This research entitled The PRO-SELF: Pain Control Program—An Effective Approach for Cancer Pain Management was published in Oncology Nursing Forum (West, Dodd, Paul, Schumacher, Tripathy et al., 2003). Finding a safe place to let down 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). 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. Many Pacific cultures share these or similar beliefs. Coping is often described as a compendium of strategies used to manage the disruption, attempts to isolate specific responses to one event that is lived within the complexity of life context, or assigned value labels (e.g., good or bad) to the responsive behaviors that are described collectively as coping. 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). She then accepted the position of assistant professor at UCSF. The sample for the larger study included 100 patients and their families. Columbia, Canada. This impressive partial listing of awards provides a sense of the magnitude of professional respect and admiration that Dodd has garnered throughout her career. These strategies were highly dynamic and responsive and occurred in varied combinations and configurations across the trajectory of illness for different players in the organization. Type of Activity . The reconceptualized uncertainty in illness theory “addresses the process that occurs when a person lives with unremitting uncertainty found in chronic illness or in illness with a potential for recurrence . If sociology is the systematic study of human behavior in society, medical sociology is the systematic study of how humans manage issues of health and illness, disease and disorders, and healthcare for both the sick and the healthy. It should be noted that traditional grounded theory methods typically involve a concurrent, reiterative process of data collection and analysis (Glaser, 1978; Glaser & Strauss, 1965).  Jeopardized body resistance This is a very large data set for a qualitative inquiry. Conceptions of self are rooted in the physical body and are formulated based on the perceived capability to perform usual or expected activities to accomplish the objectives of varied roles. “The uncertainty surrounding a chronic illness like cancer is the uncertainty of life writ large. • Body: activities of life and derived perceptions based in the body She then accepted the position of assistant professor at UCSF. Maternal role attainment becoming a mother. 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.  Disease recurrence Studies in Hawaii and other islands have suggested that a return to traditional diets, focused on staples such as taro, breadfruit, and sweet potato, could help lower serum cholesterol, blood sugar levels and other obesity related conditions. But the sheer size of the data set does not tell the whole story. The trajectory is this course of change, of variability, that cannot be confined to or modeled in linear phases or stages. It encouraged cleanliness and paved the way for public health reform. The experience of illness always is placed within the biographical context, that is, illness is experienced in the continual flow of the life. . Faith in the body is shaken (body failure). Interpretation of self is distorted as the body fails to perform in usual ways, and expectations related to the flow of events (temporality) are altered by disease and treatment. Uncertainty Abatement Work It looks at a more holistic look at disease examining the host instead of the invader. Interviews were structured around family coping and were conducted at three points during chemotherapeutic treatment. In 2002, she instituted two new courses (“Biomarkers I and II”) developed by the Center for Symptom Management Faculty Group. Health beliefs and compliance with prescribed medication for hypertension among black women—New Orleans, 1985–86. Her volume of original publications began in 1975. Dodd worked as an instructor in nursing at University of Washington following graduation with her master’s degree. The trajectory is this course of change, of variability, that cannot be confined to or modeled in linear phases or stages. The audiotaping and verbatim transcription of these dialogues contributed to the variation and appropriateness of the resultant data set. Faith in the body is shaken (body failure). Conceptions of self are rooted in the physical body and are formulated based on the perceived capability to perform usual or expected activities to accomplish the objectives of varied roles. Specifically, Native Hawaiians have the highest incidence of morbidity and mortality and the highest age-adjusted mortality of any ethnic group in Hawai’i (Anderson et al., 2006). Among these honors, she was recognized as a fellow of the American Academy of Nursing (1986). He or she cannot be divided into parts, and … Dissemination of research findings and methodological papers is a hallmark of Wiener’s work. Changes related to illness and treatment centered in one’s ability to perform usual activities, involving appearance, physiological functions, and response to treatment She returned to UCSF to pursue her doctorate in sociology and completed her Ph.D. in 1978. Healing traditions addressed all three and healing occurred in a very holistic way. Wiener’s expertise in grounded theory methods permitted the adaptation of grounded theory methods for application to secondary data that proved successful. 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). These strategies were highly dynamic and responsive and occurred in varied combinations and configurations across the trajectory of illness for different players in the organization. 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 Wiener is an adjunct professor and research sociologist in the Department of Social and Behavioral Sciences at the School of Nursing at UCSF. As life contexts continually unfold, dimensions of uncertainty are manifest, not in a linear sequence of stages or phases, but in an unsettling intermingling of perceptions of the uncertain body, uncertain temporality, and uncertain identity. Photo credit: Robert Foothorap. The analytical inquiry proceeded inductively to reveal the core socialpsychological process around which the theory is explicated: tolerating the uncertainty of living with cancer. Evidence gleaned from reading the body is not interpretable within the usual frame of understanding. Dodd’s illustrious career has merited several prestigious awards. Resting or changing usual activities Marylin J. Dodd 1946-present Photo credit: Craig Carlson. 