Uncertainty in Illness Theory
In this assignment, you are going to explore how a nurse theorist of your choice created their theory. You will become the theorist immersing yourself in the writings from the earliest mentioned to the most current literature. Writing in the voice of the theorist (taking on the persona of the theorist), you will create the theory through the following four stages.
In the first stage, theorizing occurs. This is where you, as the theorist, identify the concepts of what nursing is and is not. Perhaps you questioned what concepts were guiding those in nursing practice and then started to question your role. You started asking yourself, ‘Where am I in nursing, and where the profession is going? Is there some overarching understanding that guides the professional in his or her practice?’ This is where you recognize that a theory is needed.
In the second stage, syntax is developed. This is where you will define the terms, explain relationships between the terms, and examine their expansion. Syntax development is an evolution. Consider, for example, Jean Watson. She starts by defining the word ‘caring.’ Within the last several years, she has refined her terminology changing the term caring to caritas and identified the relationships between terms. This demonstrates a growth and maturation from decades of research she and other scholars did to produce the theory of caring.
The third stage is theory testing. Here, the theorists and other researchers consider whether this theory helps answer questions that arise in nursing. This is where your theory is used by a widening group of researchers. For example, graduate nursing students request to use the tool you developed while testing your theory in an area of nursing.
The fourth and last stage is evaluation. This is where the theory is used in practice with the goal of improving healthcare. It is evidenced in the development of policies, procedures and best practice standards that have evolved from theory implementation.
Begin your paper with an introductory paragraph that describes why you chose this theorist. First person voice (I, me, etc.) is acceptable in this paper.
Write in the first person voice (I, me, our, etc.) as the theorist. For example: I, Dr. Jean Watson, found that caring was a core concept of how I viewed nursing. To me, caring is the essence of nursing.
Use the four stages (theorizing, syntax, theory testing, and evaluation) to explain how your theory was developed and used in nursing.
In the first (theorizing) stage, provide the historical context that influenced the theorist’s thinking.
In the second (syntax) stage, describe the development of the concepts and statements.
In the third (theory testing), provide two (2) examples of research examining the theory.
In the fourth (evaluation), provide three (3) examples of how the theory has been used in practice and a brief evaluation of the theory.
Consult the Grading Rubric for this Assignment found in the course resources for further detailed expectations.
Uncertainty in Illness Theory
Nursing seeks to provide healthcare clients with a comprehensive care and support system to assist them in dealing with their health-related problems. While the profession has tremendously evolved since its inception, some concepts remain unexplored. Particularly, not knowing what will happen affects the clients and impacts their health outcomes. Therefore, I, Merle H. Mishel, sought to explore uncertainty in illness. I wanted to provide a solid theoretical framework for caregivers and patients to identify and manage uncertainty to promote physical and mental well-being.
While uncertainty can exist in any healthcare scenario, it presents a bigger challenge when dealing with lengthy medical procedures or long-term and chronic diseases. The latter has become more prevalent in communities over the past fifty years as there is a higher proportion of the aging population. Furthermore, the onset of cancer, diabetes and autoimmune diseases among young and middle-aged adults have heightened uncertainty in healthcare settings. Moreover, as the healthcare and nursing fraternity evolve, there will be a higher demand for uncertainty management. For instance, introducing telehealth services means that it will be harder for the caregiver to assess a patient’s uncertainty level and address it. Hence, developing a theory to encapsulate uncertainty during illness allowed me to contribute to an ongoing challenge in all nursing settings.
Before even creating the theory, it is necessary to explore the contributing factors. There are the uncertainty antecedents in this case and include the stimuli frame, cognitive capacity, and structure providers. The three antecedents show why uncertainty exists. First, the stimuli frame refers to the primary trigger. For instance, a patient encountering an illness for the first time is likely to be anxious about the outcomes. The unfamiliarity may extend to the healthcare environment (e.g., being an inpatient) and treatment interventions (such as a theater procedure). In other instances, the patient’s expectations of the diseases’ impact or recovery process may not align with their experience. Hence, they will become anxious, wondering if they will get better at all.
An individual’s cognitive capacity impacts their interpretation of the stimuli frame. For instance, a person with impaired cognition due to a condition such as Alzheimer’s Disease may not fully comprehend the severity of the illness. Age is also an important cognitive factor, as teenagers and adults are more likely to understand their condition and the treatment interventions they are undergoing more than babies. Finally, health literacy may also influence cognitive capacity. Having a clinical understanding of a disease and its management options is likely to determine how patients interpret their illness stimuli.
Finally, the existence or absence of structure providers impacts uncertainty in illness. For example, patient education boosts the patient’s knowledge, alleviating unfounded worries. Social and family support also makes patients feel that they are not undergoing the ordeal alone. The help could be emotional or financial, and in both cases, it lowers anxiety and uncertainty. Finally, healthcare providers’ support, including bedside assistance and navigating bureaucratic channels, relieves some of the uncertainty patients experience in an unfamiliar environment.
