Page 555 - Encyclopedia of Nursing Research

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of uncertainty in chronic illness. This classic
Uncertainty in illness qualitative study on living with uncertainty
brought home the invasion of uncertainty
into multiple aspects of life and some strate-
Uncertainty in illness has been defined by gies to tolerate the uncertainty.
Mishel (1988) as the inability to determine Since the publication of the Uncertainty
the meaning of illness-related events; this in Illness Theory and the scales to measure
occurs in situations in which the decision uncertainty: Mishel Uncertainty in Illness
maker is unable to assign definite value Scale (Mishel, 1981), the Parents Perception
to objects and events or is unable to accu- of Uncertainty Scale (Mishel, 1983b), the
rately predict outcomes because of a lack of exploration of uncertainty scales for spe-
sufficient cues. The uncertainty theory by cific populations (Mishel, 1983a), along with
Mishel explains how uncertainty develops early conceptualization of the uncertainty
in patients with an acute illness and how it within illness (Mishel, 1981), the study of
is proposed that patients deal with uncer- uncertainty has expanded considerably. Both
tainty. Mishel further defined the original qualitative and quantitative work in nursing
theory to refer to chronic illness in 1990, and in other fields added to the knowledge
building the extended theory on chaos the- on uncertainty in illness. The research has
ory and presenting a new model. spread to practice through clinical publica-
Uncertainty regarding an illness has been tions (Hilton, 1992; Righter, 1995; Wurzbach,
identified as the greatest single psychological 1992). A second instrument on uncertainty in
stressor for the patient with a life-threatening illness has been developed by Hilton (1994).
illness (Koocher, 1985). Uncertainty is not the This instrument is based on the stress and
total experience in acute and chronic illness, coping framework by Lazarus and Folkman
yet it is a constant occurrence from diagno- (1984) and is not derived from a nursing the-
sis through living with a long-term illness ory of uncertainty in illness.
or condition. The study of uncertainty dates A number of reviews of the research on
back to some of the early work by Davis (1960), uncertainty in illness have been published.
in which he detailed the difference between The first review by Mast (1995) used the
clinical and functional uncertainty and tied uncertainty in illness theory as the frame-
the experience to the delivery of care and work for the review of research on uncer-
the agenda of health care providers. From tainty. Similarly, the two reviews by Mishel
1960 through 1974, other early perspectives in the Annual Review of Nursing Research
on uncertainty emerged, which included the (1997, 1999) also used the Uncertainty in
work by McIntosh (1974, 1976) on the desire Illness theory published in 1988 as the frame-
for information among patients with cancer. work for review, although Mishel (1999) also
This work provided some of the first ideas included the uncertainty theory published
about the ambiguity surrounding diagnosis in 1990 to evaluate the qualitative work done
and prognosis and the impact of this ambi- on uncertainty in chronic illness. Stewart
guity on the patient’s psychological state. and Mishel (2000) reviewed the research on
Work by Wiener in 1975 explored the topic parent and child uncertainty. Other recent