Problems that might arise throughout The course of a nurse’s work

With the wide variety of problems that might arise throughout the course of a nurse’s work, the profession requires a high level of expertise. Improving nursing practice may be achieved using by models such as middle-range nursing theories, which serve as a meeting place for the profession’s most cutting-edge researchers and practitioners.

For those constantly faced with difficulties, this may help them better grasp how to handle them. In addition, if nurses use these models, they may be able to better cope with stressful events in the workplace.

Mishel’s idea of sickness uncertainty is widely accepted as a middle-range hypothesis. This approach aims to improve patient care and outcomes by looking for treatment-related uncertainty. This paper discusses the components of Mishel’s theory of uncertainty in illness, the structural aspects, and the use of this theory in clinical practice. This paper also identifies the Intensive Care Unit as an area of practice that this theory could be applicable. Finally, the evaluation of Mishel’s theory of uncertainty in illness is also discussed.

Keyword: Mishel’s theory of uncertainty in illness, middle-range theory, nursing, ICU

1. Components of the theory

According to Mishel’s theory, the most critical factor is the generation of antecedent doubt. The three central concepts of the Theory of Uncertainty in Illness are “antecedents of uncertainty, appraisal of uncertainty, and coping with uncertainty” (Bailey, 2021, p.503). Uncertainty Antecedents are instances that take place prior to disease and have an impact on the patient’s inference; among them are pain and perception (Fitzpatrick, 2020).

Uncertainty Appraisal is used when putting a value on an ambiguous circumstance (Fitzpatrick, 2020). Managing uncertainty consists of the techniques or actions used to manage Uncertainty (Fitzpatrick, 2020). Mishel explained uncertainty as not being able to establish a connection between illness-related occurrences (Bailey, 2021). Uncertainty can arise due to several things, such as the severity of an illness, the treatment course, and how a particular disease affects an individual’s life’s goal (Bailey, 2021).

When a patient is unfamiliar with the experience, which is frequent in an inpatient setting, new stimuli related to the patient’s ailment might generate uncertainty. Suggestion frameworks, such as symptoms pattern, event familiarity, and congruence, are all examples of the antecedent that causes doubt (Bailey, 2021).

Practitioners may also be affected if their patients’ expectations do not match their actual experiences. The patient’s cognitive ability and the organizational structure of the nurses influence the analysis of illness-related stimuli. In other words, a patient’s ability to grasp triggers is enhanced by a strong cognitive capacity (Bailey, 2021). In addition, the structural provider impacts how the patient interprets inputs.

Patients’ perceptions and interpretations of inputs may be influenced by the actions of nurses, thereby reducing ambiguity (Bailey, 2021). Hospitals may better prepare for the unexpected by using patient boards and bedside shift reports, which can help patients feel more at ease throughout their hospital stay.

Philosophical doubt regarding disease diagnosis may arise from a person’s inability to classify illness-related experiences resulting from disinformation (Bailey, 2021). To reduce ambiguity regarding a new topic, philosophy urges practitioners to explain it in detail. For an investigation, disease theory’s uncertainty offers an appropriate and intellectual foundation that establishes the framework for determining the root cause of a particular illness.

Nurses may utilize this strategy to deal with problems that seem complex to others who aren’t in the medical profession.

2. Structural aspects of the theory

In 1988, nursing theorist Merle Mishel created the Uncertainty in Illness Theory (Fitzpatrick, 2020). This middle-range theory considers uncertainty as a cognitive stressor that sickness places on patients and their families (Fitzpatrick, 2020).

The notion of disease uncertainty is based on the idea of evaluating and dealing with the uncertainty of the condition. Mishel created the Uncertainty in Illness Scale, which assesses the degree of uncertainty in patients ranging from the patient’s illness to the treatment and understanding of the disease process (Bailey, 2021).

An assessment occurs when a cognitive process is used to discover the root cause of danger. The solution-finding process has just begun. An opportunity may be created by the mystery surrounding the disease’s genesis if it is seen as such.

The concept of coping is a fundamental part of sickness theory (Fitzpatrick, 2020). In order to effectively deal with stress, one must use both mental and physical strategies (Fitzpatrick, 2020). How people deal with the stress of illnesses affects their perceptions of ambiguity. People become more active when they see uncertainty as a threat. Nursing staff may turn to experts to assist patients in coping with the anticipation of a new condition. Consistently delivering Medication Administration Records to patients in the surgical ward, for example, is an easy way to provide comfort (Fitzpatrick, 2020). Incorporating patients within the treatment plan has reduced anxiety and preconceptions about common diseases in these facilities (Fitzpatrick, 2020).

