Which middle range theory developed by a nurse focuses on a persons inability to understand the meaning of illness related events?

Use of empirical evidence

The Uncertainty in Illness Theory grew out of Mishel’s dissertation research with hospitalized patients, using both qualitative and quantitative findings to generate the first conceptualization of uncertainty in the context of illness. With the publication of Mishel’s Uncertainty in Illness Scale (Mishel, 1981), extensive research began into adults’ experiences with uncertainty related to chronic and life-threatening illnesses. Considerable empirical evidence has accumulated to support Mishel’s theoretical model in adults. Several integrative reviews of uncertainty research have comprehensively summarized and critiqued the state of the science (Cahill, Lobiondo-Wood, Bergstrom, et al., 2012; Hansen, Rørtveit, Leiknes, et al., 2012; Mishel, 1997a, 1999; Stewart & Mishel, 2000). The authors included studies that directly support the elements of Mishel’s uncertainty model.

Most empirical studies have been focused on two antecedents of uncertainty, stimuli frame and structure providers, and the relationship between uncertainty and psychological outcomes. Mishel tested other elements of the model, such as the mediating roles of appraisal and coping, early in her program of research (Mishel & Braden, 1987; Mishel, Padilla, Grant, et al., 1991; Mishel & Sorenson, 1991), and these elements, as well as cognitive capacity as an antecedent to uncertainty, generated less research attention.

Several studies have shown that objective or subjective indicators of the severity of life-threat or illness symptoms associate positively with uncertainty (Baird & Eliasziw, 2011; Grootenhuis & Last, 1997; Somjaivong, Thanasilp, Preechawong, et al., 2011). Across a sustained illness trajectory, unpredictability in symptom onset, duration, and intensity has been related to perceived uncertainty (Arroll, Dancey, Attree, et al., 2012; Becker, Jason-Bjerklie, Benner, et al., 1993; Kim, Lee, & Lee, 2012; Murray, 1993). Similarly, the ambiguous nature of illness symptoms and the consequent difficulty in determining the significance of physical sensations have been identified as sources of uncertainty (Cohen, 1993; Hilton, 1988; Nelson, 1996).

Social support has been shown to have a direct impact on uncertainty by reducing perceived complexity and an indirect impact through its effect on the predictability of symptom pattern (Lin, 2012; Mishel & Braden, 1988; Somjaivong, Thanasilp, Preechawong, et al., 2011; Scott, Martin, Stone, et al., 2011). The perception of stigma associated with some conditions, particularly HIV infection (Regan-Kubinski & Sharts-Hopko, 1995) and Down’s syndrome (Van Riper & Selder, 1989), served to create uncertainty when families were unsure about how others would respond to the diagnosis. Family members have been shown to experience high levels of uncertainty as well, which may further reduce the amount of support experienced by the patient (Baird & Eliasziw, 2011; Brown & Powell-Cope, 1991; Hilton, 1996; Wineman, O’Brien, Nealon, et al., 1993). Uncertainty was heightened by interactions with health care providers when patients and family members received unclear information, received simplistic explanations that did not fit their experience, or perceived that care providers were not expert or responsive enough to help them manage the intricacies of the illness (Becker, Jason-Bjerklie, Benner, et al., 1993; Checton & Greene, 2012; Sharkey, 1995; Step & Ray, 2011).

Numerous studies have reported the negative impact of uncertainty on psychological outcomes, characterized variously as anxiety, depression, hopelessness, psychological distress (Arroll, Dancey, Attree, et al., 2012; Failla, Kuper, Nick, et al., 1996; Grootenhuis & Last, 1997; Kim & So, 2012; Miles, Funk, & Kasper, 1992; Mishel & Sorenson, 1991; Page, Fedele, Pai, et al., 2012; Schepp, 1991; Wineman, 1990), quality of life (Lasker, Sogolow, Short, et al., 2011; Somjaivong Thanasilp, Preechawong, et al., 2011; Song, Northouse, Braun, et al., 2011), satisfaction with family relationships (Wineman, O’Brien, Nealon, et al., 1993), satisfaction with health care services (Green & Murton, 1996; Tai-Seale, Stults, Zhang, et al., 2012), and family caregivers’ maintenance of their own self-care activities (Brett & Davies, 1988; O’Brien, Wineman, & Nealon, 1995).

In 1990, the original theory was expanded to include the idea that uncertainty may not be resolved but may become part of an individual’s reality. In this context, uncertainty is appraised as an opportunity that prompts the formation of a new, probabilistic view of life. To adopt this new view of life, the patient must be able to rely on social resources and health care providers who themselves accept the idea of probabilistic thinking (Mishel, 1990). When uncertainty is framed as a normal part of life, it becomes a positive force for multiple opportunities and resulting positive mood states (Gelatt, 1989; Mishel, 1990).

Support for the reconceptualized Uncertainty in Illness Theory has been found in predominantly qualitative studies of people with chronic and life-threatening illnesses. The process of formulating a new view of life is described by women with breast cancer and cardiac disease as a revised life perspective (Hilton, 1988), new life goals (Carter, 1993), new ways of being in the world (Mast, 1998; Nelson, 1996), growth through uncertainty (Pelusi, 1997), and new levels of self-organization (Fleury, Kimbrell, & Kruszewski, 1995). In studies of men with chronic illness or their caregivers, the process is described as transformed self-identity and new goals for living (Brown & Powell-Cope, 1991), a more positive perspective on life (Katz, 1996), reevaluating what is worthwhile (Nyhlin, 1990), contemplation and self-appraisal (Charmaz, 1995), uncertainty viewed as opportunity (Baier, 1995), and redefining normal and building new dreams (Mishel & Murdaugh, 1987).