Uncertainty in Illness theory

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Information about Uncertainty in Illness theory

Published on November 23, 2009

Author: cgannon

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Dr. Merle H. Mishel Uncertainty in Illness TheoryPresentation by Carl GannonNursing 212 by Dr. H-S : Dr. Merle H. Mishel Uncertainty in Illness TheoryPresentation by Carl GannonNursing 212 by Dr. H-S Background : Background Born 1939 in Boston Massachusetts Graduate 1961 with a Bachelors of Arts from Boston University Graduate 1966 with Master of Science in psychiatric nursing from University of California Graduate 1976,1980 with Masters of Arts, Doctorate in social psychology from Claremont Graduate school, Claremont California During Mishel’s dissertation research she developed the Mishel Uncertainty in Illness scale (MUIS) Mishel and others have done research using her theory and tool in the areas of Breast Cancer, Prostate Cancer, Head and Neck Cancer, and Traumatic Injury Evolution of Uncertainty in Illness Theory : Evolution of Uncertainty in Illness Theory In the late 1970’s there was very little known about the phenomena of uncertainty in illness. “There is an absence of systemic investigation of uncertainty as a perceptual variable influencing the appraisal of illness related events.” (Mishel, 1981) With the assistance from a National Research Service Award Mishel was able to develop the Mishel Uncertainty in illness Scale, and the midrange theory Uncertainty in Illness. Purpose of Theory : Purpose of Theory The uncertainty in illness theory helps measure the degree to which an individual is experiencing uncertainty during illness or an acute injury when the possibility of recurrence and extension exist. The illness causes uncertainty that spreads into the individual’s life and breaks down the individual’s point of view and reality. Slowly a new point of view is formed. Uncertainty is the driving force and is accepted as reality. Now the individual may see that many options are possible as opposed to only a cause and effect paradigm. Nurses are an important part of this process. (Mishel,1999). Slide 6: MISHEL UNCERTAINTY IN ILLNESS SCALE (Adult) —SAMPLE Do not administer. 1. I have a lot of questions without answers. Strongly Agree Agree Undecided Disagree Strongly Disagree (5) (4) (3) (2) (1) ____ ____ ____ ____ ____ 2. I understand everything explained to me. Strongly Agree Agree Undecided Disagree Strongly Disagree (5) (4) (3) (2) (1) ____ ____ ____ ____ ____ 3. The doctors say things to me that could have many meanings. Strongly Agree Agree Undecided Disagree Strongly Disagree (5) (4) (3) (2) (1) ____ ____ ____ ____ ____ 4. There are so many different types of staff, it’s unclear who is responsible for what. Strongly Agree Agree Undecided Disagree Strongly Disagree (5) (4) (3) (2) (1) ____ ____ ____ ____ ____ 5. The purpose of each treatment is clear to me. Strongly Agree Agree Undecided Disagree Strongly Disagree (5) (4) (3) (2) (1) Uncertainty Left Untreated : Uncertainty Left Untreated Uncertainty can lead to fear of illness. This may be characterized by several manifestations. Fear of recurrence, loss of control of one’s life, emotional distress, and use of inappropriate coping mechanisms like avoidance are all effects of uncertainty. Truly these conditions if not addressed will lead to the inability of the patient to form cognitive structures for illness related events, poor decision making, poor psychological adjustment, and possible post traumatic stress like responses. Concept Definitions in Relationship to Uncertainty in Illness : Concept Definitions in Relationship to Uncertainty in Illness Ambiguity: In the context of disease the nature of it’s progression, symptoms, onset, and duration are cause for uncertainty. Unknown: In the context of self related to the idea of the future, making long/short term life plans. Lack of information: A major source of uncertainty for patients is lack of information related to treatments, hospital systems, and illness related events. Cancer patients expressed that the need for information was a frequent concern and assisted with building coping skills to deal with uncertainty(Merle H. Mishel, et al., 2002). Slide 9: Uncertainty: The inability to determine the meaning of illness related events, occurring when the decision maker is unable to assign definite value to objects or events, or is unable to predict outcomes accurately.  Social Support: Influences uncertainty by assisting the individual to interpret the meaning of events. Probabilistic Thinking: A belief in a conditional world in which the expectation of continual certainty and predictability is abandoned. New View Of Life: The formulation of a new sense of order, resulting from the integration of continual uncertainty into one’s self-structure, in which uncertainty is accepted as the natural rhythm of life. Model of Perceived Uncertainty in Illness Structure : Model of Perceived Uncertainty in Illness Structure Major Assumptions : Major Assumptions Uncertainty is a cognitive state, representing the inadequacy of an existing cognitive schema to support the interpretation of illness-related events. Uncertainty is an inherently neutral experience, neither desirable nor aversive until it is appraised as such. Adaptation represents the continuity of an individual’s usual biopsychosocial behavior and is the desired outcome of coping efforts to either reduce uncertainty appraised as danger or maintain uncertainty appraised as opportunity. Drawing on tenets of chaos chaos theory people typically function in far-from-equilibrium states. Major fluctuations in a system enhance the persons receptivity to changes. A person needs time to focus on self, and if this time isn’t available, the process of integrating the uncertainty into one’s view of life will not occur. Clarity : Clarity Despite the complex nature that uncertainty plays in a patient’s illness the concepts of this model are presented clearly and they are easily comprehended. The model translates easily into clinical and research