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As the nature of the American health care system, chronic illness, and nursing change, theoretical models used to guide nursing management of chronic conditions must be updated to keep abreast of these changes, while still retaining their core concepts. This article offers a revised version of the Corbin and Strauss Chronic Illness Trajectory Framework. The most notable changes include a greater emphasis on health promotion and illness prevention, streamlined language to make it more user friendly, and increased focus on the global influences on health care. The nurse also takes a more prominent position in management of such conditions, because only nurses, among health care workers, have the wide based education, training, focus on health promotion, technological expertise, and holistic approach to health care necessary to address the wide range issues and problems of chronic mangement, which will continue to grow as we move into the 21st Century.
Eight years have passed since the Corbin and Strauss Model (1991, 1992) was first introduced, and many changes have occurred within the American health care system since that time. It is time to rethink and update the model, not only to keep pace with present changes but with those still to come in the 21st century. First, let us review some of those changes, so that we might see what aspects of the model are in need of revision.
According to a newspaper article dated September 16, 1996 (San Jose Mercury News'), chronic illness is expected to be the major health problem in the next quarter century. There will be a rise in heart disease, stroke, mental illness and problems of the elderly (see Table 1). By the year 2020, however, the most lethal of all diseases will be those that are tobacco related, causing 1 out of every 10 deaths.
On the other hand, there have been many new technological advances in the treatment of chronic conditions, thereby extending lives and "curing" illnesses. AIDS, once thought of primarily as an infectious disease, has now taken on the profile of a chronic condition because of the development of new drugs. This, however, also has its drawbacks. As Nokes (1998) states so clearly in her article, technology often has a trajectory of its own, with biographical and...