplinary Healthcare, 9, 587-614. Web.

World Health Organization. (2019). WHOQOL: Measuring quality of life. Web.

Zadeh, R. S., Eshelman, P., Setla, J., & Sadatsafavi, H. (2017). Strategies to improve quality of life at the end of life: interdisciplinary team perspectives. American Journal of Hospice and Palliative Medicine, 35(3), 411-416. Web.

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