Trajectories and Transferability: Building Nursing Knowledge about Chronicity

Abstract

We have seen a shift in the generation of nursing knowledge, from biomédical, illness, and disease models (exemplified by "a diabetic patient") to psychosocial, educational models (exemplified by "a person with diabetes" or, more broadly, "a person with a chronic condition"). Behind this shift is a generic view of chronicity, one which posits that the psychosocial issues shared by individuals across hundreds of medical diagnostic groups outweigh those that are unique and bio-medically based (Perrin et al., 1993). The psychosocial model recognizes the importance of the effect of the condition on the individual, as opposed to the condition alone. For example, it is from this generic perspective that Magyary and Brandt (1996) view children and their families as they cope with chronic conditions. The shift to generic views of chronicity has not been absolute. Nearly all nursing researchers sensibly still report the disease categorizations of their subjects, while at the same time designing their research and discussing their findings with a view to generalizing to a broader population of persons with similar chronic conditions. This approach assumes that a generic view might be too simplistic and that abandonment of the medical categorizations might be premature. Generalizing about chronicity issues might be well served by the more multidimensional concept of illness trajectory. For example, Ellerton, Stewart, Ritchie, and Hirth (1996) studied children with three types of medical diagnoses in order to sample a range of illness trajectories.