Negotiating Health Care The Social Context of Chronic Illness

Contributing a unique perspective to health reform, Negotiating Health Care presents the findings of a large qualitative investigation of the experiences of the chronically ill within today′s health care system. The author develops the argument that chronic illness and acute illness are social experiences of a vastly different order that lead to different health care consequences, especially in a health system geared to the "miracle cure." From interviews with chronically ill patients, Thorne discusses the onset of their diseases, handling acute episodes, and their attempts to normalize life. The author also examines the interpersonal experience with health care providers exploring the issues of trust, confidence, and compliance. The institutional experience can, and often does, pose daunting problems for the chronically ill because of organizational and sociocultural issues, health care politics and ideology, and the individual patient′s response to the system. In her concluding chapter, Thorne proposes future directions for health care organization, biomedical technology, and social policy. Students and professionals in the fields of nursing, allied health/medical sciences, and human services will find Negotiating Health Care a valuable resource. "This book is highly recommended for all health care professionals and anyone involved in legislation regarding chronic health care on a national basis. The book also could be very useful for lay people who are chronically ill and for their caregivers and families." --Rehabilitation Nursing "Finally, a window is opened to the experience of chronic illness as it exists within the North American health care system. Just in time. Every health care provider and reformer who looks inside will be changed by the reflections of themselves they see. This book is a courageous voice for both the bolder, more conclusive clinical research and for the chronically ill who may yet show us a better way." --William L. Miller, M.D., The University of Connecticut "Although there are a number of texts available on chronic illness, Dr. Thorne′s approach to the topic is unique in that it provides a graphic illustration of how the beliefs and values guiding the health care system contribute to problems which the chronically ill encounter in obtaining care. By setting the experience of chronic illness in the broader context of the health care system, the [book] provides some clear guidelines for needed changes, something I have not found elsewhere. . . . This is a valuable piece of work . . . which is a valuable contribution to our understanding of chronic illness and which provides a guide both to practice and to health policy revision." --Lee Walker, R.N., Ph.D., The University of Utah "This extraordinary book provides rich description and unique insights into the illness experience. Data obtained from interviews with 91 informants provides remarkable detail, strong linkages to existing theory, and powerful development of the illness trajectory. The book is well documented, methodologically rigorous, and presented in a refreshing style. Dr. Thorne has written a classic! Negotiating Health Care will become the book of the 90s for anyone interested in providing humanistic care." --Jan Morse, R.N., Ph.D., College of Health and Human Development, The Pennsylvania State University "The book provides a view into the major issues adults with chronic illness experience in obtaining health care, a perspective that is rarely available to those of use who use the health care system mainly for acute problems, or indeed, who are the providers. The book is powerful, intense, and often uncomfortable reading; the ′patients′ own words should sensitize all of us who work with the chronically ill. Verbatim accounts of patients′ experiences are woven into a lucid and perceptive view of the structure and organization of Canadian health care, which should be read by health policymakers in all the western industrialized countries." --Juliene G. Lipson, Ph.D., F.A.A.N., University of California, San Francisco "Thorne takes a unique approach in providing a graphic illustration of how the beliefs and values guiding the health care system contribute to the problems the chronically ill encounter in obtaining care. . . . Those concerned with the evolving social and health policy in the United States would be well served in reading Negotiating Health Care." --Academic Library Book Review

Sally Thorne, RN, PhD, FAAN, FCAHS, is a Professor and former Director of the School of Nursing at the University of British Columbia, where she currently also holds the position of Associate Dean of Applied Science. She has a longstanding research program in the field of patient experience and relational practice in chronic illness and cancer care in addition to a body of scholarly work in the philosophy of science, the nature of evidence, and applied qualitative methodology. She is author of four books, including a popular qualitative research text on Interpretive Description. She has an extensive record of peer reviewed journal publications and has presented her work internationally as invited scholar, keynote lecturer and distinguished professor. She is Editor-in-Chief of the scholarly journal Nursing Inquiry and Associate Editor for Qualitative Health Research. She has served terms as Board Director for numerous organizations, including the Canadian Academy of Health Sciences, Canadian Partnership Against Cancer, Canadian Association of Nurses in Oncology, the Michael Smith Foundation for Health Research, and the Association of Registered Nurses of British Columbia, and is a Fellow of both the American Academy of Nursing and the Canadian Academy of Health Sciences.