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600 UNIT V Middle Range Nursing Theories

Corbin and Strauss (1988). As the central worker, theory was grounded in the reported experiences of
actions are undertaken by the person to manage the the participants and integrated with illness knowledge
impact of living with illness within a range of con- trajectories to advance the science.
texts, including the biographical (conception of self)
and the sociological (interactions with others). From Acceptance by the Nursing Community
this perspective, managing disruptions (or coping
with uncertainty) involves patient interactions with Practice
various players in the organization as well as external The Theory of Illness Trajectory provides a framework
sociological conditions. Given the complexity of such for nurses to understanding how cancer patients toler-
interactions across multiple contexts and with the ate uncertainty manifested as a loss of control. Identi-
numerous players throughout the illness trajectory, fication of the types of uncertainty is especially useful
coping is a highly variable and dynamic process. because it reveals strategies commonly employed by
Originally, it was anticipated that the trajectory of oncology patients in their attempt to manage their
living with cancer had discernible phases or stages that lives as normally as possible in the wake of the uncer-
could be identified by major shifts in reported prob- tainty created by a cancer diagnosis. Awareness of the
lems, challenges, and activities. This was the rationale themes of uncertainty and related management strate-
for collecting qualitative data at three points during gies faced by patients undergoing chemotherapy and
the chemotherapy treatment. In fact, this notion did survivorship and their family members has a signifi-
not hold true: the physical status of the patient with cant impact on how nurses subsequently intervene
cancer and the social-psychological consequences of with these compromised patient systems who are
illness and treatment were the central themes at all managing the work of their illness to “facilitate a less
points of measurement across the trajectory. troubled trajectory course for some patients and their
The authors conceptually equate uncertainty with families” (Wiener & Dodd, 1993, p. 29). An example is
loss of control, described as “the most problematic Schlairet and colleagues (2010), who examined the
facet of living with cancer” (Wiener & Dodd, 1993, needs of cancer survivors receiving care in a cancer
p. 18). This theoretical assertion is reflected further in community center using the Theory of Illness Trajec-
the identification of the core social-psychological tory as a framework. They concluded that nurses need
process of living with cancer, “tolerating the uncer- to be aware of the specific needs of cancer survivors so
tainty that permeates the disease” (p. 19). Factors that that interventions can be developed to meet their
influenced the degree of uncertainty expressed by the needs (Schlairet, Heddon, & Griffis, 2010).
patient and family were based in the theoretical
framework of the total organization and external so- Education
ciological conditions, including the nature of family Wiener and Dodd are highly respected educators who
support, financial resources, and quality of assistance share their ongoing work through international confer-
from health care providers. ences, seminars, consultations, graduate thesis advis-
ing, and course offerings. Incorporation of this work
into these presentations not only advances knowledge
Logical Form related to the utility of illness trajectory models but
The primary logical form was grounded theory and also, perhaps more importantly, demonstrates how
inductive reasoning. Analytical reading of the inter- data-based theoretical advancement contributes to an
views provided insights that led to the identification of evolving program of research in cancer care (Dodd,
the core process that unifies the theoretical assertions: 1997, 2001). Including the theory in nursing texts on
tolerating uncertainty. Systematic coding processes research and theory exposes researchers to the work
were applied to define the dimensions of uncertainty and those in nursing practice (Wiener & Dodd, 2000).
and management processes used to deal with disease.
The findings were then examined for fit within extant Research
theoretical writings to extend understanding of the The theory has been referenced in a limited number
illness trajectory. The resultant qualitatively derived of concept analyses or state-of-the-science papers