Uncertainty, according to the theory put into place by Merle Mishel, is the inablility to determine the meaning of illness-related events because of a lack of sufficient cues that allow patients to assign value to objects or events and accurately predict outcomes (Elphee, 2008). This author believes it is important for nurses to completely understand the patient as a whole and what they are experiencing when faced with a new and frightening diagnosis. It is necessary to supply patients with sufficient information regarding their diagnosis, if they desire. This author believes the Theory of Uncertainty may help the nurse understand more fully what challenges and uncertainty the patient is presented with when undergoing a new diagnosis.
Mishel’s Uncertainty of Illness Theory is a middle-range theory indicating the theory is not overly broad or narrow (Black, 2014). The theory was developed from studying men with prostate cancer who were watchfully waiting for the advancing signs of their disease (Black, 2014). The theory has three main components, which incorporate: the antecedents of uncertainty, impaired cognitive appraisal, and coping with uncertainty in illness (Neville, 2003). The antecedents of Mishel’s theory are the stimulus frame, cognitive capacities and event congruence (Neville, 2003). The stimulus frame concerns three parts including: symptom pattern, event familiarity and event congruency (Neville, 2003). Symptom pattern may be when symptoms of illness present with consistency to form a pattern (Elphee, 2008). Event familiarity refers to the repetitive nature of the healthcare environment and not necessarily the physical characteristics of the disease (Elphee, 2008). Elphee also defines event congruence as the cor...
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References
Black, B. P., & Chitty, K. K. (2014). Professional nursing: Concepts & challenges(7th ed.). St. Louis, Missouri: Saunders.
Elphee, E. E. (2008). Understanding the Concept of Uncertainty in Patients With Indolent Lymphoma. Oncology Nursing Forum, 35(3), 449-454.
Kazer, M. W., Jr., D. E., & Whittemore, R. (2010). Out of the Black Box: Expansion of a Theory-Based Intervention to Self-Manage the Uncertainty Associated With Active Surveillance (AS) for Prostate Cancer. Research and Theory for Nursing Practice,24(2), 101-112.
Neville, K. L. (2003). Uncertainty in Illness: An Integrative Review. Orthopaedic Nursing,22(3), 206-214.
Suzuki Phd, RN, AOCNP, M. (2012). Quality of Life, Uncertainty, and Perceived Involvement in Decision Making in Patients With Head and Neck Cancer. Oncology Nursing Forum, 39(6), 541-548.
6). However, Spiers’s (2000) view indicates that vulnerability is based on how “objective assessment views person as she/he actually is while subjective assessment derives from the self-concept” (pp. 716-717). Carel (2009) supports this indicating “subjective vulnerability plays a role in patient’s experience of illness, as they may perceive themselves as (as well as actually be) susceptible to external threats, pressures, and harm” (p. 217). It is crucial to evaluate both vulnerabilities. For example, this patient expressed the feeling of being afraid and scared of the pain that comes with this malignant disease during admission. However, the patient’s subjective perspective showed awareness of vulnerability, acceptance of life and death, and motivating strength to prosper in battle this cruel illness. Then from an objective viewpoint, this patient would be vulnerable to psychosocial complications and impairment of everyday
Making a clinical decision is a skill that needs to be acquired, and nurses are accountable for any decision that is made, so they need to understand how they make decisions (Nursing and Midwifery Council (NMC), 2015). A greater understanding of how nurses make decision is essential to follow research and development of decision making skills (Clark et al, 2009) . A first step to a decision making process may entail understanding a framework or model. Baumann and Deber (1986) define decision making as situations in which a choice is made among a number of possible alternatives often involving values given to different outcomes”.
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According to the American College of Preventative Medicine (2011), non-adherence to medications is estimated to cause 125,000 deaths annually and overall, about 20% to 50% of patients are non-adherent to medical therapy. Through my personal experience working in the healthcare field, I have observed an increasing number of patients seemingly detached from the seriousness of their medical diagnoses, as the majority of my patients have taken very little personal responsibility in their own healing and overall health. While these patients have a variety of medical issues, they do share similar characteristics: disengagement from their medical diagnoses and taking the necessary steps towards healing, health and vitality. In my work or in my clinical experiences, I get frustrated when patients are
The healthcare system can be difficult for clients to navigate and they are often unsure how to access information which puts them at the mercy of others and can lead to feelings of helplessness (Erlen, 2006). Nurses can provide resources to educate patients when they becomes dependent on a health care provider and no longer feel in control of their own body which can lead to fear, hopelessness, helplessness and loss of control (Cousley et al., 2014). The change in roles individuals face can further increase their stress and feelings of powerlessness (Scanlon & Lee, 2006). According to the CNA code of ethics, nurses are responsible for protecting patients from objective risks that place them in an increased level of vulnerability (Carel, 2009). They can do this by providing the resources necessary for patients to educate themselves and be better able to cope with the health challenges they
As health care providers, nurses strive to instill confidence in their patients and their loved ones. A nurse is respectful to their colleagues as well as their patients. Nurses promote patients’ independence, patients can be confident in the knowledge that a nurse will do what is best for them, respecting their privacy and dignity. This means that a nurse does not share the patient information for personal reasons nor does the nurse get involved in a patients personal relationship if it is not medically relevant (NCSBN, 2011).
