Merle Mishel
Uncertainty of Illness Theory: Merle Mishel
Background
Background
- Merle
Mishel focused of her
career has been the development of the middle range theory of uncertainty of
illness, which has been translated into more than 17 languages and used around
the world
- Mishel developed her "Uncertainty in Illness
Scale" in 1980.
- The Perceived Ambiguity in Illness Scale began as
Merle's dissertation for doctoral degree in social psychology
- Early in her career, Mishel practiced as a
psychiatric nurse in acute care and in community settings
- Mishel has done research using her theory and tool in
the areas of Breast Cancer, Prostate Cancer, Head and Neck Cancer and Tramautic
Injury.
Key
Concepts
Purpose of Theory
- The uncertainty in illness theory helps
measure the degree to which an individual is experiencing uncertainty during
illness or an acute injury.
- The illness causes uncertainty that
spreads into the individual’s life and breaks down the individual’s point of
view and reality. Slowly a new point of view is formed.
- Uncertainty is the driving force and is
accepted as reality. Now the individual may see that many options are possible
as opposed to a cause and effect paradigm.
Uncertainty is the
inability to determine the meaning of illness-related events, occurring when
the decision maker is unable to assign definite value to objects or events, or
is unable to predict outcomes accurately (Mishel, 1988)
The theory of uncertainty of illness is composed of
three major themes:
- Antecedents of uncertainty-
anything that occurs prior to the illness experience that affects the
patient's thinking such as pain, prior experiences, and perception
- Appraisal of uncertainty-
the process of placing a value on the uncertain situation
- Coping with uncertainty-
activities that are used in dealing with the uncertainty
Uncertainty Theory Four Factor
Scale
·
Ambiguity
·
Complexity
·
Inconsistency
·
Unpredictability
Theoretical Model
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Stimuli frame is the characteristics of the stimuli as perceived by the individual.
A cognitive capacity is the patient's
ability to process information. Physiological malfunctions & stress
related demands on cognitive processing will decrease available cognitive
capacity.
Structure providers are the health
care providers or support group that can affect the patient either negatively
or positively.
Stimuli
frame, cognitive capacities, and structure providers are all antecedents to
uncertainty. Uncertainty can
either be a positive or negative (or a danger or seen as an opportunity).
Inference is how the patients sees
themselves as part of the environment and illusion
is how they want to be. Either of these can lead to danger making uncertainty a negative experience or to an
opportunity as a positive. The use of coping mechanisms leads to adaptation to uncertainty of the
illness. Some effective coping strategies are avoidance, priority
promotion, and alteration of the stimuli.
Major Concepts
1. Person
- The person experiences uncertainty
gradually, beginning as the illness as the illness insidiously invades life.
- Questioning one’s self as the body
changes with progression of illness and how this will change their
interpersonal relationship is common in uncertainty.
- Uncertainty in Illness Theory helps to
address this effect on the patient and assist with coping mechanisms.
2. Environment
- Using MUIS tool clinicians can identify
the areas of illness that are causing the greatest uncertainty.
- Addressing these areas and assisting
the patient to build better coping mechanisms will improve the patient’s health
during times of illness.
3. Health
- Uncertainty in illness has been
researched primarily in the hospital setting. Illness effects many aspects of
life and with increased research it might show Uncertainty in Illness Theory
can be used to help a variety of patients in different environments.
4. Nursing
- Nursing practice using the uncertainty
in illness model.
- Research utilizing the theory of
uncertain illness.
References
Merle Mishel Middle Range Nursing Theorist - Theory
Development (Online) Available at https://sites.google.com/a/northgeorgia.edu/merle-mishel-middle-range-nursing-theorist/home/theory-development Accessed: September
14, 2016
Mishel’s Uncertainty Illness Theory (Online)
Available at www.slideshare.net/Sujatamohapatra/mishels-uncertainity-in-illness-theory Accessed: September
14, 2016
What do we do in Uncertainty of Ilness (Online) Available at www.jsnr.jp/meeting/docs/31_02.pdf Accessed: September 14, 2016
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