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Mischel's theory of uncertainty of illness
Uncertainty in illness used in nursing practice
Mishel’s Uncertainty in Illness Theory
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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). These conditions if left untreated will lead to patients that are unable to form cognitive structures for illness related events, develop improper psychological adjustments, poor decision-making, and traumatic stress responses (Mishel 1988). Along with her theory, Mishel (1988) developed a scale to rate uncertainty to measure the degree of an individual’s uncertainty during acute injuries, illness, and recurrence of chronic sickness. There is a desire to know what is happening to one’s body, and not understanding the illness will lead to patients being less comfortable. It is the obligation of the nursing profession to help patients understand what their illness means to them, expect outcomes, and managing the stress of uncertainty. Mishel’s theory (1981) is an important aspect of the nurse’s ability to overcome obstacles in place by uncertainty to benefit the well-being of patients.
Uncertainty in Chronic Diseases
Chronic diseases put people in a state of watchful awareness of their condition. While chronic conditions and the outcomes are well studied, the psychological effects of uncertainty remain in question (Baily, Lawrence, Barroso, Bixby, Michel, Muir, Strickland & Clip, 2009). The intrusion of any chronic sickness is a highly stressfu...
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...essors that invoke a greater perceived severity of symptoms (Johson, Zautra & Davis, 2006). Nurses entering the field of practice must be prepared to encounter and manage peoples varying levels and symptoms from uncertainty.
Managing Uncertainty as Nurses
Levels of uncertainty can lead to an increase in symptoms and many negative psychological effects (Mishel 1988). Nurses entering the field of practice must understand the effects of uncertainty and tailor efforts to help patients with this additional stressor. It is the job of the nursing profession to learn how to create interventions to help patients deal with uncertainty. Using up to date research, effectively informing individuals of outcomes, and teaching self-management techniques is key to lowering the levels of uncertainty in individuals with chronic diseases (McNulty, K., Lineh, H., & Wilson, L. 2004).
Nurses help patients with their physical needs with details, explain the complex steps of medical treatment, communicate with doctors to share patients’ health conditions and proper treatments, and give emotional support to patients in stressful situations. There are certain limitations that nurses have in decision makings because doctors obtain the most power in patients’ medical clinics. However, nurses are more friendly, helpful, and suffering for patients. Lastly, experienced nurses can make a better choice for the patients over young and un-experience
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”.
During my career as a registered nurse I have had the privilege of caring for my patients at the bedside and meeting their needs holistically. Additionally, the safety of my patients is one of the most important aspects of my current role. The experience of advocating for my patients during my nursing career has taught me to place my patient’s health and wellbeing first. The second most important aspect of nursing that I have learned during my career is how to meet my patient’s needs as a whole, not just physically but also emotionally and psychologically applying the holistic approach to each patient. I believe that the patient’s needs
The framework of this model is utilized throughout hospital settings to form a basis for all nursing decisions in respect to nursing diagnosis, care plans, discharge planning, and quality assurance (Reynolds & Cormack, 1991). This conceptual model focuses on the effects of internal and external environments that contribute to someone’s behavior. Pain (being the internal force) in patients with altered mental status usually manifests externally in non-verbal cues. Nursing as the external force can use tools that focus on the non-verbal cues given by the patients to accurately assess the pain and properly treat it.
When it comes to a bad diagnosis it is often difficult for doctors to tell their patients this devastating news. The doctor will likely hold back from telling the patient the whole truth about their health because they believe the patient will become depressed. However, Schwartz argues that telling the patient the whole truth about their illness will cause depression and anxiety, but rather telling the patient the whole truth will empower and motivate the patient to make the most of their days. Many doctors will often also prescribe or offer treatment that will likely not help their health, but the doctors do so to make patients feel as though their may be a solution to the problem as they are unaware to the limited number of days they may have left. In comparison, people who are aware there is no cure to their diagnosis and many choose to live their last days not in the hospital or pain free from medications without a treatment holding them back. They can choose to live their last days with their family and will have more time and awareness to handle a will. Schwartz argues the importance of telling patients the truth about their diagnosis and communicating the person’s likely amount of time left as it will affect how the patient chooses to live their limited
Transition is the process of changing from one state to another. Transition is the core of discipline in nursing ( Schumacher & Meleis, 1994, p.120). One particular transition listed in the Conceptual Curriculum Model is Health-Illness. Health can subjectively be defined as a state of optimal well being while illness can be defined as a sickness having a negative affect on the body. Two of the four aims of nursing are to promote health and prevent illness. In order to be successful in meeting these aims, a nurse will use knowledge, skills and critical thinking. (Taylor, 2011, p. 9). Health Illness can include acute or chronic illness (Murphy, 1990, p.3) There is a correlation between health illness and program outcomes. In order to promote health and prevent illness, a nurse must care for patients,...
Wichowski, H.C. (1994). Professional uncertainty: nurses in the technologically intense arena. Journal of Advanced Nursing. 19, 1162-1167.
