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The Theory of Illness

Trajectory
Lycia L. Harris
NU 504
Jacksonville State University
November 7, 2014

Introduction
Benjamin Franklin said when speaking on constitutional issues, The
only thing in this world that is certain is death and taxes. This was a profound
statement, because so long ago, he probably had no real idea the impact taxes
would have on us all. Illness is another thing in this world that is definitely
uncertain and those experiencing chronic illness often feel helpless and lost from
the time of diagnosis and also throughout the course of treatment. Chronic illness
along with its uncertainty can have a great impact on the person experiencing the
illness and their families. Chronic illness causes the person experiencing the illness
to come to terms with his or her mortality. End of life issues are subjects many
refuse to face. Carolyn L Weiner and Marylin J. Dodd penned The Theory of
Illness Trajectory. This serves as a framework for strategies for coping with the
uncertainty of illness. The purpose of this presentations is to show the importance
and usefulness of this theory when dealing with chronic illness and its relevance to
nursing practice.

Carolyn L. Wiener, Theorist

Born in 1930 in San Francisco, California


Lives in San Francisco, California
Emeritus professor in the Department of
Social and Behavioral Sciences at the School
of Nursing at UCSF
(Alligood, 2014)

Educational Background
Earned bachelors degree in interdisciplinary social
science from San Francisco State University in 1972
Received Masters degree in sociology from the University
of California, San Francisco (UCSF) in 1975
Received doctoral in sociology and completed her Ph.D. in
1978

(Alligood, 2014)

Work Experience
Current Emeritus Professor, Department of Social and
Behavior Sciences at School of Nursing at UCSF
Professor of Sociology 1999
Assistant research sociologist at UCSF
(Alligood, 2014)

Publications, Honors and Awards


She Authored and co-Authored books and publications in
nursing journals:

Hazards in hospital care; Ensuring Patient Safety.


Social organizations of medical work.
The politics of Alcoholism: Building an arena around a social problem
The elusive quest: Accountability in hospitals.
Coping amid uncertainty: an illness trajectory perspective. Scholarly Inquiry for
Nursing Practice: an International Journal
Coping amid uncertainty: an illness trajectory prospective.
Where medicine fails (5th e.d.).
Grounded theory in medical research: from theory to practice.
Applying the Straussian framework of action, negotiation, and social arenas to
study accountability in hospitals
Holding American hospitals accountable: Rhetoric and reality

(Alligood, 2014)

Other Applicable Accolades


Opening lecturer Critiquing Health Improvement at Nottingham
University School of Nursing in England, 2001
Honoree UCSF Celebrating Women Faculty at UCSF, 2001
Presenter Celebration of the Life and Work of Anslem Strauss,
UCSF in 1996
Presenter Anslem Strauss, A Theoretician: The Impact of His
thinking on German and European Social Sciences, 1999
Presenter First Anslem Strauss Research Colloquium at UCSF, 2005

(Alligood, 2014)

Marylin J. Dodd, Theorist


Born in 1946 in Vancouver, Canada
Resides in San Francisco, California
Earned a bachelors degree and masters degree in nursing,
1971 & 1973
Completed Ph.D. in nursing at Wayne State University,
1977
(Alligood, 2014)

Work Experience

Instructor of nursing, University of Washington, 1977.


Assistant Professor of Nursing at UCSF, 1977
Advanced to full professor of Nursing, serving as Director for the
Center for Symptom Management at UCSF
Awarded Sharon A. Lamb Endowed Chair in Symptom Management
at the UCSF School of Nursing in 2003.

(Alligood, 2014)

Some of Dodds many


publications

Oncology nursing case studies


Managing the side effects of chemotherapy and radiation therapy: A guide for patients and
nurses
Monograph of the advanced research session at the 13 th Annual Oncology Nursing Societys
Congress
Managing the side effects of chemotherapy and radiation therapy: A guide for patients and their
families (3rd.ed.)
The pathogenesis and characterization of oral mucosistis associated with cancer therapy.
The Pro-Self program: A self care intervention program for patients receiving cancer treatment
Cancer related fatigue
Self-care and patient/family teaching
(Alligood, 2014)

Honors and Awards


Recognized as a fellow of the American Academy of Nursing, 1986
Oncology Nursing Society/Schering Excellence in Research Award,
1993 & 1996
Best Original Research Paper in Cancer Nursing, 1994 & 1996
Oncology Nursing Society Bristol-Myers Distinguished Researcher
Career Award, 1997
Oncology Nursing Society/Chiron Excellence of Scholarship and
Consistency of Contribution to the Oncology Nursing Literature Career
Award, 2000
Episteme Laureate (considered the Nobel Prize in nursing) Award from
Sigma Theta Tau International, 2005
(Alligood, 2014)

