Page 556 - Encyclopedia of Nursing Research

UnceRTAInTy In ILLneSS n 523

reviews of the research and theory on uncer- in this area, it should be focused on building
tainty include the review by neville (2003), on what is known instead of repeating simi-
with a focus on application to orthopedic con- lar findings. U
ditions, and the chapter by Barron (2000), on concerning the role of personality dis-
stress, uncertainty, and health. Mishel’s work positions as antecedents or modifiers of
on uncertainty has lead to stimulating fur- uncertainty, the evidence is not solid. In acute
ther work within nursing and related fields. illness, there is some support for mastery in
Work on the concept of uncertainty has been a mediating role, but the study of personality
published by Mccormick (2002), Brashers dispositions related to uncertainty has been
(2003, 2004), and by Babrow (2001) from the limited to a small number of studies, all with
field of health communication. Discussion cancer patients receiving treatment. Other
of the theory of uncertainty as conceptual- acute illnesses require study to see which
ized by Mishel has appeared in two sources personality dispositions are associated with
on nursing theory (Alligood & Tomey, 2002; uncertainty and at which phase in the illness
Smith & Liehr, 2003, 2008). experience. Further research is necessary to
As noted by Barron (2000) and Mishel determine if the acuity of illness immobi-
(1997), there has been a strong interest in lizes personality variables and whether they
the study of uncertainty; however, most of come into play during the recovery phase or
it has been atheoretical. Most of the quanti- during the management of continual uncer-
tative studies of uncertainty in illness have tainty in chronic illness.
used one of Mishel’s uncertainty scales, but In chronic illness, interesting findings
the selection of variables had not been tied to are emerging from quantitative studies of
the theory of uncertainty in illness. Most of perceived personal control as a personality
the research has been on uncertainty in spe- disposition for influencing uncertainty and
cific clinical populations, with the predom- the relationship between uncertainty and
inance of the quantitative research on acute mood state. Likewise, spirituality is also
illness and with more qualitative work on being studied for its potential in modifying
chronic illness. This may be due to the focus the impact of uncertainty in mood. Both of
of the uncertainty scales on acute illness and these avenues of study are important and
hospitalization, with less use of the Growth point out that in a long-term illness, person-
through Uncertainty Scale, which was devel- ality dimensions may come into play for their
oped to address the chronic enduring illness ability to reduce uncertainty or to reduce the
conditions. negative impact of uncertainty.
In the study of uncertainty, most of the Studies of coping with uncertainty in
descriptive studies are cross-sectional and persons with acute illness have resulted
the findings are associative, although the in consistent findings for the relationship
analyses in many studies are often consid- between uncertainty and emotion-focused
ered predictive when causal modeling is coping. To determine if a broader range of
used. At this time, some consistent findings coping strategies exists, attention needs to
have emerged. Across all illnesses studied be given to developing instruments that are
to date, uncertainty decreases over time and related to the problem under study. If coping
returns upon illness recurrence or exacerba- strategies were derived from the setting and
tion, and uncertainty is highest or most dis- population, results may differ from those
tressing while awaiting a diagnosis. current consistently accrued from global measures of
evidence is strong for the role of social sup- coping.
port in reducing uncertainty among those There is sufficient evidence that uncer-
with an acute illness. Because of the consen- tainty has a negative impact on quality of life
sus of the findings, if further research is done and psychosocial adjustment in acute illness