INNER STRENGTH AND THE EXISTENTIAL SELF: IMPROVING MANAGED CARE FOR HIV+ WOMEN THROUGH THE INTEGRATION OF NURSING AND SOCIOLOGICAL CONCEPTS

Abstract

The purpose of this paper is to contribute to the understanding of women’s experiences of living with and surviving HIV/AIDS. We argue that strong conceptualization of this experience will lead to more efficient health care delivery for this growing population, within the general framework of managed care. Our analytical strategy is to integrate the nursing concept of inner strength with ideas from the sociological concept of the existential self. There are numerous definitions of the increasingly popular concept of inner strength in the health care literature, largely developed through the experiences of women living with breast cancer. In general, this concept is useful because it focuses research attention on patients’ experiences and perceptions of illness. Nevertheless, current definitions can be critiqued for their tendency: (1) view inner strength as a thing-like phenomenon, as if it were like a disease, to be measured, treated and supplemented; (2) describe inner strength in overly metaphoric and romanticized terms that do not reflect the everyday life of living with a serious illness; and (3) assume that inner strength is equivalent to doing well. We argue that this concept can be of greater scholarly and clinical use if it is defined as follows: Inner strength refers to the different ways women with serious illnesses experience and, subsequently, talk about the deepest, existential resources available to and used by them to manage severe threats to body and self. We developed this concept through a series of 19 biographical and conversational interviews with women living with HIV/AIDS. Our interviews found that these women describe their experiences in terms of three types of narratives or stories. Faith stories recount the ways reliance upon a higher power (spiritual or religious) provides a sense of inner strength. Character stories recount the ways women experience inner strength as a resource available to them before as well as during their illness. Uncertainty stories recount the ways women perceive their inner strength as problematic. We conclude with specific suggestions for the application of our revised concept of Inner strength to the role of nursing in the delivery of managed care to women living with HIV/AIDS.

Citation

Kotarba, J.A., Haile, B., Landrum, P. and Trimble, D. (2003), "INNER STRENGTH AND THE EXISTENTIAL SELF: IMPROVING MANAGED CARE FOR HIV+ WOMEN THROUGH THE INTEGRATION OF NURSING AND SOCIOLOGICAL CONCEPTS", Jacobs Kronenfeld, J. (Ed.) Reorganizing Health Care Delivery Systems: Problems of Managed (Research in the Sociology of Health Care, Vol. 21), Emerald Group Publishing Limited, Leeds, pp. 87-106. https://doi.org/10.1016/S0275-4959(03)21005-X