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596 UNIT V Middle Range Nursing Theories

uncertainty in profound ways. Being chronically ill In other words, the illness trajectory is driven by
exaggerates the uncertainties of living for those who the illness experience lived within contexts that are
are compromised (i.e., by illness) in their capability inherently uncertain and involve both the self and
to respond to these uncertainties. Thus, although the others. The dynamic flow of life contexts (both bio-
concept of uncertainty provides a useful theoretical graphical and sociological) creates a dynamic flow of
lens for understanding the illness trajectory, it can- uncertainties that take on different forms, meanings,
not be theoretically positioned so as to overshadow and combinations when living with chronic illness.
conceptually the dynamic context of living with Thus, tolerating uncertainty is a critical theoretical
chronic illness. strand in the Theory of Illness Trajectory.

MAJOR CONCEPTS & DEFINITIONS
Life is situated in a biographical context. Concep- flow of the life. The domains of illness-related uncer-
tions of self are rooted in the physical body and are tainty vary in dominance across the illness trajectory
formulated based on the perceived capability to per- (Table 30–1) through a dynamic flow of perceptions
form usual or expected activities to accomplish the of self and interactions with others.
objectives of varied roles. Interactions with others The activities of life and of living with an illness
are a major influence on the establishment of the are forms of work. The sphere of work includes the
conception of self. As varied role behaviors are en- person and all others with whom he or she interacts,
acted, the person monitors reactions of others and a including family and health care providers. This
sense of self in an integrated process of establishing network of players is called the total organization.
meaning. Identity, temporality, and body are key The ill person (or patient) is the central worker;
elements in the biographical context, as follows: however, all work takes place within and is influ-
n Identity: the conception of self at a given time that enced by the total organization. Types of work are
unifies multiple aspects of self and is situated in organized around the following four lines of trajec-
the body tory work performed by patients and families:
n Temporality: biographical time reflected in the con- 1. Illness-related work: diagnostics, symptom man-
tinuous flow of the life course events; perceptions of agement, care regimen, and crisis prevention
the past, present, and possible future interwoven 2. Everyday-life work: activities of daily living,
into the conception of self keeping a household, maintaining an occupa-
n Body: activities of life and derived perceptions tion, sustaining relationships, and recreation
based in the body 3. Biographical work: the exchange of information,
Illness, particularly cancer, disrupts the usual or ev- emotional expressions, and the division of tasks
eryday conception of self and is compounded by the through interactions within the total organization
perceived actions and reactions of others in the so- 4. Uncertainty abatement work: activities enacted
ciological context of life. This disruption permeates to lessen the impact of temporal, body, and
the interdependent elements of biography: identity, identity uncertainty
temporality, and body. This disruption or sense of The balance of these types of work is dynamically
disequilibrium is marked by a sense of a loss of con- responsive, fluctuating across time, situations, per-
trol, resulting in states of uncertainty. ceptions, and varied players in the total organization
As life contexts continually unfold, dimensions of in order to gain some sense of equilibrium (i.e., con-
uncertainty are manifest, not in a linear sequence of trol). This interplay among the types of work creates
stages or phases, but in an unsettling intermingling a tension that is marked by shifts in the dominance
of perceptions of the uncertain body, uncertain tem- of types of work across the trajectory. Recall, how-
porality, and uncertain identity. The experience of ever, that the biographical context is rooted in the
illness always is placed within the biographical con- body. As the body changes through the course of ill-
text, that is, illness is experienced in the continual ness and treatment, the capacity to perform certain