uncertainty in illness theory

8/19/2019 Uncertainty in Illness Theory

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Uncertainty in Illness TheMerle H. MIshel


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Credentials and Backgro


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Credentials and Background

Born in 1939, in Boston Massachusetts

She Graduated from Boston University with 19!1

"eceived her M.S. in #sychiatric nursin$ fromUniversity of %alifornia in 19!!

%om#leted her M.. and &h.'. in social #sycthe %laremont Graduate School, %alifornia in19)*, res#ectively.


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Her dissertation research, su##orted +y an i

national research service award, was the deand testin$ of the #erceived am+i$uity in Illlater renamed the Mishel Uncertainty in IllneMUIS-. the ori$inal scale has +een used afor the followin$ three additional scales/

community version MUIS-% for chronically ill inwho are not hos#itali0ed or receivin$ active care.

measure of #arents #erce#tions of uncertainty re$ard to their childs illness e2#erience.

measure of uncertainty in s#ouses or other famwhen another mem+er of the family is acutely ill


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4arly in her #rofessional career, Mishel #rac#sychiatric nurse in acute care and communsettin$s, while #ursuin$ her doctorate, she wfaculty in the 'e#artment of 5ursin$ in the %State University at 6os n$eles, risin$ from

to full #rofessor. She #racticed as a nurse thera#ist in +oth co

and #rivate #ractice settin$s from 19(3-19(

U#on com#letion of her doctorate de$ree in #sycholo$y, she relocated to the University

%olle$e of 5ursin$ in 19)1.


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She served as division head for mental healtfrom 19)7-1991.

She received numerous intramural and e2traresearch $rants that su##orted the the contidevelo#ment of her theoretical framewor8.

She was inducted as fellow in the merican of 5ursin$ in 199*

Became #rofessor at the University of 5orth School of 5ursin$ in 1991


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as awarded, :enan &rofessor of 5ursin$ %h1997

Given the "esearch Merit ward in 199(

"eci#ient of Si$ma ;heta ;au International S%ha#ter 5urse "esearch &redoctoral ellows

19(( to 19(9 and received the Mary =#al "esearch ward in 19)!.


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She is a mem+er of merican cademy of 5Si$ma ;heta ;au International, merican &syssociation, merican 5urses ssociation, SBehavioral Medicine, and =ncolo$y 5ursin$

Served as $rant reviewer for the 5ational %a

Institute, 5ational %enter for 5ursin$ "esear5ational Institute for $in$ and was a charteof the study section on human immune de>virus HI? at the 5ational Institute of Menta


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Theoretical Sources


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Theoretical Sources

hen Mishel started her research into unce

conce#t had not #reviously +een a##lied in and illness conte2t.

Her ori$inal Uncertainty in Illness ;heory M19)) drew from e2istin$ information-#rocesmodels ar+urton, 19(9 and #ersonality rBudner, 19!@ from #sycholo$y disci#line, wcharacteri0ed uncertainty as a co$nitive staresultin$ from insuAcient cues with which foco$nitive schema or inter#ersonal re#resentsituation or event.

She attri+utes the underlyin$ stress-a##rais

ada#tation framewor8 in the ori$inal theory


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The unique aspect was her application of thframework to uncertainty as a stressor in thof illness, which made the framework particmeaningful for nursing.

ith the conce#tuali0ation of the theory, Mi

199* reco$ni0ed that the western a##roacscience su##orted a mechanistic view in its on control and #redicta+ility.


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By usin$ critical social theory, Mishel reco$n+ias inherent in the ori$inal theory, an orientoward certainty and ada#tation. She incor#tenets from chaos theory, and +ecause of itso#en systems, allowed for a more accurate

re#resentation of how chronic illness createsdiseuili+rium and how #eo#le ultimately caincor#orate continual uncertainty to >nd newin illness.


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Major Concepts & Defnit


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Major Concepts & Defnition

Uncertainty

;he ina+ility to determine the meanin$ ofrelated events, occurrin$ when the decisiuna+le to assi$n de>nite value to o+Cectsor is una+le to #redict outcomes accurate

Cognitive Schema

Is a #ersons su+Cective inter#retation of itreatment, and hos#itali0ation

Stimuli rame

Is the form, com#osition, and structure ofstimuli that a #erson #erceives, which are

structured into a co$nitive schema


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Symptom !attern

Is the de$ree to which sym#toms occur wsuAcient consistency to +e #erceived as #attern or con>$uration

"vent amiliarity

Is the de$ree to which a situation is ha+it

re#etitive, or contains reco$ni0ed cues "vent Congruence

"efers to the consistency +etween the e2and the e2#erienced in illness-related eve


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ST#UCTU#" !#$%ID"#S

re the resources availa+le to assist the #the inter#retation of the stimuli frame

Credile 'uthority

Is the de$ree of trust and con>dence a #ein his or her healthcare #roviders

Social Supports

Social Su##orts inDuence uncertainty +y the individual to inter#ret the meanin$ of


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C$()ITI%" C'!'CITI"S

re the information-#rocessin$ a+ilities ofreDectin$ +oth innate ca#a+ilities and situconstraints

I)"#")C" "efers to the evaluation of uncertainty us

related, recalled e2#eriences

I**USI$)

"efers to +eliefs constructed out of uncer


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'D'!T'TI$)

"eDects +io#hysical +ehavior occurrin$ w#ersons individually de>ned ran$e of usu+ehavior