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. Currently, she teaches in the Oncology Nursing Specialty. Her research focuses on organization in healthcare institutions, chronic illness, and health policy. As the nature of the American health care system, chronic illness, and nursing change, theoretical models used to guide nursing management of chronic conditions must be updated to keep abreast of these changes, while still retaining their core concepts. Ambiguity in reading body signs Concerns surrounding: The key concepts include self-care maintenance, self-care monitoring, and self-care management. 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, The activities of life and of living with an illness are forms of work. This network of players is called the total organization. Rather, the trajectory of illness organizes insights to better understand the dynamic interplay of the disruption of illness within the changing contexts of life. Meticulous attention was paid to consistency in data collection: family members were consistent and present for each interview, the interview guide was structured, and the same nurse-interviewer conducted each data collection point for a given family. Behavioral Manifestations This theoretical approach defines this theory’s significant contribution to nursing: coping is not a simple stimulus-response phenomenon that can be isolated from the complex context of life. From this perspective, coping is best viewed as change over time that is highly variable in relation to biographical and sociological influences. Skewed temporality impairs the expected life course. In 2005, Dodd received the prestigious Episteme Laureate (the Nobel Prize in Nursing) Award from the Sigma Theta Tau International Honor Society of Nursing. Wiener, a grounded theorist who collaborated with Anselm Strauss, one of the method’s founders, was subsequently recruited to conduct a secondary analysis of interview data. 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. Each patient had been diagnosed with cancer (including breast, lung, colorectal, gynecological, or lymphoma) and was in the process of receiving. Such disruption affects all aspects of life, including physiological functioning, social interactions, and conceptions of self. Oberst pointed out that given this volume of data, some semblance of theoretical sampling (within the full data set) would likely be permitted by the researchers (Oberst, 1993). Carolyn L. Wiener Her active service to the university, School of Nursing, Department of Physiological Nursing, and to numerous professional and public organizations and journal review boards augments her outstanding record of service to the profession of nursing. When identifying a theory or model to guide health promotion or disease prevention programs, it is important … Wiener’s expertise in grounded theory methods permitted the adaptation of grounded theory methods for application to secondary data that proved successful. It should be noted that traditional grounded theory methods typically involve a concurrent, reiterative process of data collection and analysis (Glaser, 1978; Caring, Clinical Wisdom, and Ethics in Nursing Practice, 9. Personalistic Causes. Her many presentations at scientific gatherings around the world accentuate this work. Wiener received her master’s degree in sociology from the University of California, San Francisco (UCSF) in 1975. By listening to those who are tolerating this exaggerated uncertainty, we can learn much about the trajectory of living.” (Wiener & Dodd, 1993, p.29) With this brief overview of but a few highlights in an amazing career, it is clear that Dodd is an exemplar of excellence in nursing scholarship. After receiving a Ph.D., Wiener accepted the position of assistant research sociologist at UCSF. An old adage tells us that nothing in life is certain, except death and taxes. By 1977, Dodd returned to academe and completed a Ph.D. in nursing from Wayne State University. All of this work is grounded in her strong methodological expertise and sociological perspective. Expected life course is shattered. She earned her bachelor’s degree in interdisciplinary social science from San Francisco State University in 1972. As the body changes through the course of illness and treatment, the capacity to perform certain types of work and, ultimately, one’s identity are transformed. Looking toward the future to achieve desired activities Responses to the disruptions caused by illness are interwoven into the various contexts encountered in one’s life and the interactions with other players in those life situations. Despite the breadth and volume of these activities, Dodd is an active teacher and mentor. Uncertainty abatement work: activities enacted to lessen the impact of temporal, body, and identity uncertainty. This disruption or sense of disequilibrium is marked by a sense of a loss of control, resulting in states of uncertainty. It should be noted that traditional grounded theory methods typically involve a concurrent, reiterative process of data collection and analysis (Glaser, 1978; Glaser & Strauss, 1965). 