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602 UNIT V Middle Range Nursing Theories

cancer patients and their families. The sense of under- remains problematic. Applicability of this theory to
standing imparted by the theory is highly relevant to phenomena of concern to nursing has been estab-
oncology nursing practice. The theory presents an elo- lished by the focus on cancer chemotherapy. There-
quent and parsimonious interpretation of the complex- fore, potential utility for guiding nursing practice
ity of cancer work using key concepts with adequate is demonstrated by the integration of the theory
definition; however, in order to comprehend the theo- into Dodd’s exemplary program of research in cancer
retical assertions fully, review of previous published care (Dodd & Miaskowski, 2000; Dodd, 2001; 2004;
studies would be very helpful. Miaskowski, Dodd, & Lee, 2004; Jansen, Miaskowski,
Dodd, et al., 2007).
Generality
The authors have limited the scope of this theory to
patients and families progressing through chemo- Summary
therapy for initial treatment or recurrence of cancer. Wiener and Dodd’s Theory of Illness Trajectory is at
The Theory of Illness Trajectory is well defined within once complex, yet eloquently simple. The sociological
this context. The integration of this middle-range perspective of defining the work of managing illness
theory with other work in illness trajectories and un- is especially relevant to the context of cancer care. The
certainty theory indicates an emergent fit with other theory provides a new understanding of how patients
models of illness trajectories and uncertainty. Further and families tolerate uncertainty and work strategi-
theory-building work may produce a broader scope cally to abate uncertainty through a dynamic flow of
that permits application of the theoretical proposi- illness events, treatment situations, and varied players
tions in other contexts of illness trajectories. involved in the organization of care. The theory is
pragmatic and relevant to nursing. The merits of this
Accessibility work warrant attention and use of the theory for prac-
Grounded theory methods rely on the dominance of tice applications that inform nurses as they interpret
inductive reasoning, that is, drawing abstractions or and facilitate the management of care during illness.
generalities from specific situations. Thus, the derived
theory is rooted in the experiences expressed in the
hundreds of interviews with cancer patients and their CASE STUDY
families. The integration of data-based evidence (e.g.,
quotes) in the formal description of the theory sup- Mr. Miller is a 67-year-old man who has metastatic
ports the linkages between the theoretical abstrac- cancer. His primary caregiver is his wife, Mrs. Miller.
tions and empirical observations. Empirical evidence Early in the course of treatment in your outpatient
is presented in a logical, consistent manner that rings cancer care center, the couple focused their ques-
true to clinical experiences. Thus, the theory is useful tions on the course of the disease, treatment options,
to clinicians and holds promise for further research and potential side effects of varied treatment op-
application. tions. They were proud of their ability to maintain
“normal life” as Mr. Miller continued to work
Importance throughout aggressive treatment, taking time off
The importance of the theoretical contributions made only when the discomforts of treatment were so de-
by this work, especially types of work and uncertainty bilitating that he was physically unable to get to his
abatement strategies during chemotherapy, has been office. Mr. and Mrs. Miller expressed little emotion
established. The utility of the theory is apparent in throughout the course of treatment; they frequently
cancer treatment, and further theoretical develop- praised each other’s strength and fortitude. During
ment holds promise of being generalizable to other recent visits, Mrs. Miller has become extremely fo-
contexts within cancer care and other illness trajecto- cused on laboratory values and test results, using
ries. Yet, the limited evidence of directly derived highly technical language. She has also become ada-
consequences related to application of the Theory of mant that certain staff members must perform cer-
Illness Trajectory in practice-based studies in nursing tain tasks because “she does it better than anyone.”