Uncertainty in Illness Nursing Theory

Uncertainty in Illness

• Uncertainty in illness theory helps to address the effect on the patient and assist with coping mechanisms.
• Uncertainty in illness has been researched primarily in the hospital setting.
• Illness affects many aspects of life (physical, mental, emotional, spiritual, financial).
• It is important to identify what the patient's perception of their own health is.

Nursing Metaparadigm

• Nurses can offer credible information and facilitate adaptation in this model.
  • Offering person-centered care, FCC, sharing information can reduce stress in patients and caregivers.
  • Giving information can allow patients to be in control.
  • Nurses can assist the patient by constructing a personal scenario for illness which includes:
    • Why or how the illness began.
    • How it will progress.
    • How the patient can recover.
    • Incorporating the uncertainty is an approach where there is a change in the patient's and family's perspective in life, away from orientation to control and predict towards an acceptance of unpredictability and uncertainty as normal.
    • Help the patient make sense of what is happening.
    • Help patient learn how to live with uncertainty -- this is valuable.
• The milieu that a patient exists in has a great impact on their uncertainty.
  • How does the patient feel about the environment? What supports do they have?
  • Nurses can influence how the patient interprets the illness or symptoms they experience.
  • It's important for nurses to pick up on how the patient is coping, so we know how to support them.
  • After the mechanisms of adaptation, the patient adjusts to the new experience.
  • Adaptation to the initial uncertainty involves biological, psychological, and social factors.

Reconsidered Theory

• Original theory -- doesn't account for lasting change.
  • Looks at the initial presentation and that specific uncertainty.
• Reconceptualized theory -- looks at uncertainty and coping over time (OT).
  • Self-organization -- continuous integration of uncertainty that leads to a new normal.
  • Probabilistic thinking -- belief in a world where one accepts things that aren't always predictable.
  • Formulation of new life perspective.

Underlying Factors

• Patient is trying to return to previous level of function.
• Driving force: "I just want to get better and feel well"
• Underlying factors that contribute to uncertainty:
  • Complexity
  • Unpredictability
  • Lack of information
  • Ambiguity

Mishel's Uncertainty in Illness Scale

• Mishel's uncertainty scale is made up of 33 items covering aspects of the four factors.
• Subjective scale.
• By using Mishel's Uncertainty in Illness Scale (MUIS) tool, nurses can identify the areas of illness that are causing the greatest uncertainty.
• Addressing these areas and assisting the patients to build better coping mechanisms will improve the patient's health during times of illness.

Process of Recognizing Uncertainty

• Recognizing uncertainty involves the processes of assessing, reflecting, questioning, and/or being unable to predict aspects of the patient situation.
• Some uncertainty related to future illness cannot be avoided.
• Imperative that nurses understand how patients cope with uncertainty and how it affects their support needs and preferences for communication.
• Disease complexity, poor information provision, and the unpredictability or ambiguity of events interfere with patient's ability to confer meaning, thereby increasing uncertainty.
• Uncertainty is not always negative -- some patients may find prognostic uncertainty protective, which others find not knowing distressing.
• When assessing a patient:
  • What are all the contributing factors?
  • Ask the patient questions related to them -- avoid dumping a bunch of information.
• Don't be afraid to say "I don't know."
• Determine how your patient is coping so you know how best to assist them.

Implications for Practice

• When managing patients with advanced illness and uncertain prognosis, professionals should realize that uncertainty is often a central feature of patient's illness experience.
• Nurses should consider an individual patient's preferences in terms of temporal focus, information needs, and engagement with illness.
• Tailor discussions with patients so that patient's priorities are addressed, and information and support are provided according to their preferences.

This quiz explores the Uncertainty in Illness Theory, focusing on its implications for nursing practice and patient care. It emphasizes the importance of understanding patients' perceptions of health and the role of nurses in facilitating coping mechanisms. Assess your knowledge of how uncertainty affects various aspects of life and how nurses can support patients and their families.