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Uncertainty in Illness Theory

Merle Mishel

Krista Angeline

on 11 November 2012

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Transcript of Uncertainty in Illness Theory

COGNITIVE SCHEMA STRUCTURE PROVIDERS ORIGINS Uncertainty is the result of an individual experiencing an acute or chronic illness. The individual is unable to interpret illness-related events due to ambiguity, complexity of the illness, lack of inconsistent information or unpredictability/possibility of recurrence. Within this theory, nurses promote optimal well-being of the individual by providing information and supporting individuals to reduce the level of uncertainty. In Mishel's original theory, she suggests that individuals appraise uncertainty as an opportunity only when a downward trajectory is known.
However, in her reconceptualized theory, Mishel explains that individuals can still view continual uncertainty as an opportunity and formulate a new view of life based on probabilistic thinking. Reconceptualized Theory Unable to understand the meaning and outcomes of illness-related events How an individual interprets his or her illness, treatment and hospitalization Perceived stimuli that are organized into a patient's cognitive schema
Symptom pattern
Event familiarity
Event congruence Resources available, such as physicians, nurses and other forms of social support to assist patients in interpreting the meaning of their illness.
Healthcare providers can be considered credible authorities. The ability of a person to process information based on his or her background and the context of the situation Evaluating uncertainty based on past experiences Beliefs constructed out of uncertainty How a person modifies his or her behavior Coping strategies that result from an appraisal of opportunity or danger (an appraisal of danger can lead to severe emotional distress) The acceptance of uncertainty as an everyday part of life The belief that we can not always be certain or predict outcomes God is the creator of all things. He created man in His image. But how did I end up with this illness when God said His creation was good?
God has created a purpose and intentionally seeks a relationship with every human being.
Individuals who have self-doubt and experience depression are less likely to see a purpose for their life ("I have nothing to live for").
However, if the patient views his or her uncertainty as an opportunity, he or she is more optimistic, recognizes a purpose in life and forms a new view of life. God's word is truth and morality is based on God's law. The Holy Spirit guides and convicts moral reasoning.
When will we stop testing?
When will we stop treating/prolonging life?
Is it right to treat an illness in which the outcome is ambiguous?
Who decides when to withdrawal life-sustaining measures? Through Jesus Christ's death and resurrection, there is hope for eternal life.
Uncertainty in illness leads to questions of death.
Am I going to die?
What happens when I die? Is there life after death?
Patients who accept uncertainty form a new, natural view of life--there is hope and less fear in death. Nurse's Role in the Biblical Worldview Assist patient in recognizing spiritual beliefs
If a patient is in spiritual distress, meet their needs
Provide them with Bible verses
Jeremiah 29:11; Philippians 4:6-7
Instill hope and provide comfort Gives the nurse insight into the patient's point of view
Can be used as a universal framework to assess uncertainty in acute and chronic illness, whether adults or children
Once uncertainty is identified, nursing interventions can be implemented to help patient effectively cope and resolve uncertainty
Broad enough to consider cultural context Complexity-difficult to grasp unless personal experience
"The many meanings of uncertainty" What major concepts did you identify in the case study?
How was a biblical worldview illustrated in this case study?
How did Kacey's age contribute to her uncertainty?
Once uncertainty is identified in your client how might you alleviate this uncertainty? References
Babrow, A., Kasch, C., & Ford, L. (1998). The many meanings of uncertainty in illness:
Toward a systematic accounting. Health Communication, 10(1), 1-23. Retrieved from http://web.ebscohost.com/ehost/detail?sid=b2562f11-44fb-498f-a0b3-8bd579c902ca%40sessionmgr104&vid=1&hid=119&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=mnh&AN=16370987
Guadalupe, K. (2010). Understanding a meningioma diagnosis using Mishel's theory of
uncertainty in illness. British Journal of Neuroscience Nursing, 6(2), 77-82. Retrieved from http://web.ebscohost.com/ehost/detail?sid=80b951d5-2aa2-4114-81e3-922d0d43fe0d%40sessionmgr113&vid=1&hid=119&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzh&AN=2010572171
Neville, K. (2003). Uncertainty in illness. An integrative review. Orthopaedic
Nursing/National Association of Orthopaedic Nurses, 22(3), 206-214. Retrieved from http://web.ebscohost.com/ehost/detail?sid=aac7e87d-9de7-44b8-a900-1eed45188bc0%40sessionmgr104&vid=1&hid=119&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=mnh&AN=12803150
Stewart, J. L., Mishel, M. H., Lynn, M. R., & Terhorst, L. (2010). Test of a conceptual model of
uncertainty in children and adolescents with cancer. Research in Nursing & Health, 33(3), 179-191. Retrieved from http://web.ebscohost.com/ehost/detail?sid=aa750f62-d3be-4635-9e50-1733eaec4410%40sessionmgr111&vid=1&hid=119&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=psyh&AN=2010-10558-002
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