Trajectory Model

Introduction

• Trajectory Model is a nursing model particularly applicable in situations of people with chronical diseases developed by Anselm L. Straus, medical sociologist  and Juliet Corbin, a nurse theorist.
• This model is also called “Corbin-Strauss-Model” and is recognised as a middlerange explanatory nursing theory (Corbin & Straus, 1991)
• This model was developed following over 30 years of interdisciplinary research on a variety of chronic illnesses.

Definitions

Trajectory

• -“a course of illness over time plus the actions taken by patients,
  families and health professionals to manage or shape the course”-
• The term “trajectory” refers to the course of a chronical disease in its different stages and phases.

Chronic Illness

• Chronical illnesses are serious diseases which could last the whole life of the concerned person affecting the person’s mental, emotional and social well-being.

Eight stages of the course of disease

McCorkle & Pasacreta, 2001- explains eight phases of chronic illness trajectory

1. Initial or pretrajectory phase - occurs before any signs and symptoms are present.
2. Trajectory onset phase- occurs with the first onset of signs and symptoms and includes the diagnostic period.
3. The crisis phase -is when a potentially life-threatening situation arises
4. The acute phase- follows the crisis phase and refers to the period when the patient's symptoms can be controlled by a prescribed regimen.
5. Stable phase - this phase starts once symptoms are controlled.
6. Unstable phase - when the patient's symptoms are uncontrolled by the previously adopted regimen
7. Downward phase - characterized by progressive deterioration in mental and physical status
8. Dying phase - refers to a period of weeks, days, or hours preceding death .

The nursing process in Trajectory Model

The Corbin and Strauss Chronic Illness Trajectory Framework consists of six steps:

1. Identifying the trajectory phase.
2. Identifying problems and establishing goals.
3. Establishing plans to meet goals.
4. Identifying factors that facilitate or hinder attainment of goals.
5. Implementing interventions.
6. Evaluating the effectiveness of interventions.

Conclusion

• Trajectory model can be used as a management instrument for the professional care.
• It helps the nursing person to get familiar with the patient’s perspective.
• Trajectory model has been applied in conditions like cancer, cardiovascular diseases, HIV, Aids, diabetes mellitus and multiple sclerosis..

References

1. Corbin J., and Strauss A. A Nursing Model for Chronic Illness Management Based upon the Trajectory framework. Scholarly
   Inquiry for Nursing Practice, 1991, 5, 155-174.
2. Smeltzer SC. Use of the Trajectory Model of nursing in multiple sclerosi. Sch Inq Nurs Pract. 1991 Fall;5(3):219-34.
3. McCorkle R, Pasacreta JV. Enhancing caregiver outcomes in palliative care. Cancer Control. 2001 Jan-Feb;8(1):36-45. Available at http://www.moffitt.org/CCJRoot/v8n1/pdf/36.pdf . Accessed on 31/1/2011.
4. Kabinga M, Banda SS. A Conceptual Review of the Demands of chronic care and the Preparedness of Nurses Trained with the General Nursing Council of Zambia Curriculum. Medical Journal of Zambia,2008; 35:3.