This paper will discuss three theories of decision-making that can be adopted in nursing practice, additionally how decision-making theories are able to be implemented and used. Decision-making in nursing is adopted through the critical thinking process that provides each nurse a model to make the best choices, solve problems and to meet goals in clinical practice (Berman & Kozier 2018, pp. 199-200; Levett-Jones & Hoffman 2013, pp. 4-5). Effective decision-making in nursing is a vital component and part of the role of a registered nurse; each year a substantial number of patients die due to medical errors and poor decision-making (Levett-Jones & Hoffman 2013, pp. 4-5; Nibbelink & Brewer 2017, p. 3). Through the use of effective decision making
The 'Path of the Earth'. Making effective clinical decisions: a framework for nurse practitioners. British Journal of Nursing, 15(3), 128-130. Scanlon, A., & Lee, G. (2007). The use of the term vulnerability in acute care: why does it differ and what does it mean?
The uncertain nature of chronic illness takes many forms, but all are long-term and cannot be cured. The nature of chronic illness raises hesitation. It can disturb anyone, irrespective of demographics or traditions. It fluctuates lives and generates various inquiries for the patient. Chronic illness few clear features involve: long-lasting; can be managed but not cured; impacts quality of life; and contribute to stress. Chronic illnesses can be enigmatic. They often take considerable time to identify, they are imperceptible and often carry a stigma because there is little sympathetic or social support. Many patients receive inconsistent diagnoses at first and treatments deviate on an individual level. Nevertheless, some circumstances require
There are many ways to categorize illness and disease; one of the most common is chronic illness. Many chronic illnesses have been related to altered health maintenance hypertension and cardiovascular diseases are associated with diet and stress, deficient in exercise, tobacco use, and obesity (Craven 2009). Some researchers define the chronic illness as diseases which have long duration and generally slow development (WHO 2013); it usually takes 6 month or longer than 6 month, and often for the person's life. It has a sluggish onset and eras of reduction for vanishing the symptoms and exacerbation for reappear the symptoms. Some of chronic illness can be directly life-threatening. Others remain over time and need intensive management, such as diabetes, so chronic illness affects physical, emotional, logical, occupational, social, or spiritual functioning. Chronic diseases, such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, all of these diseases are the cause of mortality in the world, representing 63% of all deaths. So a chronic illness can be stressful and may change the way a person l...
A patient is not entirely “healthy” or “sick;” a patient may be healthy in some ways but sick in others. “Health” is subjective in that what works for one patient might harm another. Health is not just related to the state of the body but also is influenced by emotions and the environment.
Those who have experienced with cognitive health issues will be able to recognize how an able body with an irregular mindset can hold their lives back right under the surveillance of the people around them. Having been struggling with major depressive disorder for years, I am able to witness the changes that occur within my life and the effect of the absence of “equilibrium” (Sartorius. 662) that an individual needs in order to conciliate with oneself. Through the journey to recovery, I learn that in order to overcome the problem, one must first learn to acknowledge the issue, and explore the different actions that can be taken to treat it with. In the perspective of someone who is aiming to become a healthcare provider, it is a never ending cycle of learning how to better improve the ways to take care of each patient, and most oftenly, the patient’s emotion has great effects on how their diseases can be treated. It is beneficial to view “the disease with the person who has it” (Sartorius. 663) in order for doctors to progress through the treatment, as this method “improve the practice of medicine” and provides a more “realistic” and “humane” (Sartorius. 663) connection between the two parties. Ultimately, both the caregiver and the receiver gains experience from the improved
The first published theory of coping was imagined by Lazarus (1984), who ascribed to the cognitive viewpoint. Lazarus was interested in the concept of stress as a transaction, and suggested that people go through stages of appraisal. The first stage is where the individual determines whether or not the event is a threat. If the event is identified as threatening, the individual then evaluates their ability to cope with the stressor. These evaluations are repeated regularly to ensure continued accuracy, especially as the individual attempts to deal with the stressor. Dienstbier (1989) refined this theory so that the term "stress" pertained only to negative outcomes, whereas the term "challenge" was introduced in reference to transactions which could lead to either a positive or negative outcome. The distinction was important because these outcomes resulted in different physiological responses. Frankenhaeuser (1986) discovered that these responses were tied to the level of dissatisfaction the ...
In order to lead a healthy lifestyle, it is essential that individuals constantly monitor their health. This involves not only physical, but also mental and emotional aspects of the body’s functioning, as they relate to the home, school, work, and leisure environments. If necessary changes are made sooner rather than later, then a stable, balanced and healthy lifestyle will be more consistently maintained. In fact, the World Health Organization says being healthy is feeling that there are few physical or emotional impediments to doing things in your life that you would like. For example, there are many people who are suffering from chronic illnesses who are healthy because they are able to maintain their creativity and vivacity when others cannot. It is evident that self-awareness enc...