Working with people with chronic illness or disability requires not just
dealing with the medical aspects of their disorder, but also working with the
whole person, physically, emotionally, and socially (Dean, 1999). This holistic
approach to care requires nurses to draw upon their entire repertoire of
knowledge and skills, including knowledge from the social sciences, psychology
in particular. People often respond to illness, health teaching, and regimens
in ways that are different from the expectations of health care providers.
Although quality of life is usually affected by chronic illness, especially if
the illness is severe (Schlenk, Erlen, Dunbar-Jacob et al., 1998), patients’
perceptions of what consti-tutes quality of life often drive their management
behaviors. Nurses and other health care professionals need to recognize this,
even though it may be difficult to see patients make unwise choices and
decisions about lifestyles and disease management. Individ-uals have the right
to receive care without fearing ridicule or re-fusal of treatment, even if they
caused their medical conditions through their own indiscretions, such as
smoking or failure to follow therapeutic regimens.
As stated previously, chronic conditions have a course, although that
course might be too uncertain to predict with any degree of accuracy. An
illness course can be thought of as a trajectory— a course—that can be managed
or shaped over time to some ex-tent through proper illness management
strategies (Robinson, Bevil, Arcangelo et al., 2001; Strauss & Corbin,
1988; Woog, 1992). The trajectory of an illness can also be divided into phases
that enable more precise thinking about a person’s condition. This enables the
nurse to put the present situation into the con-text of what might have
happened to the patient in the past—that is, the life factors and
understandings that might have contributed to the present state of the illness.
In this way, nurses can more readily address the underlying issues and
Each phase of chronic illness brings with it different problems, both
medical and psychosocial. The needs of a stroke patient who is a good candidate
for rehabilitation, for example, are very dif-ferent from those of a patient
with terminal cancer. By thinking in terms of phases, and individual patients
within a phase, nurses can target their care more specifically to each person.
Not every chronic condition is necessarily life-threatening, and not every
patient passes through each possible phase of a chronic condition.