Page 583 - alligood 8th edition_Neat

564 UNIT V Middle Range Nursing Theories

1990, and these publications fully explicate the model development and testing of nursing interventions to
for application in clinical and research contexts. manage uncertainty.

Simplicity Importance
The two uncertainty-in-illness models contain con- Derivable consequences are determined by examining
cepts comprising relationships that range from simple whether a theory guides research, informs practice,
to complex and direct to indirect. Eleven major con- generates new ideas, and differentiates the focus of
cepts are found in the three themes of the original nursing from other professions. Mishel’s work repre-
theory, and several new concepts are introduced in the sents an exemplar of middle-range theory that in-
reconceptualized model. The antecedents of uncer- forms clinical practice in the encompassing context of
tainty are concise, and their definitions are clear and acute and chronic illness. The theory has generated
simple. The appraisal component is complex because it considerable empirical research with adults dealing
considers cognitive processes along with beliefs and with illness or that of family members and continues
values held by the individual. The coping phase of the to stimulate new research directions, such as uncer-
theory is also complex because it is dependent on the tainty in ill children, in older men electing watchful
appraisal portion of the model and again involves dif- waiting as treatment of choice for prostate cancer, and
ferent kinds of strategies targeted toward adaptation. in health care providers informing patients of treat-
The outcome portion of the model is differentiated ment choices in conditions with uncertain prognoses.
into two conceptualizations of the theory, the first Mishel believes that by defining and conceptualizing
relating to patients with acute illness and the second an important clinical problem, her work supports and
representing an expansion of the model to accommo- enriches nursing practice. The Uncertainty in Illness
date patients with chronic illness. Although the models Theory and its reconceptualization represent frame-
can hardly be called simple, overall the concept defini- works derived from and for practice, a process essen-
tions and relationships are well-operationalized and tial to nursing as a practice discipline.
easily understood.
Generality Summary
The theory explains how individuals construct The Uncertainty in Illness Theory provides a com-
meaning from illness-related events. It is broad and prehensive framework within which to view the ex-
generalizable and can be used with individuals expe- perience of acute and chronic illness and to organize
riencing illness, as well as with spouses and parents nursing interventions to promote optimal adjustment.
of those experiencing illness-related uncertainty. The theory helps explain the stresses associated with
The concept of credible authority can be applied to the diagnosis and treatment of major illnesses or
physicians, nurses, and other health care workers. chronic conditions, the processes by which individ-
The theory can be applied in many areas of nursing uals assess and respond to the uncertainty inherent
practice and has been used by clinicians for acute in an illness experience, and the importance of pro-
and chronic illnesses such as cancer, cardiac disease, fessional caregivers in providing information and
and multiple sclerosis. supporting individuals in understanding and man-
aging uncertainty. The reconceptualized theory
Accessibility addresses the unique context of continual uncer-
Mishel derived both theoretical models from her tainty and thereby expands the original theory to
program of research. Many of the concepts, as- encompass the ongoing uncertain trajectory of many
sumptions, and relationships among variables draw life-threatening and chronic illnesses. The original
support from empirical investigation. The concepts theory and its reconceptualization are well expli-
are well described, and their relationships are pre- cated, deriving support from sound theoretical
cisely constructed with clear, tested operational foundations and extensive empirical confirmation,
definitions. Theory testing has occurred in research and it can be applied in illness contexts to support
and clinical settings. The theory has led to the evidence-based nursing practice.