Thus, although the concept of uncertainty provides a useful theoretical lens for understanding the illness trajectory, it cannot be theoretically positioned so as to overshadow conceptually the dynamic context of living with chronic illness. Recall, however, that the biographical context is rooted in the body. A major contribution of this work was the delineation of types of uncertainty abatement work (Table 30-2). Finally, despite the structured format of the interview, it is important to note that the patients and families dialogued about the previous month’s events in a form of “brainstorming” (Wiener & Dodd, 1993, p. 18). Although coping with illness has been of interest to social scientists and nursing scholars for decades, Weiner and Dodd clearly explicate that formerly implicit theoretical assumptions have limited the utility of this body of work (Wiener & Dodd, 1993, 2000). The experience of illness always is placed within the biographical context, that is, illness is experienced in the continual flow of the life. This disruption permeates the interdependent elements of biography: identity, temporality, and body. The activities of life and of living with an illness are forms of work. Her intense collaborative relationship with the late Anselm Strauss (co-originator of grounded theory methods) and prolific experience in grounded theory methods are evidenced by her invited presentations at the Celebration of the Life and Work of Anselm Strauss at UCSF in 1996 and at a conference entitled Anselm Strauss, a Theoretician: The Impact of His Thinking on German and European Social Sciences in Magdeburg, Germany, in 1999. From this perspective, coping is best viewed as change over time that is highly variable in relation to biographical and sociological influences. THEORIES OF HEALTH AND ILLNESS Theories about health and illness deal with the ideas people use to explain how to maintain a healthy state and why they become ill. Ideas about illness causation may include such ideas as breach of taboo, soul loss, germs, upset in the hot-cold balance of the body, or a weakening of the body's immune system. MMWR Morb Mortal Wkly … Her exemplary program of research is focused in oncology nursing, specifically, self-care and symptom management. Taken-for-granted expectations regarding the flow of life events are disrupted She earned her bachelor’s degree in interdisciplinary social science from San Francisco State University in 1972. It is an examination of how an individual protects their personal identify if they depart from an approved standard of conduct, behavior, or appearance. Becoming “professional” patients The Theory of Illness Trajectory * addresses these theoretical pitfalls by framing this phenomenon within a sociological perspective of a trajectory that emphasizes the experience of disruption related to illness within the changing contexts of interactional and sociological processes that ultimately influence the person’s response to such disruption. Subjects in the study designated at least one family member who was willing to participate in the study. As varied role behaviors are enacted, the person monitors reactions of others and a sense of self in an integrated process of establishing meaning. The analytical inquiry proceeded inductively to reveal the core socialpsychological process around which the theory is explicated: tolerating the uncertainty of living with cancer. Life is situated in a biographical context. Supported by Theory Health is a revolutionary virtual functional medicine practice providing a holistic and scientific approach to health. Being ill creates a disruption in normal life. Despite the breadth and volume of these activities, Dodd is an active teacher and mentor. Dimensions of the uncertainty, management processes, and consequences were further explicated to reveal the internal consistency of the theoretical perspective of illness trajectory. Her many presentations at scientific gatherings around the world accentuate this work. Studies in Hawaii and other islands have suggested that a return to traditional diets could help lower serum cholesterol, blood sugar levels and other obesity related conditions. After receiving a Ph.D., Wiener accepted the position of assistant research sociologist at UCSF. Yet, the complex interplay of physiological disruption, interactions with others, and the construction of biographical conceptions of the self warrants a more sophisticated perspective of coping. Many Pacific cultures share these or similar beliefs. Thus, although the concept of uncertainty provides a useful theoretical lens for understanding the illness trajectory, it cannot be theoretically positioned so as to overshadow conceptually the dynamic context of living with chronic illness. From the late 1980s to 1990s, Wiener focused on coping, uncertainty, and accountability in hospitals. Changes related to illness and treatment centered in one’s ability to perform usual activities, involving appearance, physiological functions, and response to treatment. UNCERTAIN IDENTITY She then accepted the position of assistant professor at UCSF. Throughout her career, Wiener’s excellence has earned for her several meritorious awards and honors. Dodd’s illustrious career has merited several prestigious awards. Dodd’s outstanding record of funded research provides evidence of the superiority and significance of her work. Throughout her career, Wiener’s excellence has earned for her several meritorious awards and honors. The activities of life and of living with an illness are forms of work. The balance of these types of work is dynamically responsive, fluctuating across time, situations, perceptions, and varied players in the total organization in order to gain some sense of equilibrium (i.e., a sense of control). 