Page 462 - Encyclopedia of Nursing Research

QuAlITy OF lIFE n 429

leininger, and Parse). A provisional defini- which allow flexibility in the conceptualiza-
tion was proposed based on the synthesis of tion of QOl while permitting comparability
the theorists’ definitions of QOl as “an intan- of specific dimensions across studies (Frank- Q
gible, subjective perception of one’s lived Stromberg & Olsen, 2004).
experience” (Plummer and Molzahn, 2009). limitations of QOl research include
Although the theoretical paradigms analyzed (a) lack of meaningful findings that can be
by Plummer and Molzahn (2009) encompass used to base clinical and treatment decisions
the holistic perspective of the lived experi- upon, (b) heterogeneity of treatment effects
ence in QOl, researchable middle-range the- across similar or identical patient popula-
ories can provide the substructures needed tions, (c) varying levels of perceived QOl
to build unique nursing knowledge on QOl and health across time, (d) multicultural
and make comparisons between studies that and linguistic translation of QOl instru-
will sufficiently translate into clinical prac- ments, (e) the amount and complexity of
tice and improved outcomes. factors influencing QOl, and (f) use of sur-
Ferrans and Powers (1985, 1992) devel- rogate measures for QOl, such as health,
oped and empirically verified the Quality symptoms, or functional status, alone for
of life Index (QlI), which has moved the measuring HRQOl (Guyatt, 1997; Plummer
science forward in aspects of QOl where and Molzahn, 2009). In addition, some of
nurses can intervene. Weighted satisfaction the questionnaires are lengthy and complex,
responses based on subjective (i.e., patient) rendering them clinically unusable due to
importance ratings are used in the QlI, such the added measurement burden they would
that scores reflect satisfaction with patient- impose on patients and clinicians. Thus, lit-
valued aspects of life. The QlI produces tle continues to be known about dimensions
five scores, including overall QOl, in four of QOl most amenable to nursing interven-
domains, health and functioning, psycholog- tion. This lack of knowledge is a critical prob-
ical/spiritual domain, social and economic lem because, without this understanding,
domain, and family. Although a generic form delivery of effective interventions aimed at
of the QlI is composed of common items, improving QOl is unlikely. However, efforts
individual versions of the questionnaire con- are being made to address these issues.
sist of additional items pertinent to specific using the example of heart failure, the
illnesses and disorders. Kansas city cardiomyopathy Questionnaire
Methodological and logistic challenges (KccQ), designed to collect subjective
in QOl measurement can be daunting. measures of QOl and other health status
Thorough knowledge of conceptual and psy- measures, has been empirically verified
chometric aspects of a QOl measure is essen- in numerous domestic and international
tial in research. Instruments must adequately studies. The KccQ is a self-administered
capture the conceptualization of QOl and 23-item questionnaire that quantifies heart-
must be sensitive to changes over time. failure-specific domains, including physical
Other considerations needed when selecting limitation, symptoms (frequency, severity,
instruments is the level of measurement (e.g., and recent change over time), self-efficacy,
individuals or populations), the study design social interference, and QOl (Green et al.,
(e.g., cross-sectional vs. longitudinal, quanti- 2000). The KccQ was found to be reli-
tative vs. qualitative), and whether objective, able, responsive, and valid in study com-
subjective, or a combination of both objective parisons with the 6-minute walk test, New
and subjective measures are needed (e.g., york Heart Association functional status
QOl relative to a particular disease or illness, classification, the medical outcomes Short
where objective assessments are included). Form-36, and Minnesota living with Heart
Many studies employ multiple instruments, Failure questionnaire. The KccQ captures