Academic journal article Scholarly Inquiry for Nursing Practice

Operationalizing the Corbin & Strauss Trajectory Model for Elderly Clients with Chronic Illness

Academic journal article Scholarly Inquiry for Nursing Practice

Operationalizing the Corbin & Strauss Trajectory Model for Elderly Clients with Chronic Illness

Article excerpt

A research team of six nursing faculty at Thomas Jefferson University College of Allied Health Sciences collaborated to develop a research proposal to provide nursing care to a selected population of chronically ill elderly persons. The Corbin and Strauss Nursing Model for Chronic Illness Management (1991) was selected as the organizing framework to guide research and care delivery. While conceptual models offer direction for nursing practice, specific guidelines for providing care can only be identified when major concepts of the model are operationalized (Fawcett, 1989). This article describes the first step in operationalizing the Corbin and Strauss Trajectory Model undertaken by the research team which resulted in the development of eight "Phase-specific protocols." Two of the eight phase-specific protocols are presented.

Conceptual models are developed to provide an organizing framework for nursing practice, education, and research. Such models are highly abstract and general. While conceptual models offer general guidelines for nursing practice, more specific guidelines must be developed through operationalizing major concepts of the model and theory testing (Fawcett, 1989). This manuscript describes the process undertaken by a team of nursing faculty members at Thomas Jefferson University, Department of Nursing, to operationalize major concepts described in the Corbin and Strauss Nursing Model for Chronic Illness Management (1991). Concepts of the model are briefly described to illustrate the research team' s interpretation of how this body of work can be used to guide care for a group of chronically ill elderly adults and to design nursing interventions for a nursing research project For the sake of brevity, the nursing model cited above will be referred to hereafter as the "Corbin and Strauss Trajectory Model."

BACKGROUND OF THE PROJECT

In response to a call for research proposals focusing on care of the chronically ill elderly, six nursing faculty members formed a research group to develop such a proposal. The chronically ill elderly residing in low income subsidized housing were identified as the focus of the proposal. This focus was based on data obtained during a community health experience of baccalaureate nursing students who made home visits to fifty elderly persons whose residence fit this description and is located in Center City, Philadelphia. Under the direction of a faculty preceptor, the students identified unrecognized and untreated chronic illnesses, made referrals of chronically ill residents to collaborating physicians, provided health teaching and counseling, and assisted in coordination of services. The experience indicated that elderly residents in low income housing in this large metropolitan area had a number of significant chronic health care problems that required screening, case finding, monitoring, referral, and follow up. Further, the students' experience indicated that many of the problems could be appropriately addressed by nurses. The data obtained through students' experiences were consistent with the documented incidence of at least one chronic illness in 85% of individuals 65 years of age and older, and decreased functional ability secondary to chronic illness in 40% of older adults (Folden, 1989).

SELECTING AN ORGANIZING FRAMEWORK

An initial step in developing a research proposal to test nursing interventions directed toward the health care needs of this population was to review nursing models and frameworks that might address the needs of elderly clients with chronic illness residing in the community and guide the design of specific nursing interventions. Following review of several theoretical approaches, the Corbin and Strauss Trajectory Model was selected because it was designed to enhance the individual's management of the chronic illness course. The long term nature of chronic illness necessitates that most management of the illness course occurs outside formal health care facilities, that is, in people's homes, and involves making adjustments to facilitate everyday life activities (Corbin & Strauss, 1991). …

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