2. Because life is centered in the living body, the physiological disruptions of illness permeate other life contexts to create a new way of being, a new sense of self. Her research focuses on organization in healthcare institutions, chronic illness, and health policy. The recent Special Issue of Health Education Research highlighted 15 health intervention research projects, and in the articles each researcher was asked to describe how and why a certain theory was chosen to guide one's particular health intervention (Nigg et al., 2002b). The resultant data set consisted of 300 interviews (three interviews for each of 100 patient-family units) that were obtained at varied points in the course of chemotherapeutic treatment for cancer. Then she completed a study examining the quality management and redesign efforts in hospitals and the interplay between agencies and hospitals around the issue of accountability (Wiener, 2000). Taking charge The first major theory within sociology that analysed the role of health and illness in social life was devised by the functionalist theorist Talcott Parsons (1951) in his book The Social System. The patients and the family members were asked to recall the previous month and then discuss the most important problem or challenge with which they had to deal, the degree of distress created by that problem within the family, and their satisfaction with the management of that concern. Sampling patients who had a relatively wide range of types of cancers (ranging from gynecological cancers to lung cancer) and both patients undergoing initial chemotherapeutic treatment and those receiving treatment for recurrence contributed significantly to variation in the data set. Uncertainty Abatement Work Caring, clinical wisdom, and ethics in nursing practice, 27. Her continued excellence and significant contributions to oncology nursing are evidenced by her having been awarded the Oncology Nursing Society/Schering Excellence in Research Award (1993, 1996), the Best Original Research Paper in. Dissemination of research findings and methodological papers is a hallmark of Wiener’s work. Illness Trajectory: States of Uncertainty, Frequency: how often the experience of time is distorted (i.e., stretched out, constrained, or limitless), Taken-for-granted expectations regarding the flow of life events are disrupted. Those enacting these strategies affected the conception of self as they monitored others’ responses to the strategy as they attempted to manage living with illness. Those enacting these strategies affected the conception of self as they monitored others’ responses to the strategy as they attempted to manage living with illness. Self-regulation theory postulates that illness representations determine a person's appraisal of an illness situation and health behavior. The ill person (or patient) is the central worker; however, all work takes place within and is influenced by the total organization. Many Pacific cultures share these or similar beliefs. From this perspective, coping is best viewed as change over time that is highly variable in relation to biographical and sociological influences. When Mishel began her research into uncertainty, the concept had not previously been applied in … Dissemination of research findings and methodological papers is a hallmark of Wiener’s work. Types of work are organized around the following four lines of trajectory work performed by patients and families: See Also: Lydia Hall: Care, Cure, Core Theory. Covering up Uncertainty in Illness Theory CREDENTIALS AND BACKGROUND OF THE THEORIST. The conception of the former body (the way it used to be) comingles with the altered state of the body at present and the changed expectations for how the body may perform in the future. The patients and the family members were asked to recall the previous month and then discuss the most important problem or challenge with which they had to deal, the degree of distress created by that problem within the family, and their satisfaction with the management of that concern. chemotherapy for initial disease treatment or for recurrence. By 1977, Dodd returned to academe and completed a Ph.D. in nursing from Wayne State University. The self-regulation framework is conceptualized as a parallel processing framework. The first is a brief introduction to various criteria we use to define or distinguish between