1. Wiener received her master’s degree in sociology from the University of California, San Francisco (UCSF) in 1975. Consequently, rates of cardiovascular disease, obesity and diabetes are all increasing (National Institutes of Health & National Heart Lung and Blood Institute (NHLBI), 2000). “The theory of health as expanding consciousness (HEC) was stimulated by concern for those for whom health as the absence of disease or disability is not possible. She has authored or coauthored 130+ data-based peer-reviewed journal articles, seven books and many book chapters, and numerous editorials, conference proceedings, and review papers (1978, 1987, 1988, 1991, 1997, 2001). She qualified as a registered nurse after studying at the Vancouver General Hospital, British, Dodd’s research was designed to test self-care interventions (PRO-SELF Program) to manage the side effects of cancer treatment (mucositis) and symptoms of cancer (fatigue, pain). She continued her education, earning a bachelor’s and a master’s degree in nursing from the University of Washington in 1971 and 1973, respectively. Diseases are examined and compared based on the traditional medicine, economics, religion, and culture that is specific to each region. Carolyn L. Wiener was born in 1930 in San Francisco. In 2003, she was awarded the Sharon A. Lamb Endowed Chair in Symptom Management at the School of Nursing, UCSF. This interplay among the types of work creates a tension that is marked by shifts in the dominance of types of work across the trajectory. Many Hispanic, African American, and Arab groups also embrace the hot/cold theory of health and illness. Currently, the prevalence of obesity in Native Hawaiians is 69.3% (Anderson et al., 2006). 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. This technique would allow the subjects to introduce almost any topic that was of concern to them (regardless of the subsequent structure of the interview). Dodd’s illustrious career has merited several prestigious awards. Taken-for-granted expectations regarding the flow of life events are disrupted 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. Dodd’s record in research dissemination is equally illustrious. Dodd’s research was designed to test self-care interventions (PRO-SELF Program) to manage the side effects of cancer treatment (mucositis) and symptoms of cancer (fatigue, pain). Covering up Balancing expertise with super-medicalization Dodd’s outstanding record of funded research provides evidence of the superiority and significance of her work. She continued her education, earning a bachelor’s and a master’s degree in nursing from the University of Washington in 1971 and 1973, respectively. The UCSF School of Nursing Annual Publication, The Science of Caring, 13(1), 7.  Efficacy and risks of treatment 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 continued her education, earning a bachelor’s and a master’s degree in nursing from the University of Washington in 1971 and 1973, respectively. It received much publicity, and has become a classic, well known as an argument against the tendency of psychiatrists to label people who are "disabled by living" as "mentally ill". Carolyn L. Wiener 1930-present Photo credit: Robert Foothorap. Currently, she teaches in the Oncology Nursing Specialty. CHAPTER 30 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. 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. She earned her bachelor’s degree in interdisciplinary social science from San Francisco State University in 1972. From the late 1980s to 1990s, Wiener focused on coping, uncertainty, and accountability in hospitals. Illness-related work: diagnostics, symptom management, care regimen, and crisis prevention She teaches qualitative research methods and has conducted numerous seminars and workshops on the grounded theory method. The pioneer nurse Florence Nightingale (1820-1910) firmly believed in miasmas and became celebrated for her work in making hospitals clean, fresh and airy. Responses to the disruptions caused by illness are interwoven into the various contexts encountered in one’s life and the interactions with other players in those life situations. This article describes a middle-range theory of self-care that addresses the process of maintaining health with health promoting practices within the context of the management required of a chronic illness. 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. This research entitled The PRO-SELF: Pain Control Program—An Effective Approach for Cancer Pain Management was published in, Dodd’s illustrious career has merited several prestigious awards. From this perspective, coping is best viewed as change over time that is highly variable in relation to biographical and sociological influences. 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). From (2001). Table 30-2 “ The Spoon Theory ”, a personal story by Christine Miserandino, is popular among many people dealing with chronic illness. . 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). Uncertainty abatement work: activities enacted to lessen the impact of temporal, body, and identity uncertainty Dodd has been an invited speaker throughout North America, Australia, Asia, and Europe. Types of work are organized around the following four lines of trajectory work performed by patients and families: Living is fraught with uncertainty, yet illness (especially chronic illness) compounds this uncertainty in profound ways. Among these honors, she was recognized as a fellow of the American Academy of Nursing (1986). However, in this project, the data were collected previously using a structured interview guide; this was a secondary analysis of an established data set. 3. These activities were enacted to lessen the impact of the varied states of uncertainty induced by undergoing cancer chemotherapy. 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. . This interplay among the types of work creates a tension that is marked by shifts in the dominance of types of work across the trajectory. The first is a brief introduction to various criteria we use to define or distinguish between normality and abnormality. Illness Trajectory: States of Uncertainty Cardiovascular and cerebrovascular disease, Chronic Kidney Disease and End Stage Renal Disease. She returned to UCSF to pursue her doctorate in sociology and completed her Ph.D. in 1978. Anticipation of the future self is altered. The domains of illness-related uncertainty vary in dominance across the illness trajectory (Table 30-1) through a dynamic flow of perceptions of self and interactions with others. A major contribution of this work was the delineation of types of uncertainty abatement work (Table 30-2). Parsons did not disagree with the dominance of the medical model of health in determining illness, yet Using evidence-based medical nutrition therapy along side cutting-edge testing we provide a personalized plan to assist clients in achieving their health and wellness goals. The sample for the larger study included 100 patients and their families. Her research focuses on organization in healthcare institutions, chronic illness, and health policy. Healing traditions addressed all three and healing occurred in a very holistic way. Dimensions of Uncertainty 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. In this model, the human is unitary. 