Chronic Illness Trajectory Framework Research Articles

Developmental trajectory of care dependency in older stroke patients.

Stroke is the leading cause of death in China. Older stroke survivors often have other chronic conditions, not only musculoskeletal deterioration due to age, but also changes in body image that can be brought on by stroke and other diseases, making them unable to take good care of themselves and dependent on others. The degree of dependency affects the rehabilitation progress of stroke survivors and shows dynamic changes that need to be recognized. This study investigates the trajectory of dependency changes in older stroke patients with comorbidities and analyze the influencing factors. Grounded in the Chronic Illness Trajectory Framework (CITF), a longitudinal study was conducted from February 2023 to October 2023, tracking 312 older stroke patients with comorbidities admitted to two tertiary hospitals in Guangzhou. Care dependency levels were assessed using Care Dependency Scale on admission day 5 (T0), at discharge (T1), 1 month post-discharge (T2), and 3 months post-discharge (T3). Growth Mixture Model were utilized to identify trajectory categories, and both univariate analysis and multivariate logistic regression methods were employed to explore factors associated with different developmental trajectories. A total of four developmental trajectories were fitted, C1 (high independence-slow increased group, 52.0%), C2 (moderate independence-rapid increased group, 13.0%), C3 (moderate independence-slow increased group, 25.0%), and C4 (low independence-increased and decreased group, 10.0%). Length of hospital stay, place of residence, level of social support, residual functional impairments, NIHSS score, and BI index independently influence the trajectory categories. There is heterogeneity in care dependency among older stroke patients with comorbidities. Most patients gradually reduce their dependency and become more independent, but others remain dependent for an extended period of time. It is recommended to focus on patients who live in rural areas, have low social support, have high admission NIHSS scores and have residual functional impairment, and provide them with personalized continuity of care and rehabilitation services in order to reduce care dependency and the burden of care, and to improve patients' quality of life.

Nursing practice for a patient with chronic respiratory failure based on the chronic illness trajectory framework

Nursing practice for a patient with chronic respiratory failure based on the chronic illness trajectory framework

Coping Processes of Patients with Ostomies in South Korea: A Focus Group Study.

Despite the adverse effects of negative coping after receiving a stoma, there is a lack of information on how patients cope with ostomies and on their families’ experiences throughout the coping process. We aimed to explore the coping experiences of individuals with ostomies throughout their illness, applying the Corbin and Strauss Chronic Illness Trajectory Framework, using exploratory qualitative methods involving focus group interviews. Purposive sampling was utilized to recruit 19 participants (split across three groups) through an ostomy association in South Korea. Two focus group interviews were separately conducted from March through to May 2017 until data saturation was achieved. Using qualitative content analysis, we analyzed the transcribed interviews and identified words and themes to interpret the results. The coping experiences of patients with ostomies were expressed through three interrelated themes: struggling and suffering, learning how to live with ostomy, and living with ostomy. We found gender differences in spousal support and a struggle among older patients regarding social coping. The themes identified suggest that gender should be considered when designing interventions to help patients cope with ostomies.

Nurses' experiences of caring for patients during a prolonged critical illness.

The literature regarding nurses' experiences of caring for chronically critically ill (CCI) patients is scant, however, there are subtleties within the literature, identifying nurses are often challenged providing care to this patient group. This can lead to feeling frustrated, lack of control, and distress. As part of a larger study, this paper reports nurses' experiences of caring for patients during a prolonged critical illness in the intensive care unit (ICU). A longitudinal, qualitative, instrumental, multi-case study consisting of six cases from four New Zealand ICUs was conducted. Theoretical underpinnings were informed by the Chronic Illness Trajectory Framework. The principles of consolidated criteria for reporting qualitative research were applied in reporting the methods and findings. Patients, family members, nurses, and other health care professionals constituted the participant groups in the larger body of work. Data were collected from observations, conversations, interviews, and document review. Data were analysed by identifying themes, developing vignettes, and trajectory mapping. Nurses' experiences of caring for CCI patients in the ICU can be framed by a prolonged critical illness trajectory that is unpredictable, problematic, and prolonged. Nurses experienced distress in one of the phases in the trajectory because of uncertainty about a positive outcome for the patient related to multiple complications, with anxiety, delirium, and the suffering they witnessed. Nurses were frustrated and challenged to meet all the patient's needs because of the many tasks they needed to complete over the shift. Understanding the trajectory of a prolonged critical illness from the perspective of nurses, allows for challenges to be identified and is the first step in improving practice through the education of nurses. Understanding the challenges posed by caring for CCI patients will assist in improving their interactions and prioritizing their care for nurses.