normality and abnormality. Her research trajectory has advanced impeccably as she progressively utilized both descriptive studies and intervention studies employing randomized clinical trial methodologies to extend an understanding of complex phenomena in cancer care. • Temporality: biographical time reflected in the continuous flow of the life course events; perceptions of the past, present, and possible future interwoven into the conception of self Expectations of the present self are distorted by illness and treatment. The theory has not addressed the experience of living with continual, constant uncertainty in either a chronic illness or in an illness with a treatable acute phase and possible eventual recurrence. Within this sociological framework, Wiener and Dodd address serious concerns regarding conceptual overattribution of the role of uncertainty in the framework of understanding responses to living with the disruptions of illness (Wiener & Dodd, 1993). occurred in varied combinations and configurations across the trajectory of illness for different players in the organization. Cultural historical trauma is the psychological, physical, social and cultural aftermath of the colonialism many indigenous people have experienced. Traditionally, illness was thought to be the result of an imbalance in the three anchors of the lokahi triangle (physical, mental/emotional and spiritual). Photo credit: Robert Foothorap. Dodd has been an invited speaker throughout North America, Australia, Asia, and Europe. © 2020 Stanford School of Medicine | Terms of Use | In 2003, she was awarded the Sharon A. Lamb Endowed Chair in Symptom Management at the School of Nursing, UCSF. The sphere of work includes the person and all others with whom he or she interacts, including family and healthcare providers. Skewed temporality impairs the expected life course. The trajectory is this course of change, of variability, that cannot be confined to or modeled in linear phases or stages. This network of players is called the total organization. She has produced a steady stream of research and theory articles since the mid-1970s. It looks at a more holistic look at disease examining the host instead of the invader. Her volume of original publications began in 1975. The purpose of the middle range theory of Self-Care of Chronic Illness was to capture a more holistic view of patients those with varied or multiple chronic conditions. Her continued excellence and significant contributions to oncology nursing are evidenced by her having been awarded the Oncology Nursing Society/Schering Excellence in Research Award (1993, 1996), the Best Original Research Paper in Cancer Nursing (1994, 1996), the Oncology Nursing Society Bristol-Myers Distinguished Researcher Career Award (1997), and the Oncology Nursing Society/Chiron Excellence of Scholarship and Consistency of Contribution to the Oncology Nursing Literature Career Award (2000). She teaches qualitative research methods and has conducted numerous seminars and workshops on the grounded theory method. Dodd’s outstanding record of funded research provides evidence of the superiority and significance of her work. As the data for the larger study were analyzed, it became apparent to Dodd (principal investigator) that the qualitative interview data held significant insights that could further inform the study. During her tenure there, Dodd has advanced to the rank of full professor, serving as the director for the Center for Symptom Management at UCSF. This disruption or sense of disequilibrium is marked by a sense of a loss of control, resulting in states of uncertainty. The term also refers to the cumulative emotional and psychological wounding that seems to be carried forth into successive generations and affects all aspects of health. Illness, particularly cancer, disrupts the usual or everyday conception of self and is compounded by the perceived actions and reactions of others in the sociological context of life. She is the faculty member on record for several graduate courses and carries a significant advising load in the master’s, doctoral, and postdoctoral programs at UCSF. Further, it is important to recall the size of this data set: 100 patients and families were interviewed 3 times each, for a total of 300 interviews. First, Wiener was certainly well prepared to advance new applications of the method by her training and experience as a grounded theorist. Those enacting these strategies affected the conception of self as they monitored others’ responses to the strategy as they attempted to manage living with illness. Illness-related work: diagnostics, symptom management, care regimen, and crisis prevention The dynamic flow of life contexts (both biographical and sociological) creates a dynamic flow of uncertainties that take on different forms, meanings, and combinations when living with chronic illness. These sampling strategies ultimately contributed to establishing an appropriate sample, especially for revealing a trajectory perspective of change over time. 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