Page 622 - alligood 8th edition_Neat

CHAPTER 30 Carolyn L. Wiener; Marylin J. Dodd 603

The Theory of Illness Trajectory helps the clini- families are to manage care effectively, they must
cian to interpret these behaviors and to intervene be educated proactively to do so (Dodd, 1997,
to help ease transitions across this trajectory. For 2001).
example, clinicians can identify easily with pa- In proactively educating the patient-family sys-
tients and families who have become “professional tem, consider the varied domains of uncertainty
patients” as they learn to use complex technical and the varied forms of uncertainty abatement
jargon about their treatment, laboratory values, or work. To understand the patient-family trajectory,
illness (Wiener & Dodd, 1993). These “junior doc- assessment data are critical. For example, although
tors” attempt to earn a modicum of control as they well-developed protocols for symptom manage-
manage treatment by requesting particular staff ment or palliation are available, such protocols are
members to perform specific tasks (Dodd, 1997, useless if patients or caregivers fail to describe the
p. 988). Care providers have a tendency to view this extent of symptoms because they perceive these
behavior as a positive hallmark of assuming self- “hassles” or “bothers” as trivial in the face of life-
care and, therefore, often reinforce such behaviors. threatening disease. Compounding this issue,
Deeper consideration of the theoretical asser- nurses may fall into a pattern of focusing on illness-
tions of the Theory of Illness Trajectory reveals related work, thereby diverting important attention
that these behavioral strategies are efforts to toler- from the other forms of work faced by these pa-
ate the uncertainty of the illness experience. The tients and their families. Understanding of the var-
confidence built through these socially reinforced ied domains of uncertainty and forms of uncer-
behaviors can be converted to guilt very quickly tainty abatement work facilitates a more open
when situations beyond the expertise of the pa- dialogue regarding these key areas of concern, al-
tient or family go awry. Given this perspective, the lowing the nurse to encourage the patient and care-
limitation of this management strategy becomes giver to share more about their experiences in an
clear, and intervention is indicated: if patients and effort to help them through this difficult time.

CRITICAL THINKING ACTIVITIES
1. How does an illness trajectory differ from a 3. As an advanced clinician, you are intimately in-
course of illness? Consider how the application of volved in the work of managing an illness. Based
each perspective yields different foci for interven- on your understanding of the work of illness
tion in a health condition. Which perspective is management espoused in the Theory of Illness
most congruent with your views of nursing? Trajectory, what nursing behaviors have you
2. Considering your clinical experiences, identify observed that exacerbate feelings of loss of
examples of how patients and their families have control or uncertainty in patients?
experienced health-related uncertainty. Was un- 4. What factors (personal, environmental, or organi-
certainty related to a loss of control? What are the zational) contributed to the nursing behaviors
conditions under which health-related uncertainty observed in question 3? What nursing interven-
is perceived as a negative life event versus those tions would create a less troubling trajectory for
when it is perceived as a growth-enhancing event? patients and families in the situations observed?

POINTS FOR FURTHER STUDY
n Dodd, M. J. (2001). Managing the side effects of n Dodd, M. J., Miaskowski, C. (2000). The PRO-
chemotherapy and radiation therapy: A guide for SELF program: A self-care intervention program
patients and their families (4th ed.). San Francisco: for patients receiving cancer treatment. Seminars
UCSF School of Nursing. in Oncology, 16(4), 300–308.