Seeking reinforcing comparisons Interactions with others are a major influence on the establishment of the conception of self. Traditionally, illness was thought to be the result of an imbalance in the three anchors of the lokahi triangle (physical, mental/emotional and spiritual). She has produced a steady stream of research and theory articles since the mid-1970s. As varied role behaviors are enacted, the person monitors reactions of others and a sense of self in an integrated process of establishing meaning. He or she cannot be divided into parts, and … In this model, the human is unitary. Changes related to illness and treatment centered in one’s ability to perform usual activities, involving appearance, physiological functions, and response to treatment. 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 trajectory is this course of change, of variability, that cannot be confined to or modeled in linear phases or stages. Biographical work: the exchange of information, emotional expressions, and the division of tasks through interactions within the total organization, 4.  Duration: how long First, Wiener was certainly well prepared to advance new applications of the method by her training and experience as a grounded theorist. By the early 1980s, she was publishing multiple, focused articles each year, and that pace has only accelerated. Labeling Theory on Health and Illness. Medical sociologists study the physical, mental, and social components of health and illness. 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. Functionalism is a theoretical approach that sees society as an interconnected system of … Identity, temporality, and body are key elements in the biographical context, as follows: • Identity: the conception of self at a given time that unifies multiple aspects of self and is situated in the body, • 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, • Body: activities of life and derived perceptions based in the body. Biographical work: the exchange of information, emotional expressions, and the division of tasks through interactions within the total organization She is highly sought as a methodological consultant to researchers and students from a variety of specialties. Evidence gleaned from reading the body is not interpretable within the usual frame of understanding. 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. Pacing 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. Covering up Such disruption affects all aspects of life, including physiological functioning, social interactions, and conceptions of self. See Also: Lydia Hall: Care, Cure, Core Theory. This disruption or sense of disequilibrium is marked by a sense of a loss of control, resulting in states of uncertainty. The analytical inquiry proceeded inductively to reveal the core socialpsychological process around which the theory is explicated: tolerating the uncertainty of living with cancer. However, in this project, the data were collected previously using a structured interview guide; this was a secondary analysis of an established data set. Becoming “professional” patients Types of work are organized around the following four lines of trajectory work performed by patients and families: Marylin J. Dodd was born in 1946 in Vancouver, Canada. She returned to UCSF to pursue her doctorate in sociology and completed her Ph.D. in 1978. Her volume of original publications began in 1975. Because the processes surrounding the disruption of illness are played out in the context of living, coping responses are inherently situated in sociological interactions with others and biographical processes of self. Personalistic Causes. Many Hispanic, African American, and Arab groups also embrace the hot/cold theory of health and illness. • Body: activities of life and derived perceptions based in the body Dodd’s outstanding record of funded research provides evidence of the superiority and significance of her work. 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.  Disease recurrence After receiving a Ph.D., Wiener accepted the position of assistant research sociologist at UCSF. 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 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. Supported by Looking back to reinterpret emergent symptoms and interactions with others in the organization Thus, tolerating uncertainty is a critical theoretical strand in the illness trajectory theory. 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. Personalistic causes are associated with social punishment or retribution … Uncertainty abatement work: activities enacted to lessen the impact of temporal, body, and identity uncertainty 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. 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. Her research focuses on organization in healthcare institutions, chronic illness, and health policy. The sample for the larger study included 100 patients and their families. Anticipation of the future self is altered. Her many presentations at scientific gatherings around the world accentuate this work. She qualified as a registered nurse after studying at the Vancouver General Hospital, British Columbia, Canada. These activities were enacted to lessen the impact of the varied states of uncertainty induced by undergoing cancer chemotherapy. 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). Interviews were structured around family coping and were conducted at three points during chemotherapeutic treatment. 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. Cultural historical trauma is the psychological, physical, social and cultural aftermath of the colonialism many indigenous people have experienced. 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. Dodd’s record in research dissemination is equally illustrious. 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). Her many presentations at scientific gatherings around the world accentuate this work. The yin/yang theory is the basis for Eastern or Chinese medicine and is embraced by some Asian Americans. There are several theories and models that support the practice of health promotion and disease prevention. As varied role behaviors are enacted, the person monitors reactions of others and a sense of self in an integrated process of establishing meaning. 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. In essence, the principles under-girding analysis (i.e., the coding paradigm) were applied to the preexisting data set. THEORETICAL SOURCES She qualified as a registered nurse after studying at the Vancouver General Hospital, British Columbia, Canada. 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. These sampling strategies ultimately contributed to establishing an appropriate sample, especially for revealing a trajectory perspective of change over time. Dissemination of research findings and methodological papers is a hallmark of Wiener’s work. 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 . She then accepted the position of assistant professor at UCSF. Developed the Care, Cure, Core Theory … It encouraged cleanliness and paved the way for public health reform. 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. Carolyn L. Wiener was born in 1930 in San Francisco. A temporal disjunction in the biography 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. Throughout her career, Wiener’s excellence has earned for her several meritorious awards and honors. 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). When considering the authors’ use of adapted grounded theory methods to analyze preexisting empirical evidence, several insights may be useful to support the integrity of this work. Each patient had been diagnosed with cancer (including breast, lung, colorectal, gynecological, or lymphoma) and was in the process of receiving chemotherapy for initial disease treatment or for recurrence. 