After defining the antecedents and their relationships, it is necessary to appraise the uncertainty. The uncertainty-causing agent that I will refer to as a stressor could be a threat or an opportunity. A threat means that uncertainty could cause further harm, while an opportunity provides hope for positive outcomes. For instance, if a patient is worried that they will not regain consciousness after sedation, they perceive the uncertainty as a threat. However, if the uncertainty relates to a poor prognosis, there is hope that an illness may not be as severe. Hence, the stressor is positive.
Coping with Uncertainty
The bane of the theory is to develop ways that patients and caregivers can employ to eradicate or manage uncertainty. These interventions are necessary when the patient perceives the stressor as a threat. Thus, they or their caregiver can eliminate or reduce the uncertainty by taking direct action, seeking (or providing) information, and maintaining healthcare vigilance. These actions will address the physical threat, resulting in lower uncertainty levels. It may be difficult or impossible to eliminate the threat in other cases. Hence, the patient and caregiver should implement affect-control interventions. For instance, relying on faith can help one navigate a nerve-wracking period of the care experience. Emotional disengagement or support may also be useful. The former enables the patient and caregiver to focus on the pragmatism of the illness and treatment options, while the latter serves the same purpose as faith. Successful coping causes illness adaptation, where the patient achieves physical, mental, and emotional harmony with their illness.
Petrongolo et al. (2020) examined the theory by establishing how a parent’s illness uncertainty affected child depression, anxiety, and health-related quality of life (HRQOL). They found a positive correlation, implying that uncertainty affects the healthcare process and outcomes, even when it is not directly on the patients. Meanwhile, Kuang (2018) explored uncertainty beyond the scope of healthcare settings. The author established that even research and academic sources have information gaps that cause uncertainty in patients and care providers. Furthermore, uncertainty may be quantifiable (objective) or subjective. In either case, developing appropriate coping mechanisms is vital to illness adjustment. Both publications show that the theory, as developed, can address key concerns in nursing. Caregivers can employ its concepts to understand patient behavior and develop appropriate coping mechanisms that aid the care process.
The theory has found relevance in nursing practice and research. For instance, Guan et al. (2020) sought to determine how illness uncertainty and coping mechanisms affected the quality of life for prostate cancer patients. A higher uncertainty level harmed patients’ physical and mental health. Furthermore, most patients recording illness uncertainty employ the avoidant coping mechanism, resulting in subpar mental health. Meanwhile, Mullins et al. (2017) explored the stimuli frame originating from a pre-diagnosed condition. They had three categories: those without a chronic illness, those with asthma/allergies, and patients with other chronic diseases, such as type 1 diabetes. All participants were college students, setting a comparable standard for health literacy and overall cognitive capacity. The researchers found that patients with chronic illnesses had higher uncertainty levels. The uncertainty, in turn, predicted depressive and anxiety symptoms. Hence, the fact that the individuals knew they were ill made them more uncertain about their current and long-term health status. Finally, Orom et al. (2017) established that people with a metacognitive awareness of their illness were more uncertain. The pessimism led to poorer health habits, such as failing to exercise or observe a healthy diet. Therefore, there is a direct correlation between patients’ uncertainty and health behavior.
The uncertainty of illness theory provides an integral basis for understanding patient psychology. It allows caregivers to examine their clients, looking for the various antecedents. It also facilitates the development and revision of coping mechanisms and an eventual illness adjustment. Hence, the theory is practical, making it a fundamental entity in modern nursing practice.
Guan, T., Santacroce, S. J., Chen, D. G., & Song, L. (2020). Illness uncertainty, coping, and quality of life among patients with prostate cancer. Psycho-Oncology, 29(6), 1019-1025. https://doi.org/10.1002/pon.5372
Kuang, K. (2018). Reconceptualizing uncertainty in illness: commonalities, variations, and the multidimensional nature of uncertainty. Annals of the International Communication Association, 42(3), 181-206. https://doi.org/10.1080/23808985.2018.1492354
Mullins, A. J., Gamwell, K. L., Sharkey, C. M., Bakula, D. M., Tackett, A. P., Suorsa, K. I., Carney, J. M., & Mullins, L. L. (2017). Illness uncertainty and illness intrusiveness as predictors of depressive and anxious symptomology in college students with chronic illnesses. Journal of American College Health, 65(5), 352-360. https://doi.org/10.1080/07448481.2017.1312415
Orom, H., Biddle, C., Waters, E. A., Kiviniemi, M. T., Sosnowski, A. N., & Hay, J. L. (2017). Causes and consequences of uncertainty about illness risk perceptions. Journal of Health Psychology, 1-13.
Petrongolo, J. L., Zelikovsky, N., Keegan, R. M., Furth, S. L., & Knight, A. (2020). Examining Uncertainty in Illness in Parents and Children With Chronic Kidney Disease and Systemic Lupus Erythematosus: A Mediational Model of Internalizing Symptoms and Health-Related Quality of Life. Journal of Clinical Psychology in Medical Settings, 27, 31–40. https://doi.org/10.1007/s10880-019-09617-3