IMPLICATIONS FOR NURSING
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 problems.
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.