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. Although both quantitative and qualitative measures were used in data collection for the larger study, this theory was derived through analysis of the qualitative data. 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). The sociology of health and illness requires a global approach of analysis because the influence of societal factors varies throughout the world. 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). 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 impressive partial listing of awards provides a sense of the magnitude of professional respect and admiration that Dodd has garnered throughout her career. CREDENTIALS OF THE THEORISTS 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. Taken-for-granted expectations regarding the flow of life events are disrupted She then accepted the position of assistant professor at UCSF. Carolyn L. Wiener was born in 1930 in San Francisco. All of this work is grounded in her strong methodological expertise and sociological perspective. Setting goals is a growth to a new value system” (Clayton et al., 2018, p 49). Interviews were structured around family coping and were conducted at three points during chemotherapeutic treatment. CHAPTER 30 Currently, the prevalence of obesity in Native Hawaiians is 69.3% (Anderson et al., 2006). The experience of illness always is placed within the biographical context, that is, illness is experienced in the continual flow of the life. Bucking up to avoid stigma or to protect others Dodd has been an invited speaker throughout North America, Australia, Asia, and Europe. 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. Such disruption affects all aspects of life, including physiological functioning, social interactions, and conceptions of self. This disruption or sense of disequilibrium is marked by a sense of a loss of control, resulting in states of uncertainty. 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 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. Photo credit: Robert Foothorap. Many Pacific cultures share these or similar beliefs. Lydia E. Hall. Assumptions and propositions of the theory are specified. 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. The methodological credibility of this researcher supports her extension of a traditional research method into a new application within her disciplinary perspective (sociology). The analytical inquiry proceeded inductively to reveal the core socialpsychological process around which the theory is explicated: tolerating the uncertainty of living with cancer. The audiotaping and verbatim transcription of these dialogues contributed to the variation and appropriateness of the resultant data set. Dodd has been an invited speaker throughout North America, Australia, Asia, and Europe. The sample for the larger study included 100 patients and their families. Changes related to illness and treatment centered in one’s ability to perform usual activities, involving appearance, physiological functions, and response to treatment Type of Activity When identifying a theory or model to guide health promotion or disease prevention programs, it is important … In addition, she has authored or coauthored several books (Strauss, Fagerhaugh, Suczek, & Wiener, 1997; Marylin J. Dodd was born in 1946 in Vancouver, Canada. In 2005, Dodd received the prestigious Episteme Laureate (the Nobel Prize in Nursing) Award from the Sigma Theta Tau International Honor Society of Nursing. Janice Penrod, Lisa Kitko and Chin-Fang Liu, “The uncertainty surrounding a chronic illness like cancer is the uncertainty of life writ large. Dodd worked as an instructor in nursing at University of Washington following graduation with her master’s degree. 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. The activities of life and of living with an illness are forms of work. Currently, she teaches in the Oncology Nursing Specialty. Marylin J. Dodd was born in 1946 in Vancouver, Canada. The sphere of work includes the person and all others with whom he or she interacts, including family and healthcare providers. The sphere of work includes the person and all others with whom he or she interacts, including family and healthcare providers. 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. Illness Trajectory: States of Uncertainty Coping is the response to such disruption. 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. She teaches qualitative research methods and has conducted numerous seminars and workshops on the grounded theory method. As theoretical insights are identified, sampling and the focus of subsequent data collection theoretically are driven to flesh out emergent concepts, dimensions, variations, and negative cases. Maternal role attainment becoming a mother. 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. Wiener is an adjunct professor and research sociologist in the Department of Social and Behavioral Sciences at the School of Nursing at UCSF. Although the miasma theory proved incorrect, it represented some recognition of the relation between dirtiness and disease. MMWR Morb Mortal Wkly … Cardiovascular and cerebrovascular disease, Chronic Kidney Disease and End Stage Renal Disease. Subjects in the study designated at least one family member who was willing to participate in the study. Being chronically ill exaggerates the uncertainties of living within being for those who are compromised (i.e., by illness) in their capability to respond to these uncertainties. Theories and models are used in program planning to understand and explain health behavior and to guide the identification, development, and implementation of interventions. The UCSF School of Nursing Annual Publication, The Science of Caring, 13(1), 7. The first is a brief introduction to various criteria we use to define or distinguish between normality and abnormality. 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. In her early efforts, Wiener focused on illness trajectories, biographies, and the evolving medical technology scene. The ill person (or patient) is the central worker; however, all work takes place within and is influenced by the total organization. As theoretical insights are identified, sampling and the focus of subsequent data collection theoretically are driven to flesh out emergent concepts, dimensions, variations, and negative cases. All of this work is grounded in her strong methodological expertise and sociological perspective. 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. “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. Types of work are organized around the following four lines of trajectory work performed by patients and families: 1. USE OF EMPIRICAL EVIDENCE This network of players is called the total organization. Marylin J. Dodd 1946-present Photo credit: Craig Carlson. Illness-related work: diagnostics, symptom management, care regimen, and crisis prevention, 2. From the late 1980s to 1990s, Wiener focused on coping, uncertainty, and accountability in hospitals. After receiving a Ph.D., Wiener accepted the position of assistant research sociologist at UCSF. 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. Despite the breadth and volume of these activities, Dodd is an active teacher and mentor. 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. Using terminology related to illness and treatment Body failure and difficulty reading the new body upset the former conception of self. [ 2] F 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 (2001). Uncertainty Abatement Work Currently, she teaches in the Oncology Nursing Specialty. The desired outcome . 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). UNCERTAIN IDENTITY By 1977, Dodd returned to academe and completed a Ph.D. in nursing from Wayne State University. She returned to UCSF to pursue her doctorate in sociology and completed her Ph.D. in 1978. 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