3. Identify an area of your practice where this theory could be applicable

Patients’ homeopathic, psychological, and social complexity is considered when interpreting ambiguity in sickness in the intensive care nursing (ICU) context. With regards to the ICU, for example, this strategy aids with a patient’s knowledge of potentially complex circumstances. In sickness theory, uncertainty gives a framework for understanding how to analyze a condition, such as patients recovering from a cardiac arrest. Mishel’s theory of uncertainty of illness can help providers obtain answers from patients regarding their illness by asking how much they understand about the disease process, how the disease affects their lives, and if they believe they will get better (Bailey, 2021).

This theory has been moved from research to practice by many clinicians. By utilizing the uncertainty theory, nurses were able to identify patients’ fears of participating in physical activities due to vague physical symptoms post-cardiac arrest (Fitzpatrick, 2020). By using this theory to assess patients’ uncertainty, nurses were able to educate patients on how physical activity is vital for their health and provide appropriate interventions that will benefit the patient (Fitzpatrick, 2020).

This theory is appropriate and applicable for practice. Mishel’s theory can guide nurses in helping patients understand and cope with their uncertainty in illnesses (Bailey, 2021). Adapting this theory in practice can only help nurses aim for the best patient outcome.

Nurses understand that a disease is more than just a physical condition and that physiological health is just as important as physical health. Using this theory to help patients cope and understand their disease process will help improve patient outcomes in the clinical settings.

One of the strengths of Mishel’s theory of uncertainty is that it allows practitioners to assess a patient’s uncertainty while also selecting the best interventions that will help improve both physical and physiological doubts that patients experience during times of sickness (Fitzpatrick, 2020). ICU nurses benefit greatly from uncertainty in sickness theory because it helps them build coping strategies that reduce ambiguity when confronted with a new situation.

4. Use of theory in clinical practice

The Theory of Uncertainty in Illness has become an important subject in clinical practice. Research by Fernandez-Araque et al., looked at how nurses deal with ambiguity in various conditions by this model (2020). According to the findings of this study, nurses who develop coping skills based on the uncertainty in sickness theory may improve the quality of life of their patients (Fernandez-Araque et al., 2020).

Furthermore, this study proved that Mishel’s theory is a valuable tool for nurses and the interdisciplinary team as it allows for early identification of doubts and planned interventions, which will help reduce uncertainty and improve patient outcomes (Fernandez-Araque et al., 2020).

5. Evaluation of theory

It is clear from this example that nursing practice relies heavily on the idea of sickness. Nurses may use the model to help them better understand how to treat a new ailment, which in turn determines the kind of action they can take to manage it better. Risks can be reduced by selecting the optimum coping mechanism for each situation, and this technique helps practitioners do just that (Bora & Buldukoğlu, 2021). This one has advantages and disadvantages in terms of a nursing paradigm.

When faced with a new situation, choosing an acceptable coping method is one of the most challenging things to do (Bora & Buldukoğlu, 2021). When faced with a novel situation, practitioners may be unable to determine the most effective way to deal with it, leading them to dread the consequences (Bora & Buldukoğlu, 2021). As a result, nurses must be educated on how to carry out this notion in hospitals.

Nurses given the proper training in this area may find it easier to put the notion into practice. There will be a push to use the model, which is a way to deal with everyday and emerging issues that can be applied across a wide range of healthcare settings.

References

Bailey, D. E. (2021). Illness Uncertainty at 40. Western Journal of Nursing Research, 43(6), 507–508. https://doi.org/10.1177/0193945921989236

Bora, S., & Buldukoğlu, K. (2021). Using the Uncertainty in Illness Theory to provide care for the caregiver: A case report. Journal Of Psychiatric Nursing, 11(1), 70-77. http://doi.org/10.14744/phd.2019.44365

Fernandez-Araque, A., Gomez-Castro, J., Giaquinta-Aranda, A., Verde, Z., & Torres-Ortega, C. (2020). Mishel’s Model of Uncertainty Describing Categories and Subcategories in Fibromyalgia Patients, a Scoping Review. International journal of environmental research and public health, 17(11), 37-56. https://doi.org/10.3390/ijerph17113756

Fitzpatrick J. J. (2020). The Value of Uncertainty. Archives of psychiatric nursing, 34(4), 150-191. https://doi.org/10.1016/j.apnu.2020.07.025