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Theory of Illness Trajectory

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Winnie Irorita

on 31 July 2014

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Transcript of Theory of Illness Trajectory

Born in SFO
an adjunct professor and research sociologist in the Department of Social and Behavioral School of Nursing at UCSF
In her early efforts, Wiener focused on illness trajectories, biographies, and the evolving medical technology scene. From the late 1980s to 1990s, Wiener focused on coping, uncertainty, and accountability in hospitals.

Born in Vancouver, Canada
Her exemplary program of research is focused in oncology nursing, specifically self-care and symptom management.
Nobel Prize in Nursing awardee
The Best Original Research Paper in Cancer Nursing (1994-1996)
Excellence of Scholarship And Consistency Contribution to the Oncology Nursing Literature Career Award (2000)
About the Authors...
Major Concepts and Definitions
IDENTITY -the conception of self at a given time that unifies multiple aspects of self and is situated in the body

TEMPORALITY -biographical time reflected in the continuous flow of the life course events; interwoven into the perception of self

BODY -activities of life and derived perceptions in the body

Illness Trajectory:
States of Uncertainty
Uncertain Temporality
taken-for-granted expectations regarding the flow of life events are disrupted
a temporal disjunction in the biography

Uncertain Body
changes r/t illness and treatment centered in one's ability to perform usual activities

Uncertain Identity
interpretation of self is distorted as the body fails to perform in usual ways, and expectations r/t the flow of events (temporality) are altered by disease and treatment

The beginning of the theory
used of empirical evidence
a prospective longitudinal study that examined family coping and self-care during 6 months of chemotherapy treatment
100 patients and their family were included
all patients are diagnosed with cancer (breast, lung, colorectal, gyenecological, or lymphoma)
structured interview with the same nurse-interviewer
patients and families dialogued about the previous months' events in a form of "brainstorming"
Carolyn L. Wiener
Marylin J. Dodd

Theory of Illness Trajectory
Marilyn J. Dodd
"The uncertainty surrounding a chronic illness like cancer is the uncertainty of life writ large. By listening to those who are tolerating this exaggerated uncertainty, we can learn much about the trajectory of living."
Major Concepts and Definitions
Types of works are organized around the following four lines of trajectory work performed by patients and family.

Illness-related work
-diagnostics, symptom management, care regimen, and crises prevention

Everyday-life work
-ADL's; keeping household, maintaining occupation, sustaining relationship and recreation

Biographical work
- the exchange of information, emotional expressions and the division of tasks through interactions within the total organization

Uncertainty abatement work
-activities enacted to lessen the impact of temporal, body, and identity uncertainty
Illness Trajectory
The trajectory of illness is driven by the illness experience lived within the contexts that are inherently uncertain and involve both the self and the other.
Being ill creates a disruption in the normal life. Such disruption affects all aspects of life...

Physiological Functioning
Social Interactions
Conceptions of Self
...tolerating uncertainty is a critical theoretical strand in the illness trajectory theory
compendium of strategies used to manage the disruption
change over time that is highly variable in relation to biographical and sociological influences
It provides framework for understanding how patients tolerate uncertainty manifested as a loss of control
Warrants further attention to produce more direct practice implications that could change the way nurses interpret and facilitate the management of an illness
The Theory of Illness Trajectory helps the clinician interpret these behaviors and to intervene to help ease transitions across this trajectory.
If patients and families are to manage care effectively, they must be educated proactively to do so.
“a course of illness over time plus the actions taken by patients, families and health professionals to manage or shape the course
...end of presentation...
Thank you!
Winielda V. Irorita, RN
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