Persuading Rico to abandon his long-held beliefs about family structure, end of life and palliative care is a difficult task. As I discussed in the above prompt, the most immediate and effective action to take is “meeting Rico where he is.” In PMH we learned of three different theoretical models that could be implemented to help sway Rico’s decision: The Theory of Plan Behavior (TPB), The Health Belief Model (HBM) and the Extended Parallel Processing Model (EPPM). The Theory of Plan Behavior examines a patient’s behavioral beliefs, normative expectations and their locus of control in health decisions. The HBM expands on the TPB and includes variables of patient self-efficacy; this model also examines the perceived risk and severity the patient
Not every day that I come across a person who has overcome cancer three times. No doubt, I have invariably admired people such as Lisa Brown for continuously showing optimism about life, although life has not been so fair to them. Additionally, as I listened intently to Lisa Brown’s speech, there were moments where I questioned how she persevered through her treatment with such a superb attitude and how in the world does someone get diagnosed with cancer three times. Nevertheless, besides those two thoughts throughout her speech, there was a duo of information from her that made me emotional and admired Lisa brown by the end of her speech. First and foremost, her guilt about surviving cancer and her attitude is admirable in my opinion.
Clinical confidence, and independence are two components of nursing practice such that cannot be perfected through classroom education, self-study or by reading the evidence based literature. Throughout my nursing education, I have struggled with as many of clinical instructors have put it “being too hard on myself”. Morrell & Ridgway (2014) highlight how students’ perception of a lack of knowledge often contributes to ongoing anxiety. My tendency of being highly critical of my abilities, and having a consistent sense of anxiety associated with practicing independently has been an ongoing challenge for me. Reflecting upon how I have coped with the challenges of developing, and maintaining clinical confidence is
O’Connor, Llewellyn-Thomas, & Flood. (2004). Modifying unwarranted variations in health care: Shared decision making using patient decision aids. Health Affairs (Millwood), 63-72.
The chronology, consequences and coherence of the illness (dimensions of illness perception) have been significantly correlated with passive adaptation (van Oostrom et al., 2007). Simultaneously, passive adaptation has anticipated the emotional suffering caused by hereditary cancer,
The Health Belief Model (HBM) is one of the first theories of health behavior. It was developed in the 1950s by social psychologists in the U.S. Public Health Services to better understand the widespread failure of tuberculosis screening programs. Today it continues to be one of the most widely used theories. Research studies use it to explain and predict health behaviors seen in individuals. There is a broad range of health behaviors and subject populations that it is applied in. The concepts in the model involve perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. Focusing on the attitudes and beliefs of individuals being studied create an understanding of their readiness to act on a health/behavioral factor based on their particular opinions on selected conditions. Several modifying factors such as age, sex, ethnicity, socioeconomic status, or level of education, etc. can determine one’s opinion on their perceived threat of obtaining a disease such as lung cancer based on the severity of the triggers causing the illness. Their likelihood to change an opinion or behavior depends on their perceived benefits or certain barriers that may be out of their control. Interventions can be used to promote health behavior changes and aid in persuading or increasing awareness on a particular issue.
The Health Belief Model tries to explain and predict one’s health behaviors. I feel that although doctors take precautionary actions and provide helpful preventative information that not everyone takes the information and uses it wisely. Although there are actions we can take to prevent illness or health conditions, not everyone applies these preventative actions to their daily lives. The Health Belief Model is also still relevant today because people are still avoiding treatment and/or are also not utilizing new technology and the availability of these tests to detect a disease early on in their
Mishel’s (1988) Uncertainty in Illness theory is a mid-range nursing theory that examines how uncertainty can affect patients. In addition, Mishel’s theory identifies causes of uncertainty that negatively or positively affect the patient. If an individual is spiraling down a known path of illness, they may perceive uncertainty as a benefit. However, illness uncertainty causes breakdowns, fear of the illness, emotional distress, loss of control, and inappropriate coping methods (Mishel 1988).