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In this paper, stories of illness are identified as belonging to a specific genre of story that represents an ill person's interpretation of experience and hence the meaning(s) of illness. The ill person is recognized as member of a family embedded in a social setting with cultural mores that contribute to experience and meanings. The meaning of illness is significant because it affects the care of illness. This paper focuses on chronic illness, an illness without cure that is managed over a lifetime and is characterized by remission and exacerbation of symptoms. Our current bio-medical health care system reframes the illness to disease, reduces it to pathology and misses the meaning for patients. Conflict and noncompliance result. What I am calling a storied approach complements current care and management of chronic illness by improving patient care, and the management of illness and by encouraging collaborative care. We organize experience and make sense of things by telling our stories. Jerome Bruner characterizes narrative knowing based on storytelling as a way to construct reality and understand human behavior. The conception of illness story is based on the work of Arthur Kleinman, who has studied chronic illness meaning(s), and describes a supporting framework that includes symptom meaning, cultural input and personal/social meaning and explanatory models. Stories change over time and circumstance; the meaning of illness experience changes. Two research studies are presented to identify factors that influence change from loss to mastery. The story of my nursing practice in case management has significantly changed over time with new skills, knowledge and experience acquired in the Critical and Creative Thinking Program. I briefly describe my progress at the beginning of each chapter. I propose a reorientation of my nursing practice as well as next steps to take in my journey. Two illness stories are included in the appendix: Donna's story and Lisa's story provide examples of illness stories encountered during my graduate study. |
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