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CHAPTER 28 Merle H. Mishel 563

Khoo, 2011; Kazer, Bailey, Sanda, et al., 2011; Muth- also can lead to the individual appraising the situa-
usamy, Leuthner, Gaebler-Uhing, et al., 2012; Schover, tion as having a positive outcome. In this situation,
Canada, Yuan, et al., 2012). Others focused on the uncertainty is preferred and the individual remains
provision of support (Heiney, Adams, Wells, et al., hopeful.
2012) and specific coping strategies (Faithfull, Cockle- Coping is the third theme of the original model of
Hearne, & Khoo, 2011) to help patients manage their uncertainty. Coping occurs in two forms with the
uncertainty. end result of adaptation. If uncertainty is appraised
as a danger, then coping includes direct action, vigi-
Critique lance, and seeking information from mobilizing
strategies, and it affects management using faith, dis-
Clarity engagement, and cognitive support. If uncertainty is
Uncertainty is the primary concept of this theory and appraised as an opportunity, coping offers a buffer to
is defined as a cognitive state in which individuals are maintain the uncertainty.
unable to determine the meaning of illness-related The original theory was reconceptualized in 1990
events (Mishel, 1988). The original theory postulates to incorporate the idea that chronic illness unfolds
that managing uncertainty is critical to adaptation over time, possibly years, and with that, uncertainty
during illness and explains how individuals cogni- is reappraised. The person is viewed as an open
tively process illness-associated events and construct system exchanging energy within his or her envi-
meaning from them. The original theory’s concepts ronment, and, rather than seeking to return to a
were organized in a linear model around the follow- stable state, chronically ill individuals may move
ing three major themes: toward a complex world orientation, thus forming
1. Antecedents of uncertainty new meaning for their lives. If uncertainty is framed
2. Process of uncertainty appraisal as a normal view of life, it becomes a positive force
3. Coping with uncertainty for multiple opportunities with resulting positive
The framework is clear and easy to follow. The mood states. To achieve this, the individual must
antecedents of uncertainty include the stimuli develop probabilistic thinking, which allows one
frame, cognitive capacities, and structure providers. to examine a variety of possibilities and consider
In the linear model, these antecedent variables have ways of achieving them as the individual envisions
both a direct and indirect inverse relationship with a variety of responses and realizes that life changes
uncertainty. from day to day.
The second conceptual component of the model Mishel described this process as a new view of life
is appraisal. Uncertainty is seen as a neutral state, in which uncertainty shifts from being seen as a
neither positive nor negative, until it has been ap- danger to being viewed as an opportunity. To adopt
praised by the individual. Appraisal of uncertainty this new view of life, the patient must be able to rely
involves the following two processes: (1) inference on social resources and health care providers who
and (2) illusion. Inference is constructed from the accept probabilistic thinking. The relationship be-
individual’s personality disposition and includes tween the health care provider and the patient must
learned resourcefulness, mastery, and locus of con- focus on recognizing continual uncertainty and
trol. These characteristics contribute to an individu- teaching the patient how to use the uncertainty to
al’s confidence in the ability to handle life events. generate different explanations for events. Hence the
Illusion is defined as a belief constructed from importance of structure providers, introduced in the
uncertainty that considers the favorable aspects of a original theory, is maintained in the reconceptual-
situation. Based on the appraisal process, uncer- ized model.
tainty is viewed as either a danger or an opportunity. Despite the complexity and dimensionality of
Uncertainty viewed as a danger results when the the two models, they are presented clearly and con-
individual considers the possibility of a negative ceptualized comprehensively. Mishel published her
outcome. Uncertainty is viewed as an opportunity measurement model in 1981, her original theoretical
primarily through the use of illusion, but inference model in 1988, and her reconceptualized theory in