practice. Simplicity : Simplicity The antecedents of uncertainty are concise and their definitions are clear and simple. The appraisal of uncertainty is in itself complex, but with the use of this theory and the MUIS tool it is made easier. The complete model although not simple is easily made operational. Generality : Generality The theory can be applied to many areas of nursing practice and has been used by clinicians for acute and chronic illness such as cancer, cardiac disease, and multiple sclerosis. Accessibility : Accessibility With use of this theory it’s been shown that uncertainty is indeed a phenomena that patients experience, and specifies what areas of the illness may be responsible for uncertainty. With application of this theory a goal of increased coping mechanisms for patient comfort is made attainable. Scope of Theory : Scope of Theory The middle-range theory by definition gives a more specific guidance for nursing practice, and closely aligns with the scientific-empiric pattern. Uncertainty in illness theory fits into this definition very well as evidence by the many studies conducted with the theory and it’s collaborative tool MUIS. Level of Theory Development : Level of Theory Development Middle range theory applies readily to nursing practice and uncertainty in illness theory lends itself easily to practice. Person : Person The person experiences uncertainty gradually, beginning as the illness insidiously invades life. Questioning one’s self as the body changes with progression of illness, and how this will change their interpersonal relationships is common in uncertainty. Uncertainty in Illness Theory helps to address this effect on the patient and assist with coping mechanisms. Health : Health Using the MUIS tool clinicians can identify the areas of illness that are causing the greatest uncertainty. Addressing these areas and assisting the patient to build better coping mechanisms will improve the patient’s health during times of illness. Environment : Environment Uncertainty in Illness has been researched primarily in the hospital setting. Illness effects many aspects of life and with increased research it might show how Uncertainty in Illness theory can be used to help a variety of patients in different environments. Importance to Nursing : Importance to Nursing If an event is perceived as uncertain and the individuals coping mechanisms do not lessen the threat, the person can exhibit a typical stress reaction (Mishel, 1981) Nurses can assist the patient by constructing a personal scenario for the illness which includes why or how the illness began, how it will progress, and how the patient can recover. Incorporating the uncertainty is an approach where there is a change in the patient’s and family’s perspective in life, away from an orientation to control and predict toward an acceptance of unpredictability and uncertainty as normal. Uncertainty become the rhythm of life (Mishel, 1999) Contagiousness : Contagiousness Very.The fact that this is a mid range theory sets it up to be used easily in specific circumstances. If you work in Oncology you might take a serious look at this theory since that is where a majority of the research has been done with it. If you work in Pediatrics it might have limited use with out more research. Critique : Critique The development of this theory lacks existing scales to measure coping mechanisms in relationship to uncertainty. The study of coping with uncertainty could benefit from triangulated studies (Mishel, 1999). Some of the most important parts of this theory are the aspects to which it gives nurses insight into the point of view of the patient. The theory provides a framework to base deep and meaningful assessments about uncertainty on, and then construct interventions to assist the patient to deal with the elements of illness that are uncertain. Contacts : Contacts Merle Mishel RN,Ph.D. Kenan Professor of NursingUniversity of North Carolina at Chapel Hill School of Nursing Carrington Hall UNC-CHChapel Hill, NC 27514Phone: 919-966-5296Fax: 919-843-8240E-mail: mishel@unc.edu To request the MUIS http://nursing.unc.edu/muic/instruments.html Carl Gannon Doc_gannon@yahoo.com Do you like you like this theory? : Do you like you like this theory? I did like this theory. As I learn about every new theory it’s like seeing a mechanical schematic of how a particular system works. After learning a theory I can then see the workings of a particular situation, in this case how uncertainty pervades the life of a patient. Using a particular theory I know how to better assess the situation and then apply the theory for improved out comes. Discussion Question : Discussion Question What aspects of uncertainty do your clients face in your area of practice and how might this uncertainty impact their overall health? Web CT Question : Web CT Question Once uncertainty is identified in your client how might you alleviate this uncertainty? References Used : References Used Chinn, P. L., & Kramer, M. K. (Eds.). (2008). Integrated Theory And Knowledge Development in Nusing (Seventh Edition ed.): MOSBY ELSEVIER. Lillemor, H., & Soly, E. (1991). Validation of a Swedish Version of the Mishel Uncertainty in Illness Scale. Scholarly Inquiry for Nursing Practice, 5(1), 57-64. Mishel, M. H. (1981). The Measurment of Uncertainty in Illness. Nursing Research, 30(5), 258-253. Mishel, M. H. (1999). Uncertainty in chronic illness. Annual Review of Nursing Research, 17, 269-294. Slide 29: Mishel, M. H., Belyea, M., Germino, B. B., Stewart, J. L., Jr., D. E. B., Robertson, C., et al. (2002). Helping patients with localized prostate carcinoma manage uncertainty and treatment side effects. Cancer, 94(6), 1854-1866. Mishel, M. H., Germino, B. B., Gil, K. M., Belyea, M., LaNey, I. C., Stewart, J., et al. (2005). Benefits from an uncertainty management intervention for African-American and Caucasian older long-term breast cancer survivors. Psycho-Oncology, 14(11), 962-978 . Tomey, A. M., & Alligood, M. R. (Eds.). (2006). Nursing Theorists and Their Work (Sixth ed.).

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