)"+ %I"+ $ *I"

"efers to the formulation of a new sense

resultin$ from the inte$ration of continuauncertainty into ones self structure, in wuncertainty is acce#ted as the natural rhy

!#$B'BI*ISTIC T,I)-I)(

"efers to the +elief in a conditional world

the e2#ectation of continual certainty and


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Major 'ssumptions


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Major 'ssumptions

Mishels ori$inal Uncertainty in illness

>rst #u+lished in 19)), included seveassum#tions. ;he >rst two reDect howuncertainty was conce#tuali0ed ori$inwithin the #sycholo$y disci#lines info#rocessin$ models, as follows/

Uncertainty is a co$nitive state, re#reseninadeuacy of an e2istin$ co$nitive schemsu##ort inter#retation of illness related ev

Uncertainty is an inherently neutral e2#eneither desira+le nor aversive until it is a

as such.


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;wo more assum#tions reDect the unctheorys roots in traditional stress and

models that #osit a linear stress

coada#tation relationshi# as follows/

da#tations re#resents the continuity of aindividuals usual +io#hysical +ehavior andesired outcome of co#in$ eEorts to eitheuncertainty a##raised as dan$er or maintuncertainty a##raised as o##ortunity

;he relationshi#s amon$ illness events, ua##raisal, co#in$, and ada#tations are linunidirectional, movin$ from a situations #uncertainty toward ada#tation.


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Mishel herself challen$ed these last two assin her reconce#tuali0ation of her theory, #u+199*.

;he reconce#tuali0ation came a+out as a recontradictory >ndin$s, when the theory was#eo#le with chronic illness.

;he ori$inal theory held that uncertainty, tya##raised as an o##ortunity only in conditio

re#resent a 8nown downward traCectory. MIshel and others found that #eo#le also a#

uncertainty as an o##ortunity in situations wcertain downward traCectory, #articularly, inchronic illnesses, and that in this conte2t #edevelo# a new view of life.


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Mishel +ecame dissatis>ed with the traditionmodels that informed the ori$inal theory, shto the more dynamic chaos theory to e2#lain#rolon$ed uncertainty could function as a ca

chan$e a #ersons #ers#ective on life and ill%haos theory contri+uted two of the followintheoretical assum#tions, which re#lace the stress co#in$ ada#tation outcome #ortmodel as follows/

&eo#le as +io#hysical systems ty#ically fu

far-from-euili+rium states

MaCor luctuations in a far-from-euili+riuenhance the systems rece#tivity to chan

luctuations result in re-#atternin$, which


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Because uncertainty #ervades nearly every a #ersons life, its eEects +ecome concentraultimately challen$e the sta+ility of the systres#onse to the confusion and disor$ani0atio

+y continued uncertainty, the system ultimachan$e in order to survive

Ideally under conditions of chronic uncertain#erson $radually moves away from an evaluuncertainty as aversive to ado#t a new viewthat acce#ts uncertainty as a #art of reality.

>$ure @)-@

;hus uncertainty, es#ecially in chronic or lifethreatenin$ illness, can result in a new levelor$ani0ation and a new #ers#ective on life.Incor#oratin$ the $rowth and chan$e that ca

from uncertain e2#eriences.


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Theoretical 'ssertions


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Theoretical 'ssertions

Mishel asserted the followin$/

1. Uncertainty occurs when a #erson cannot adeuately strucate$ori0e an illness-related event +ecause of lac8 of cues

@. Uncertainty can ta8e the form of am+i$uity, com#le2ity, lainconsistent information, or un#redicta+ility

3. s sym#tom #attern event familiarity, and event con$ruen

frame increase, uncertainty decreases7. Structure #roviders %redi+le uthority, social su##ort, and

decrease uncertainty directly +y #romotin$ inter#retation oindirectly +y stren$thenin$ the stimuli frame


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F. Uncertainty a##raised as dan$er #rom#ts co#in$ eEorts direducin$ the uncertainty and mana$in$ the emotional arou+y it

!. Uncertainty a##raised as o##ortunity #rom#ts co#in$ eEormaintainin$ the uncertainty

(. ;he inDuence of uncertainty on #sycholo$ical outcomes is the eEectiveness of co#in$ eEorts to reduce uncertainty a#

dan$er or to maintain uncertainty a##raised as o##ortunit

). hen uncertainty a##raised as dan$er cannot +e reduced co#in$ strate$ies can +e em#loyed to mana$e the emotion


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9. ;he lon$er uncertainty continues in the illness conte2t, theunsta+le the individuals #reviously acce#ted mode of func+ecomes

1*.Under conditions of endurin$ uncertainty, individuals may new, #ro+a+ilistic, #ers#ective on life, which acce#ts uncenatural #art of life

11. ;he #rocess of inte$ratin$ continual uncertainty into a new

can +e +loc8ed or #rolon$ed +y structure #roviders who do#ro+a+ilistic thin8in$

1@.&rolon$ed e2#osure to uncertainty a##raised dan$er can leintrusive thou$hts, avoidance, and severe emotional distre


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Mishel +elieves the most im#ortant #rher research #ro$ram is the return of8nowled$e to #ractice. ;oward the endare under way to move the theoreticaderived intervention into current #rac

allowin$ nurses res#onsi+le for diEereof #atient #o#ulations

uncertainty in illness theory

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