Using multiple participants and longitudinal design to understand the complexity of a prolonged critical illness

Introduction: Contemporary ICU care enables critically ill patients to survive, however those who experience multi-organ failure and other complications now require that care for a prolonged period. It is only when we understand the total illness experience from patients’ and families’ perspectives, as well as the complexity of care for healthcare professionals that we can fully engage in developing services and promoting evidence-based practice to improve broad health outcomes and experiences for all groups. However, this range of perspectives as experienced throughout a prolonged patient ICU stay are rarely investigated in a single study. Objectives/Aims: This presentation focuses on selected findings, revealed through the use of a longitudinal design with multiple participant groups during a prolonged critical illness in the ICU. Methods: A longitudinal, qualitative, multi-case study approach was used, informed by the Chronic Illness Trajectory Framework. The trajectory concept recognises illness as a course, which can be altered by an interplay of medical, social, political, economic, biographical and psychological forces. Data collection involved six linked cases (patient, family and clinicians) in four New Zealand ICUs. Results: Longitudinal data analysis revealed four sub-phases in the trajectory of a prolonged critical illness. These sub-phases were determined by the patients’ physiological condition, with each sub-phase also representing different psychosocial needs. Families’ trajectories and nurses’ work were dominated by the patients’ trajectories with sub-phases representing different challenges for all participant groups. Conclusion: The longitudinal nature of this study with three participant groups provides a comprehensive understanding of prolonged critical illness that would never have been revealed if data collection occurred retrospectively or at a snapshot in time. Although ethically challenging, longitudinal qualitative designs reveal the interplay of factors that inform people’s experiences throughout the illness trajectory.

A qualitative multicase study of the trajectories of prolonged critical illness: Patient, family, and healthcare professionals’ experiences

BackgroundContemporary intensive care enables many critically ill patients to survive their initial illness; however, a small group of patients require a protracted stay in the intensive care unit (ICU), experiencing many complications throughout their illness. It is only when we understand the total illness experience from patients' and families’ perspectives, as well as the complexity of care for healthcare professionals, that we can fully engage in developing services and promoting evidence-based practice to improve broad health outcomes and experiences for all groups. ObjectiveThe objective of this study was to explore the trajectories of a prolonged critical illness in an ICU from the experiences of the patient, their family, and the healthcare professionals who provide care. MethodsThis was a longitudinal, qualitative, multicase study of six cases from four New Zealand ICUs. Theoretical underpinnings were informed by the Chronic Illness Trajectory Framework. Each case consisted of the patient, their family members, and nurses and other healthcare professionals who provided care. Data collection methods included observations, conversations, interviews, and document review. Data were analysed using thematic analysis and trajectory mapping. ResultsRegardless of the patient's admitting diagnosis, the trajectory of a prolonged critical illness is made up of common phases, determined by the patient's physiological condition. However, all subphases represented different psychosocial needs. The patients' debilitated state made them susceptible to complications and added to the complexity of their trajectory. The family's trajectory was informed by the patient's trajectory, and uncertainty dominated throughout. Each phase of the illness presented different challenges for healthcare professionals as they cared for this complex group of patients. ConclusionThe study highlights the distinct phases of a prolonged critical illness. Knowledge of these phases provides the ground work for improving care, not only for patients but also for their family and the healthcare professionals who provided care.

Self-care behaviours and trajectory management by people with scleroderma in northeastern Thailand.

Scleroderma, particularly systemic sclerosis, is a chronic illness that affects a person's physical, emotional, psychosocial, and spiritual dimensions. To investigate self-care deficits, health behaviours, and trajectory management of Thai people with systemic sclerosis, an exploratory case study method was used through interviews and patient records. Self-care deficit nursing theory and the chronic illness trajectory framework guided the research. Twelve patients with systemic sclerosis were purposively recruited at a hospital clinic in the northeastern region of Thailand. Thai people living with systemic sclerosis developed specific self-care agencies in each of 3 identified trajectory patterns to improve their health and well-being. By applying the theory and framework that guided the research, nurses can promote self-care behaviours and recognize situations along an illness trajectory that require intervention and management. The results extend the understanding of how people live and cope with systemic sclerosis.

Experiences of patients prior to operation with recurrent glioma based on the Corbin and Strauss chronic illness trajectory framework: a qualitative study

Objective To understand the experiences of patients prior to operation with recurrent glioma based on the Corbin and Strauss chronic illness trajectory framework. Methods Fourteen patients participated in the semi-structure interviews. Data were analyzed with Colaizzi's phenomenological procedure. Results Based on the Corbin and Strauss chronic illness trajectory framework, experiences of patients prior to operation with recurrent glioma were extracted. (1) Illness-related work including severe symptoms of illness and lack of knowledge of illness. (2) Biographical work including loss of biography and identity of self. (3) Everyday life work including change of social roles, complicated mood combined negative experience and positive experience, heavy economic burden. Conclusions Nursing staff should attach importance to experiences of patients, and provide targeted interventions for successful operations and recovery of physical and spiritual healing. Key words: The Corbin and Strauss chronic illness trajectory framework; Recurrent; Prior to operation; Glioma; Qualitative study

The health change trajectory model: an integrated model of health change.

