Page 557 - Encyclopedia of Nursing Research

524 n UnLIcenSeD ASSISTIve PeRSOnneL

populations. Uncertainty has consistently across studies so that support for particular
been found to be related to depression, anxi- strategies can emerge.
U ety, poorer quality of life, less optimism, and In conclusion, the research on the con-
negative mood states. Because the evidence cept of uncertainty continues to spread across
is consistent and strong, it provides direction disciplines and countries. Today, the uncer-
for interventions to target outcome variables. tainty in illness scales have been translated
There is growing evidence in support of the into more than 15 languages and the research
effectiveness of supportive educational inter- continues across all continents.
ventions in modifying the adverse outcomes
from uncertainty. Recently, interventions for Merle H. Mishel
managing uncertainty in breast and prostate
cancer have been published and reported
strong intervention effects (Braden, Mishel,
Longman, & Burns, 1998; Mishel et al., 2002, Unlicensed assistive
2003, 2005, 2009). Recent publication of the
intervention work in Advancing Oncology Personnel
nursing Science (2009) has presented
the interventions to a broader audience.
Furthermore, the recent ncI monograph Unlicensed assistive personnel (UAP), func-
(epstein & Street, 2007) on Patient-centered tioning in an assistive role to the registered
communication in cancer care includes nurse (Rn), providing specific kinds of
uncertainty as conceptualized by Mishel as direct and indirect care pursuant to dele-
a central issue in doctor–patient communica- gation of such tasks by an Rn and in accor-
tion. The research needs to expand with the dance with the respective state’s nurse
use of the theory. In other disciplines, a the- Practice Act, are a safe, appropriate, and
ory such as the uncertainty theory would be efficient use of resources to provide nursing
used and expanded. However, in nursing, the care (AnA Position Statement, 2007). They
theory is dissected and not built on except for are known by a variety of names in differ-
the work of a few. Repeated testing of these ent care/ service settings, including patient
interventions, and the development of theory care assistant, nurse extender, nurse part-
and research-based interventions that build ner, patient care technician, or nursing assis-
on the body of existing descriptive and inter- tive personnel in acute care; certified nurse
vention research, should be the direction of assistant (cnA) in nursing homes; resident
future research. assistant in assisted living; personal care
In chronic illness, the work on manage- attendant or home care aide in home care;
ment of uncertainty has been advanced by aide; orderly; and so forth. Job qualifications,
qualitative investigations in which a variety training, and nursing activities vary widely.
of management methods have been found nursing home (nH) cnAs are the subject of
across a number of chronic illnesses. The more intervention and descriptive studies
findings from qualitative studies indicate than any other UAPs.
that people are very resourceful in finding Most state boards of nursing indicate
approaches for living with enduring uncer- what nursing processes/tasks can and can-
tainty. However, there is an absence of con- not be delegated. Tasks can be assigned if the
sistent findings. This may be because of the care task is routine, low risk, unlikely to need
variation in the qualitative methods applied to be modified, has a predictable outcome,
and how uncertainty is defined in such stud- and does not require assessment, interpre-
ies. More solid research is needed in this tation, or decision making. In general, tasks
area, with an attempt to replicate findings cannot be delegated to UAPs if the patient