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. Selective sharing with individuals deemed to be positive supporters Brain defects or injury: Defects in or injury to certain areas of the brain have also been linked to … Many health disparities suffered by Native Hawaiians today are thought to have their origins in what is referred to as “cultural historical trauma” (Blaisdell, 1996). USE OF EMPIRICAL EVIDENCE This “cultural wounding” can result in communal feelings of disruption and a sense of collective helplessness, which can in turn impact one’s “sense of self” and health seeking behaviors. Everyday-life work: activities of daily living, keeping a household, maintaining an occupation, sustaining relationships, and recreation, 3. From (2001). Such disruption affects all aspects of life, including physiological functioning, social interactions, and conceptions of self. 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. After receiving a Ph.D., Wiener accepted the position of assistant research sociologist at UCSF. Domain There are several theories and models that support the practice of health promotion and disease prevention. In essence, the principles under-girding analysis (i.e., the coding paradigm) were applied to the preexisting data set. This theoretical approach defines this theory’s significant … She has produced a steady stream of research and theory articles since the mid-1970s. First, Wiener was certainly well prepared to advance new applications of the method by her training and experience as a grounded theorist. Caring, clinical wisdom, and ethics in nursing practice, 27. The audiotaping and verbatim transcription of these dialogues contributed to the variation and appropriateness of the resultant data set. Life is situated in a biographical context. Becoming “professional” patients This is a very large data set for a qualitative inquiry. Life is perceived to be in a constant state of flux related to illness and treatment. Her active service to the university, School of Nursing, Department of Physiological Nursing, and to numerous professional and public organizations and journal review boards augments her outstanding record of service to the profession of nursing. This network of players is called the, A major contribution of this work was the delineation of types of uncertainty abatement work (Table 30-2). By the early 1980s, she was publishing multiple, focused articles each year, and that pace has only accelerated. 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). The UCSF School of Nursing Annual Publication. As an example of how westernization has affected the lifestyle of many Native Hawaiians, consider how the traditional diet, which was low in fat and high in complex carbohydrates, has changed to a typically western diet, high in fat and low in complex carbohydrates (Blaisdell, 1993, 1996). Life is situated in a biographical context. By the early 1980s, she was publishing multiple, focused articles each year, and that pace has only accelerated. Biographical work: the exchange of information, emotional expressions, and the division of tasks through interactions within the total organization Personalistic causes are associated with social punishment or retribution … Bucking up to avoid stigma or to protect others 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). Pacing 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. Comparing self with persons who are in worse condition to reassure self that it is not as bad as it could be Changes related to illness and treatment centered in one’s ability to perform usual activities, involving appearance, physiological functions, and response to treatment. Masking signs of illness or related emotions Illness Theory #1: Every illness has a cause. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Throughout her career, Wiener’s excellence has earned for her several meritorious awards and honors. In 2003, she was awarded the Sharon A. Lamb Endowed Chair in Symptom Management at the School of Nursing, UCSF. In addition, she has authored or coauthored several books (Strauss, Fagerhaugh, Suczek, & Wiener, 1997; Marylin J. Dodd was born in 1946 in Vancouver, Canada. Recall, however, that the biographical context is rooted in the body. Sources of Uncertainty In other words, the trajectory of illness is driven by the illness experience lived within contexts that are inherently uncertain and involve both the self and others. © 2020 Stanford School of Medicine | Terms of Use | 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. Sociological Theories of Health and Illness Functionalist View of Health and Illness Functionalism considers how health and illness impact social order, as well as the roles of patients and health care providers. This disruption or sense of disequilibrium is marked by a sense of a loss of control, resulting in states of uncertainty. Wiener is an adjunct professor and research sociologist in the Department of Social and Behavioral Sciences at the School of Nursing at UCSF. Nurses often relate to such people: people facing the uncertainty, debilitation, loss and eventual death associated with chronic illness. The experience of illness always is placed within the biographical context, that is, illness is experienced in the continual flow of the life. 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. 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