Introduction of the Theory of Illness


Trajectory
Wiener & Dodds Theory of Illness
Trajectory is a middle-range nursing theory
that is centered around how an individual
experiencing illness, like that of cancer,
deals, with the uncertainty of treatment and
perceived loss of control over their life.
(Alligood, 2014)

Motivation for Theory


By using the Theory of Illness Trajectory,
Weiner and Dodd address serious concerns
related to concepts that over emphasize the
role that uncertainty plays in understanding
the way that continuing the process of living,
while dealing with illness, has on distribution
of illness.
(Alligood, 2014)

Life is centered in the living body, so any physiological


changes caused by illness are caught up in many contexts
that are experienced in ones life and the interactions with
other people in those life situations (Alligood, 2014).

The Way Illness Disturbs Life


Physiological functioning
Social interactions
Self concepts
Coping is the way human beings deal with
the disruptions of life caused by illness
(Alligood, 2014)

What is Coping?
Coping is described as a compounding of strategies.
Coping is used:
To manage the disruptions in life
To isolate specific responses to one event that is lived
within the complexity of life
To assign value labels to response behaviors, good or
bad, that are described collectively when assessing the
behavior of an individual experiencing stress
(Alligood, 2014)

Illness Trajectory
The idea of uncertainty in life gives a
useful way of looking at and understanding
illness trajectory. Illness trajectory is driven by
the illness experience, lived within the context
that are inherently uncertain, and involve both
self, the person experiencing the illness, and
others(those people affected by the illness of
the sick person).
(Alligood, 2014)

Dynamic Flow of Life Contexts


Contexts are biological and Sociological
Contexts create dynamic flow of
uncertainties
Uncertainties take on different forms
Uncertainties take on different meanings
Uncertainties take on different combinations
when living with chronic illness (Alligood,
2014).

Other Illness Trajectories


Three typical illness trajectories have been
used in patients with progressive illness:
Cancer
Organ failure
And the frail elderly or dementia trajectory
(ncib.nlm.nih.gov)

Trajectory 1
. Short period of evident decline, typically cancer
. predictable decline in physical health
. trajectory enmeshes well with traditional specialist
palliative care services such as hospices and
community palliative care programs
(ncbi.nlm.nih.gov)

Trajectory 2
Long term limitations with intermittent serious episodes
Used for conditions such as heart failure and chronic obstructive
pulmonary disease, patient are usually ill for many months or
years with occasional acute, severe, flare ups. Deteriorations are
associated with hospital admissions and intensive treatment
Each flare up may result in death but patient usually survives
and a gradual decline in health and function is typical
(ncbi.nlm.nih.gov)

Trajectory 3
Prolonged dwindling
This is simply dying of old age.
Usually occurs due to brain failure or
generalized multiple body system failure
(ncbi.nlm.nih.gov)

Central Theme of Theory


of Wiedner and Dodds Theory of Illness Trajectory

Being able to deal with uncertainty is a vey


important theoretical foundation in The
Theory of Illness Trajectory

(Alligood, 2014).

Strategies for Theory


Development
The primary logical form was grounded theory
and inductive reasoning (Alligood, 2014).
Research and interviews on cancer patients and
their response to illness.
Analytical reading of interviews providing
insights.
Evaluating of theoretical writings (Alligood,

2014).

Nursing Paradigms
Personis is the focus of this middle range theory (Alligood,
2014). The theory of Illness Trajectory encompasses not only
the physical components of diseaes but the total organization
of work done over the course of the disease (Alligood, 2014).
An illness trajectory is theoretically distinct from the course
of an illness (Alligood, 2014). In this theory, the illness
trajectory is not limited to the person who suffers the illness
(Alligood, 2014). Rather, the total organization involves the
person with the illness, the family and the health care
professional who render care (Alligood, 2014).

Theory of Illness Trajectory


Framework

The Importance of Self-Concept


Illness, like that of cancer, disturbs the
person experiencing the illness self concept
and is made worse by the way the ill person
thinks people act and react to their illness
(Alligood, 2014). This disruption permeates
the interdependent elements of biography:
identity, temporality, and body (Alligood,
2014).

As illness continues, the highs and lows of being sick


unfold, the types of uncertainty in illness begin to become
a reality, and do not happen in a predictable or linear way .

Use of Theory
This theory can be used in both wellness and illness.
The Theory of Illness Trajectory provides a
framework for nurses to understand how cancer
patients tolerate the uncertainty manifested in loss of
control
This theory can be utilized when dealing with other
chronically ill patients
(Alligood, 2014).

