Nursing Theory:
An Exploration of Merle Mishel’s
Uncertainty in Illness Theory
UNC School of Nursing, 2014
Ferris State University
NURS 501 Introduction to Advanced Nursing Roles
Marcie Chenette, Mariah Lab, Brandi Miller, & Tamara Putney
Bailey & Stewart, 2010
Objectives
o
Provide an overview of Mishel’s theory of
uncertainty in illness
o
Discuss the metaparadigm concepts
o
Analyze the theory
o
Use a research example to apply theory
o
Explore the usefulness of the theory
Carper, 1978
Dudley-Brown, 1997
Singleterry, 2014
Theory Overview
Original 1988 Theory
Bailey & Stewart, 2010
Mishel, 1981
Mishel, 1988
Theory Overview
Reconceptualized 1990 Theory
Bailey & Stewart, 2010
Mishel, 1990
Metaparadigm Concepts
Mishel, 1990
Mishel, 1999
Mishel, 2014
Person
Environment
Health
Nursing
Analysis of the Theory
o Accuracy
o
Applicable to nursing today
o
Multiple patient populations
o
Verified through testing
o Simplicity/Complexity
Bailey & Stewart, 2010
Dudley-Brown, 1997
Mishel, 1999
o
Antecedents are clear
o
Appraisal process is complex
o
Coping phase is complex
o
Functional with tools
Analysis of the Theory
o Scope
o Middle-range theory
o Broad and generalizable
o Acceptability
Nursing community
o Testability
o
Bailey & Stewart, 2010
Mishel, 1999
UNC School of Nursing, 2014
Wright, Afari, & Zautra, 2009
o Sociocultural Utility
o Cultures
o Demographics
o Diagnoses
Research Article
o
Outcomes of an uncertainty management
intervention
o
Purpose
o
Intervention
o
Method
o
Findings
o
Conclusion and implications
Germino et al., 2013
Theory Reflection
o Purpose:
o Appropriate interventions decrease uncertainty
o Hypothesis:
o Less uncertainty
o Better uncertainty management
o Fewer concerns
o More positive psychological outcomes
o Methods:
o Theory derived scales
o Designed to address antecedents of uncertainty
Germino et al., 2013
Implications of Framework
o With no theoretical framework:
o
Uncertainty concepts would lack
clarity and measurability
o
No existing knowledge to compare
o
Study less meaningful
Germino et al., 2013
University of Southern California, 2013
Implications of Framework
o
Framework based on nursing theory
o
Appropriateness
o
Clear conceptual definitions
o
Guided by propositional statements
o
Operational definitions provided
o
Study findings support framework
Germino et al., 2013
Nieswiadomy, 2012
Theory in Practice
o Operating room management
o
Uncertainty related to post-operative
symptoms
o
Pre- and post-operative education
can decrease uncertainty
o Nursing clinical instruction
o
Easy to teach and widely applicable
o
Valuable tool for care planning
Theory in Practice
o Hospital telemetry unit
o Uncertainty predicts depression in
female heart failure patients
o Nurses can design gender-specific
interventions
o Hospital critical care unit
o Laryngectomy patients experience fear
and traumatic thoughts
o Appropriate interventions can assist in
coping and relaxation
Kao et al., 2013
Link Between Theory & Practice
o Empirics
o Esthetics
o Personal knowledge
o Ethics
Carper, 1978
Link Between Theory & Practice
o
Interactions with people are never the same
o
Nursing knowledge is unique
o
Carper’s patterns of knowing help distinguish
relationships of phenomena seen in practice
o
State of health is in constant flux
o
Article shows treatments must be holistic and
approached from many angles to be effective
Carper, 1978
Fiandt, Forman, Megel, Pakieser, & Burge, 2003
Germino et al., 2013
Conclusion
o Theory overview
o Abbreviated analysis
o Use in research
o Use in practice
o Link between unique nursing
knowledge and nursing practice
References
Bailey, D. E., Jr., & Stewart, J. L. (2010). Merle H. Mishel: Uncertainty in illness theory. In M. R. Alligood, & A.
M. Tomey (Eds.), Nursing theorists and their work (7th ed, pp. 599-617). Maryland Heights, MO:
Mosby Elsevier.
Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 1323.
Dudley-Brown, S. L. (1997). The evaluation of nursing theory: A method for our madness. International
Journal of Nursing Studies, 1, 76-83.
Fiandt, K., Forman, J., Megel, M E., Pakieser, R.A., & Burge, S. (2003). Integral nursing: An emerging
framework for engaging the evolution of the profession. Nursing Outlook, 51(3), 130-137.
Germino, B. B., Mishel, M. H., Crandell, J., Porter, L., Blyler, D., Jenerette, C., & Gil, K. M. (2013). Outcomes
of an uncertainty management intervention in younger African American and Caucasian breast
cancer survivors. Oncology Nursing Forum, 40, 82-92. doi:10.1188/13.ONF.82-92
Kao, C. W., Chen, T. Y., Cheng, S. M., Lin, W. S., Friedmann, E., & Thomas, S. A. (2013). Gender differences
in the predictors of depression among patients with heart failure. European Journal of
Cardiovascular Nursing, 0(0), 1-9. doi: 10.1177/1474515113496493
Mishel, M. H. (1981). The measurement of uncertainty in illness. Nursing Research, 30, 258-263.
References
Mishel, M. H. (1988). Uncertainty in illness. IMAGE: Journal of Nursing Scholarship, 20, 225-231.
Mishel, M. H. (1990). Reconceptualization of the uncertainty in illness theory. IMAGE: Journal of Nursing
Scholarship, 22, 256-262.
Mishel, M. H. (1999). Uncertainty in chronic illness. Annual Review of Nursing Research, 17(1), 269-294.
Mishel, M. H. (2014). Theories of uncertainty in illness. In M. J. Smith & P. R. Liehr (Eds.), Middle range theory
for nursing [Kindle edition] (3rd ed.). Retrieved from Amazon.com
Nieswiadomy, R. M. (2012). Foundations of nursing research (6th ed.). Upper Saddle River, NJ: Pearson.
Singleterry, L. (2014). Syllabus for NURS 501 introduction to advanced nursing roles. (Available from the
Ferris State University School of Nursing, 200 Ferris Drive, Big Rapids, MI 49307)
University of Southern California. (2013). Organizing your social sciences research paper: Theoretical
framework. Retrieved from http://libguides.usc.edu/content.php?pid=83009&sid=618409
UNC School of Nursing. (2014). Directory: Merle Mishel, PhD, RN, FAAN. Retrieved from
http://nursing.unc.edu/people/merle-mishel/
Wright, L. J., Afari, N., & Zautra, A. (2009). The illness uncertainty concept: A review. Current Pain and
Headache Reports, 13, 133-138.