Kramer et al: Interventions/Models/Frameworks (ch.3)

Question 1

TRUE OR FALSE

Disease management frameworks can be used when looking for illness frameworks and models.

Answer 1

FALSE.

Disease = patho!
Illness models focus on managing illness experience of pt and family as opposed to managing disease symptoms.

Question 2

The term “trajectory” was first coined by _____, ____ and _____ in the early 1960’s. They wanted to look into illness experiences to improve care delivery as opposed to focusing on just the disease.

Answer 2

Glaser, Strauss and Benoliel

Question 3

The Trajectory Framework (1992) was developed by

a. Glaser and Strauss
b. Corbin and Leventhal
c. Corbin and Strauss

Answer 3

C

Question 4

The purpose of the Trajectory Framework was to…

1. Gain insight into pt chronic ____ ____.
2. Integrate existing ______ about chronicity into practice
3. provide direction for building nursing models that guide ____, teaching, ____ and _____.

Answer 4

1. illness experiences
2. literature
3. practice, teaching, research and policy-making

Question 5

TRUE OR FALSE

Trajectory is defined as the course of an illness over time, AND the actions of pt/family/HCPs to manage that course.

Answer 5

TRUE

Question 6

TRUE OR FALSE

The illness trajectory consists of 8 phases on a linear continuum.

Answer 6

FALSE.

The illness trajectory consists of NINE phases on a NON-LINEAR CONTINUUM.

Question 7

TRUE OR FALSE

Even if two people have the same disease, their illness trajectories will be different and UNIQUE

Answer 7

TRUE

Question 8

“This consists of previous hospital experiences and useful ways of dealing with symptoms, illness beliefs and other life experiences”

This defines what term in the Trajectory model?

Answer 8

Biography

Question 9

Name the first 5 phases of the Trajectory framework.

hint: all about symptoms!

Answer 9

1. Pre-trajectory - aka preventative
   (no symptoms: genetics and lifestyle are risk factors)
2. Trajectory
   (symptoms appear)
3. Stable (symptoms)
4. Unstable (symptoms)
5. Acute
   (symptoms = severe and unrelieved; disease complications)

Question 10

Give an example of someone in the pre-trajectory phase

Answer 10

overweight person with family hx of cardiac disease and high cholesterol but doesn’t exercise or eat healthy

Question 11

Name the last 4 phases (phases 6-9) of the illness trajectory model

Answer 11

6. Crisis
   (life-threatening/critical situations)
7. Comeback (gradual return to acceptable way of life)
8. Downward (progressive deterioration)
9. Dying (gradual or rapid shutting down of body processes)

Question 12

“I also have an illness trajectory model focusing on crisis, chronic and terminal. I was one of the first authors to describe ‘chronic illness’ as the ‘long haul’ of living day to day with chronic illness”

Who am I?

Answer 12

Rolland (1987)

Question 13

“We developed the Shifting Perspectives model of chronic illness. It’s more of an ‘insider’s perspective’ of describing illness as opposed to the traditional outsider view”

Who are we?

Answer 13

Thorne and Paterson (1998)

Question 14

Shifting Perspectives model:

Pt-as-client OR client-as-partner?

Answer 14

Client-as-PARTNER!

Question 15

TRUE OR FALSE

The Shifting Perspectives model regards chronic illness as an ongoing, continually shifting process that considers both illness and wellness.

Answer 15

TRUE

Question 16

SATA

“Illness in the foreground” focuses on…

a. sickness
b. loss
c. burden of illness
d. illness as identity

Answer 16

All of the above!

• Learning about illness, its consequences and long-term impact
• considerations for treatment

Question 17

“Wellness in the foreground” means that the pt’s identity lies within _______.

Answer 17

themselves!

Disease does not control their life.
It’s a shift in mentality that enables the pt to focus beyond the disease.

Question 18

SATA

“Illness in the foreground” happens …

a. when the disease is not in control
b. during a new chronic diagnosis
c. as a protective response
d. to maintain “sick” role as social identity for secondary gains

Answer 18

B, C and D

Question 19

TRUE OR FALSE

There is a right and wrong way for chronic illness to be described within wellness and illness.

Answer 19

FALSE

The Shifting Perspectives model is more about reflecting unique individual needs,
health status, and
pt focus at the time

Question 20

Critique of the Shifting Perspectives model

hint: “living in the orange”

Answer 20

There is no “either/or” when it comes to wellness and illness.

“If illness is red and wellness is yellow, I want a blend of both in orange.”

• if all yellow, then might do something lightly and face severe consequences.
• if all red, will feel depressed and sad all the time.

Question 21

You are a nurse with a pt who was newly diagnosed with type 1 diabetes. He is not highly dependent anymore, but rather has improved in physical status and verbalizes he wants to be ready to go back to normal life soon.

What can he benefit from to help him move toward independence?

a. A shift in mentality to “wellness in the foreground”
b. Education on self-administering insulin
c. Letting him check his glucose level on his own while you supervise

Answer 21

B. Education

When the pt is motivated to move from the impaired role, they are motivated to learn about their condition and necessary procedures to maximize health.