Strengths of Theory
Gives a sociological perspective of defining the work of
managing illness (Alligood, 2014).
Provides a new understanding of how patients and families
tolerate uncertainty and work strategically to abate
uncertainty through a dynamic flow of illness events,
treatment solutions, and varied players involved in the
organization of care (Alligood, 2014).
Is pragmatic and relevant to nursing care (Alligood, 2014).
Useful in developing theory and nursing applications
(Alligood, 2014).

Weakness of Theory
Negative delegation of care and behavior by
caregivers related to patient results by
acting as junior doctors and trying to earn
a modicum of control (Alligood, 2014).
Using this theory as a care management
strategy has limitations (Alligood, 2014).

Use in Advanced Practice


Helps to define the work of managing illness (Alligood,
2014)
Helps to inform nurses as they interpret and facilitate the
management of care during illness
Helps clinicians identify with professional patients
(Alligood, 2014)
Helps clinicians learn complex and technical jargon about
treatments, lab values or illness (Alligood, 2014)
Helps to proactively educate patients and families on
uncertainties(Alligood, 2014).

Use in Nursing Education


Helps to advance the knowledge related to
utility of illness trajectory models(Alligood,
2014)
Demonstrates how data-based theoretical
advancement contributes to an evolving
program of research in cancer care
(Alligood, 2014)

Use in Research
This theory has been referenced in a limited
number of concept analyses or state-of-thescience papers addressing uncertainty
(Alligood, 2014)
Is useful in evaluating how patients and
families of those with long term illnesses
cope with the uncertainty of care and
treatment

Case Study
Mrs. Jenson, a 56 year old, wife, mother, grandmother, active Sunday school
teacher, nursing Administrator at a large healthcare facility, and self-described
control freak, has just been diagnosed with end stage metastatic liver cancer.
She has tried to remain active with physical activity at least once a month.
She drinks a glass of wine every night before bed, sometimes more, and her
last real check up was 2 years ago, as the demands of her family and job have
prevented her from really looking after herself. She has a grown daughter
that relies on her for financial assistance due to the fact the daughter recently
divorced and has 4 children. She has recently been feeling very fatigued with
flank abdomen pain and occasional fever, but she attributed it to reflux and
allergies. She has a very large support system, both personally and socially.
Both she and her family are very upset and fearful with the diagnosis.

Conclusion
Chronic illness can have significant impact on an
individual person and their family. Carolyn J. Wiener and
Marylin J. Dodds Theory of Illness Trajectory can be
useful in helping those with chronic illness and their
family deal the uncertainties that accompany illness and
perceived loss of control and come up with positive coping
behaviors related to illness.

References

Alligood, M. & Tomey, A.(2013). Nursing Theorist And Their Work. (8th e.d.). St. Louis, MO.
Elsevier/Mosby
Clip Art. Retrieved from: http://www.googleimages.com
Illness Trajectory Framework. Retrieved from: http://www.nursing.ucsf.edu
Dodd, M.J. (1978). Oncology nursing case studies. New York: Medical publication Co.
Dodd, M.J. (1987). Managing the side effects of chemotherapy and radiation therapy: A guide for
patients and nurses. Norwalk, (CT):Appleton & Lange
Dodd, M. J. (1997). Monograph of the advanced research session at the 13 th Annual Oncology
Nursing Societys Congress. Pittsburgh: Oncology Nursing Society.
Dodd, M. J., Miaskowski, C. (2000). The PRO-SELF program: A self care intervention program for
patiens receiving cancer tretment. Seminars in Oncology, 16(4), 300-308.
Illness Trajectory Framework. Retrieved from: http://www.nursing.ucsf.edu
Murry,S. Kendall, M. , Boyd, K. , Sheikh, A. (2005). Illness trajectories and palliative care.
Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles
Dodd, M. J. (1999). Self care and patient /family teaching in cancer symptom management.
Wilsonville, (OR): Jones & Bartlett

Reference

West, C. M. Dodd, M.J., Paul, S.M., Schumacher, K., Tripathy, D., Koo, P., Miaskowski,
C. (2003). The Pro-Self: Pain control program-An effective approach for cancer pain
management. Oncology Nursing Forum, 30, 65-73.
Wiener, C. L., & Dodd, M.J. (1993). Coping and uncertainty: An illness trajectory
perspective. Scholarly Inquiry for Nursing Practice: An International Journal, 7(1), 1731
Wiener, C., & Wysmans, W. M. (1990). Grounded theory in medical research: From
theory to practice. Amsterdam: Sivets and Zeitlinger
Wiener, C. (2000). The elusive quest: Accountabiligy in hospitals. New York: Aldine
deGruyter
Wiener, C. (1981). The politics of alcoholism: Building an arena around a social
problem. New Brunswick, (NJ): Transaction Books.
Wiener, C. L. & Strauss, A (1997). Where medicine fails. (5th e.d.). New Brunswick, (NJ):
Transaction Books.