Chronic illness: the process of integration
Article first published online: 10 JUN 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd
Journal of Clinical Nursing
Volume 17, Issue 7b, pages 177–187, July 2008
How to Cite
Whittemore, R. and Dixon, J. (2008), Chronic illness: the process of integration. Journal of Clinical Nursing, 17: 177–187. doi: 10.1111/j.1365-2702.2007.02244.x
- Issue published online: 10 JUN 2008
- Article first published online: 10 JUN 2008
- Submitted for publication: 27 July 2007 Accepted for publication: 12 October 2007
- chronic illness;
- psychosocial adjustment;
- self management
Aim. The aim of this study was to explore how adults with a chronic illness integrate the illness experience into their life context.
Background. Adults with chronic illnesses are challenged to learn self-management strategies to prevent complications and achieve an acceptable quality of life. Integration represents the process undertaken by an individual to achieve a sense of balance in self-managing a chronic illness and living a personally meaningful life.
Design. A mixed-method descriptive design was employed to recruit English-speaking adults with a chronic illness. A semi-structured interview was completed, transcribed verbatim and content analysed. Descriptive data were collected on demographics, co-morbidity and depressive symptoms. The research was undertaken in Connecticut, USA.
Results. The sample (n = 26) was diverse with respect to age (25–80 years), education (8–24 years), duration of illness (1–39 years), gender (63% female) and ethnicity (63% white). Participants reported a mean of four chronic illnesses and 31% of the sample had increased depressive symptoms. The process of integration was complex and multifactorial. Themes of integration included: shifting sands, staying afloat, weathering the storms, rescuing oneself and navigating life. Numerous factors including treatment side effects, a progressive or uncertain illness trajectory, co-morbidity, bad days, financial hardships and interpersonal/environmental challenges contributed to a disruption or difficulty in the integration process.
Conclusion. All participants made considerable effort to integrate the illness into their life context and participate in a personally meaningful life. However, it was easy to be consumed with ‘living an illness’ as the daily tasks, the changing symptoms and the fluctuating emotions could be overwhelming. There was a complex co-existence between ‘living a life’ and ‘living an illness’.
Relevance to clinical practice. There were numerous challenges to the process of integration and ongoing self-management, psychosocial, vocational and existential support appears indicated, particularly with individuals with multiple chronic illnesses, progressive chronic illnesses and limited resources.