Health and illness fluctuate across a person's life span, and various theories have been developed to address the unique perceptions and situations that accompany these fluctuations. An innovative model of health change resulted from a synthesis of the major concepts from 2 such theories: Mishel's uncertainty in illness theory and the Corbin and Strauss chronic illness trajectory framework. The proposed integrated model, the Health Change Trajectory Model, provides original conceptual definitions that operationalize trajectory framework in the context of changes in health. The use of a health trajectory perspective extends applications of the model to a wide range of health changes that result in uncertainty and ambiguity.

Defining the illness trajectory of metastatic breast cancer

BackgroundWith significant developments in the management of metastatic breast cancer, the trajectory of progressive breast cancer is becoming increasingly complex with little understanding of the illness course experienced by women,...

Service Users’ and Caregivers’ Perspectives on Continuity of Care in Out-of-Hours Primary Care

Modernization policies in primary care, such as the introduction of out-of-hours general practice cooperatives, signify a marked departure from many service users' traditional experiences of continuity of care. We report on a case study of accounts of service users with chronic conditions and their caregivers of continuity of care in an out-of-hours general practice cooperative in Ireland. Using Strauss and colleagues' Chronic Illness Trajectory Framework, we explored users' and caregivers' experiences of continuity in this context. Whereas those dealing with "routine trajectories" were largely satisfied with their experiences, those dealing with "problematic trajectories" (characterized by the presence of, for example, multimorbidity and complex care regimes) had considerable concerns about continuity of experiences in this service. Results highlight that modernization policies that have given rise to out-of-hours cooperatives have had a differential impact on service users with chronic conditions and their caregivers, with serious consequences for those who have "problematic" trajectories.

Using the illness trajectory framework to describe recovery from traumatic injury

This paper seeks to highlight the utility of the Corbin and Strauss Chronic Illness Trajectory Framework in describing recovery from traumatic injury and encourages consideration of its implementation into contemporary trauma nursing (Corbin and Strauss, 1991; 1992). To date, few such frameworks have been proposed to sensitize health professionals to the path of recovery following traumatic injury. Although this framework was initially conceived for use in the domain of chronic illness, the lasting effects of severe traumatic injury have significant parallels to chronic conditions such as stroke (Burton, 2000) and multiple sclerosis (Miller, 1993) to which the framework has previously been applied. This paper demonstrates the Trajectory Framework as a useful structure to potentially enhance the development of post-discharge interventions for trauma survivors and encourages consideration of its implementation into the nursing management of this complex patient group.

The Triggers of Heightened Parental Uncertainty in Chronic, Life-Threatening Childhood Illness

Advances in the treatment of childhood diseases have created a population of technology-dependent and medically fragile children whose life expectancy is unknown and whose future quality of life is unpredictable. Seven commonly occurring events were found to precipitate increased parental anxiety by triggering a heightened awareness of the uncertainty concerning the child's survival. These triggers are presented, with supporting data from parental interviews and published autobiographical accounts, as a set of causes, contexts, conditions, and interactions that account for predictable variation in the intensity of parental awareness of uncertainty. The findings reported here constitute one aspect of the grounded theory of living under conditions of sustained uncertainty for families who have a child with a chronic, life-threatening illness. That theory, it is proposed, is related to the larger chronic illness trajectory framework of Strauss and associates. Implications for practice are suggested.

The Chronic Illness Trajectory Framework

The Chronic Illness Trajectory Framework

The Chronic Illness Trajectory Framework (Book)

The Chronic Illness Trajectory Framework (Book)

BOOK REVIEW

Journal of Advanced NursingVolume 17, Issue 12 p. 1503-1503 BOOK REVIEW First published: December 1992 https://doi.org/10.1111/j.1365-2648.1992.tb02824.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract Challenges in Caring Explorations in Nursing and Ethics by J M Brown, A L Kitson and T J McKnight Experiences of Death An Anthropological Account by Jenrufer Hockey Personal Construct Psychology in Clinical Practice Theory, Research and Applications by David A Winter Catch Me a Nightingale by Joan Ash Management Issues in Critical Care edited by Carole Birdsall The Chronic Illness Trajectory Framework The Corbin and Strauss Nursing Model edited by Pierre Woog Living and Working With Autism edited by Luisa L Arendt Volume17, Issue12December 1992Pages 1503-1503 RelatedInformation