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CHAPTER 28 Merle H. Mishel 557

situation or event. Mishel attributes the underlying supported a mechanistic view with emphasis on con-
stress-appraisal-coping-adaptation framework in the trol and predictability. She used critical social theory
original theory to the work of Lazarus and Folkman to recognize bias inherent in the original theory, an
(1984). The unique aspect of this framework was its orientation toward certainty and adaptation. Mishel
application to uncertainty as a stressor in the context incorporated tenets from chaos theory and open sys-
of illness, a particularly meaningful proposal for tems for a more accurate representation of how
nursing. chronic illness creates disequilibrium and how people
With the reconceptualization of the theory, Mishel incorporate continual uncertainty to find new mean-
(1990) recognized that the Western approach to science ing in illness.

MAJOR CONCEPTS & DEFINITIONS

Uncertainty Structure Providers
Uncertainty is the inability to determine the mean- Structure providers are the resources available to
ing of illness-related events, occurring when the assist the person in the interpretation of the stimuli
decision maker is unable to assign definite value to frame (Mishel, 1988).
objects or events, or is unable to predict outcomes
accurately (Mishel, 1988). Credible Authority
Credible authority is the degree of trust and confi-
Cognitive Schema dence a person has in his or her health care providers
Cognitive schema is a person’s subjective interpreta- (Mishel, 1988).
tion of illness, treatment, and hospitalization (Mishel,
1988). Social Supports
Social supports influence uncertainty by assisting the
Stimuli Frame individual to interpret the meaning of events
Stimuli frame is the form, composition, and struc- (Mishel, 1988).
ture of the stimuli that a person perceives, which are
then structured into a cognitive schema (Mishel, Cognitive Capacities
1988). Cognitive capacities are the information-processing
abilities of a person, reflecting both innate capabili-
Symptom Pattern ties and situational constraints (Mishel, 1988).
Symptom pattern is the degree to which symptoms
occur with sufficient consistency to be perceived as Inference
having a pattern or configuration (Mishel, 1988). Inference refers to the evaluation of uncertainty
using related, recalled experiences (Mishel, 1988).
Event Familiarity
Event familiarity is the degree to which a situation is Illusion
habitual or repetitive, or contains recognized cues Illusion refers to beliefs constructed out of uncer-
(Mishel, 1988). tainty (Mishel, 1988).

Event Congruence Adaptation
Event congruence refers to the consistency between Adaptation reflects biopsychosocial behavior occur-
the expected and the experienced in illness-related ring within persons’ individually defined range of
events (Mishel, 1988). usual behavior (Mishel, 1988).
Continued