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CHAPTER 28 Merle H. Mishel 559

Sorenson, 1991; Page, Fedele, Pai, et al., 2012; Schepp, studies of people with chronic and life-threatening ill-
1991; Wineman, 1990), quality of life (Lasker, Sogolow, nesses. The process of formulating a new view of life is
Short, et al., 2011; Somjaivong Thanasilp, Preechawong, described by women with breast cancer and cardiac
et al., 2011; Song, Northouse, Braun, et al., 2011), disease as a revised life perspective (Hilton, 1988), new
satisfaction with family relationships (Wineman, O’Brien, life goals (Carter, 1993), new ways of being in the world
Nealon, et al., 1993), satisfaction with health care (Mast, 1998; Nelson, 1996), growth through uncertainty
services (Green & Murton, 1996; Tai-Seale, Stults, (Pelusi, 1997), and new levels of self-organization
Zhang, et al., 2012), and family caregivers’ maintenance (Fleury, Kimbrell, & Kruszewski, 1995). In studies of
of their own self-care activities (Brett & Davies, 1988; men with chronic illness or their caregivers, the pro-
O’Brien, Wineman, & Nealon, 1995). cess is described as transformed self-identity and new
In 1990, the original theory was expanded to in- goals for living (Brown & Powell-Cope, 1991), a more
clude the idea that uncertainty may not be resolved positive perspective on life (Katz, 1996), reevaluating
but may become part of an individual’s reality. In this what is worthwhile (Nyhlin, 1990), contemplation and
context, uncertainty is appraised as an opportunity self-appraisal (Charmaz, 1995), uncertainty viewed as
that prompts the formation of a new, probabilistic opportunity (Baier, 1995), and redefining normal and
view of life. To adopt this new view of life, the patient building new dreams (Mishel & Murdaugh, 1987).
must be able to rely on social resources and health
care providers who themselves accept the idea of Major Assumptions
probabilistic thinking (Mishel, 1990). When uncer-
tainty is framed as a normal part of life, it becomes a Person
positive force for multiple opportunities and resulting Mishel’s Uncertainty in Illness Theory is middle-
positive mood states (Gelatt, 1989; Mishel, 1990). range and focused on persons. Mishel’s original
Support for the reconceptualized Uncertainty in Ill- Uncertainty in Illness Theory, first published in 1988,
ness Theory has been found in predominantly qualitative included several major assumptions (Figure 28–1).

Coping:
Mobilizing
strategies
Affect-
control
strategies
Danger
( )
Stimuli frame
Symptom pattern ( ) Inference
Event familiarity Uncertainty Illusion Appraisal Adaptation
Event congruency

( ) Opportunity
( )
( )
( )

Cognitive Structure providers Coping:
capacities Credible authority buffering
Social support strategies
Education

FIGURE 28-1 Model of Perceived Uncertainty in Illness. (From Mishel, M. H. [1988]. Uncertainty in illness.
Image: The Journal of Nursing Scholarship, 20(4), 226.)