Page 577 - alligood 8th edition_Neat

558 UNIT V Middle Range Nursing Theories

MAJOR CONCEPTS & DEFINITIONS—cont’d
New View of Life Probabilistic Thinking
New view of life refers to the formulation of a new Probabilistic thinking refers to a belief in a condi-
sense of order, resulting from the integration of con- tional world in which the expectation of continual
tinual uncertainty into one’s self-structure, in which certainty and predictability is abandoned (Mishel,
uncertainty is accepted as the natural rhythm of life 1988).
(Mishel, 1988).

Use of Empirical Evidence et al., 1993; Kim, Lee, & Lee, 2012; Murray, 1993).
The Uncertainty in Illness Theory grew out of Mishel’s Similarly, the ambiguous nature of illness symptoms
dissertation research with hospitalized patients, using and the consequent difficulty in determining the sig-
both qualitative and quantitative findings to generate nificance of physical sensations have been identified
the first conceptualization of uncertainty in the context as sources of uncertainty (Cohen, 1993; Hilton, 1988;
of illness. With the publication of Mishel’s Uncertainty Nelson, 1996).
in Illness Scale (Mishel, 1981), extensive research Social support has been shown to have a direct
began into adults’ experiences with uncertainty related impact on uncertainty by reducing perceived com-
to chronic and life-threatening illnesses. Considerable plexity and an indirect impact through its effect on the
empirical evidence has accumulated to support Mishel’s predictability of symptom pattern (Lin, 2012; Mishel
theoretical model in adults. Several integrative reviews & Braden, 1988; Somjaivong, Thanasilp, Preechawong,
of uncertainty research have comprehensively summa- et al., 2011; Scott, Martin, Stone, et al., 2011). The
rized and critiqued the state of the science (Cahill, perception of stigma associated with some conditions,
Lobiondo-Wood, Bergstrom, et al., 2012; Hansen, particularly HIV infection (Regan-Kubinski & Sharts-
Rørtveit, Leiknes, et al., 2012; Mishel, 1997a, 1999; Hopko, 1995) and Down’s syndrome (Van Riper
Stewart & Mishel, 2000). The authors included studies & Selder, 1989), served to create uncertainty when
that directly support the elements of Mishel’s uncer- families were unsure about how others would respond
tainty model. to the diagnosis. Family members have been shown to
Most empirical studies have been focused on two experience high levels of uncertainty as well, which
antecedents of uncertainty, stimuli frame and structure may further reduce the amount of support experi-
providers, and the relationship between uncertainty enced by the patient (Baird & Eliasziw, 2011; Brown
and psychological outcomes. Mishel tested other ele- & Powell-Cope, 1991; Hilton, 1996; Wineman, O’Brien,
ments of the model, such as the mediating roles of Nealon, et al., 1993). Uncertainty was heightened by
appraisal and coping, early in her program of research interactions with health care providers when patients
(Mishel & Braden, 1987; Mishel, Padilla, Grant, et al., and family members received unclear information,
1991; Mishel & Sorenson, 1991), and these elements, as received simplistic explanations that did not fit their
well as cognitive capacity as an antecedent to uncer- experience, or perceived that care providers were not
tainty, generated less research attention. expert or responsive enough to help them manage
Several studies have shown that objective or the intricacies of the illness (Becker, Jason-Bjerklie,
subjective indicators of the severity of life-threat or Benner, et al., 1993; Checton & Greene, 2012; Sharkey,
illness symptoms associate positively with uncertainty 1995; Step & Ray, 2011).
(Baird & Eliasziw, 2011; Grootenhuis & Last, 1997; Numerous studies have reported the negative impact
Somjaivong, Thanasilp, Preechawong, et al., 2011). of uncertainty on psychological outcomes, characterized
Across a sustained illness trajectory, unpredictability variously as anxiety, depression, hopelessness, psycho-
in symptom onset, duration, and intensity has been logical distress (Arroll, Dancey, Attree, et al., 2012; Failla,
related to perceived uncertainty (Arroll, Dancey, Kuper, Nick, et al., 1996; Grootenhuis & Last, 1997; Kim
Attree, et al., 2012; Becker, Jason-Bjerklie, Benner, & So, 2012; Miles, Funk, & Kasper, 1992; Mishel &