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562 UNIT V Middle Range Nursing Theories

her doctoral-level courses. Mishel frequently presents Stewart, Lynn, & Mishel, 2010; Stewart, Mishel,
school of nursing lectures, seminars, and symposia Lynn, et al., 2010). Bailey uses the theory to support
nationally and internationally, sharing her empirical research in chronic hepatitis C, a new and often
findings and the process of theory development for silent disease (Bailey, Barroso, Muir, et al., 2010;
faculty and students. Bailey, Landerman, Barroso, et al., 2009), and she is
testing an intervention in patients awaiting liver
Research transplant and their caregivers.
As described above, a large body of knowledge has From qualitative data supporting the reconcep-
been generated by researchers using the Uncertainty tualized theory, Mishel and Fleury (1994) devel-
in Illness Theory and scales. Mishel’s program of oped the Growth Through Uncertainty Scale
research encompassed testing the psychoeducational (GTUS) to measure the new view of life that can
nursing interventions derived from the theoretical emerge from continual uncertainty. Researchers
model in samples of adults with breast and prostate have also used the reconceptualized theory to un-
cancers. The scales and theory used by nurse derstand the uncertainty experience of long-term
researchers and scientists from other disciplines survivors of breast cancer (Mast, 1998) and indi-
describe and explain psychological responses of viduals with schizophrenia and their family mem-
people experiencing uncertainty due to illness and bers (Baier, 1995). The reconceptualized theory
test interventions to manage uncertainty in illness served as the foundation for Mishel and colleagues’
contexts. The scales have been translated into 12 lan- nursing intervention study of women younger than
guages and applied in research throughout the world. 50 years of age facing the enduring uncertainties
Mishel (1997a, 1999) reviewed research conducted inherent in surviving breast cancer. Bailey used the
on uncertainty in acute and chronic illness and theory and data from qualitative interviews with
coauthored a review of the research on uncertainty in older men who had elected watchful waiting as
childhood illness (Stewart & Mishel, 2000). Current treatment for their prostate cancer, to develop a
research on uncertainty in illness is focused on the- nursing intervention to integrate uncertainty into
ory testing. their lives, view their lives in a positive perspective,
and improve their quality of life (Bailey, Wallace, &
Mishel, 2007). In the first study of the Uncertainty
Further Development Management Intervention for Watchful Waiting,
Mishel and colleagues have used the original theory men came to see their lives in a new and positive
as the framework for seven federally funded nursing light, reported their quality of life as higher than did
intervention studies. The intervention has increased the control group, and expected it to be high in the
cancer knowledge, reduced symptom burden, and future (Bailey, Mishel, Belyea, et al., 2004). Wallace
improved quality of life in Mexican-American, (now, Kazer) and Bailey conducted a pilot test of
Caucasian, and African-American women with a web-based version of the intervention for men
breast cancer, in African-American and Caucasian with prostate cancer undergoing active surveillance
men newly diagnosed with prostate cancer, and (previously referred to as watchful waiting) (Kazer,
in those with localized, advanced, or recurrent pros- Bailey, Sanda, et al., 2011).
tate cancer and their family members (Gil, Mishel, The substantial empirical evidence supporting
Belyea, et al., 2004; Gil, Mishel, Belyea, et al., 2006; the Uncertainty in Illness theories provides a strong
Gil, Mishel, Germino, et al., 2005; Mishel, Belyea, foundation to extend the theory to intervention
Germino, et al., 2002; Mishel, Germino, Belyea, development and improve patient and family out-
et al., 2003; Mishel, Germino, Lin, et al., 2009). The comes. In addition to Mishel’s own intervention stud-
applicability of the theory to the context of serious ies in patients with breast and prostate cancer, several
childhood illness has been supported in parents of researchers tested interventions to help patients man-
children with HIV infection (Santacroce, Deatrick, & age uncertainty. Many were directed at reducing
Ledlie, 2002) and in children undergoing treatment sources of uncertainty (Chair, Chou, Sit, et al., 2012;
for cancer (Lin, Yeh, & Mishel, 2010; Stewart, 2003; Chiou & Chung, 2012; Faithfull, Cockle-Hearne, &