Effective Nurse-Patient Communication During Uncertainty in Illness

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Effective Nurse-Patient Communication during Uncertainty in Illness

Effective Nurse-Patient Communication during Uncertainty in Illness The Healthy People 2020 initiative includes goals to increase the number of patients who report that their healthcare providers listened to them carefully to 65% and increase the number of patients who report that their healthcare provider explained things so they could understand them to 66% (United States Department of Health and Human Services, 2010). The nursing profession plays an important role in making progress toward these goals through advocacy for effective communication. Being able to effectively communicate with patients is an essential skill for healthcare providers, especially nurses, to possess. Nurses spend extensive amounts of time with patients and often confuse talking with patients as communication (Thobaben, 2007). Effective communication demands that nurses not just talk to patients, but rather, speak and listen skillfully. It is often during routine interactions that patient needs, expressions of uncertainty, hopes and fears about treatment options and other health concerns are expressed to nurses requiring an effective response. Notably, the responses given by nurses to patients have important implications for health outcomes (Sheldon & Ellington, 2008). It is pertinent that nurses understand the process of how to efficiently respond to patient cues about health concerns. Within the nursing literature, nurse-patient communication research has often been unsuccessful in its attempts to apply existing communication and nursing theories which could expand the understanding of the process of how nurses respond to patients, particularly during times of uncertainty (Sheldon & Ellington, 2007). According to Mishel, Germino, Pruthi, Wallen, Crandell & Blyler (2009), evidence supports that uncertainty in illness may increase fear which could make decisions about care and treatment options difficult for patients to make. Therefore, as nurses have the most recurrent contact with patients, they are in an excellent position to decrease uncertainty by providing positive, effective communication through listening and providing health information to assist in the decision-making process (Hansen, Rortveit, Leiknes, Morken, Testad, Joa, & Severinsson, 2012).

Review of Literature
Kim, Lee, and Lee (2011) define uncertainty in illness as “the inability to determine the meaning of an illness-related event and occurs when an individual is unable to predict outcomes accurately” (p. 1015). Uncertainty experienced during illness is a psychosocial stressor that is influential in the decision-making capacity of the person affected. Nurses need to identify patients who are at risk for illness-associated uncertainty in order to develop appropriate practice interventions (Kim, Lee, & Lee, 2011). The middle range theory of uncertainty in illness was developed by Dr. Merle Mishel in 1988 to explain how individual’s dealing with illness cognitively process illness-related stimuli in an effort to build meaning for illness occurrence (Guadalupe, 2010). Mishel’s theory of uncertainty in illness (UIT) suggests that uncertainty occurs when persons are unable to successfully establish a cognitive schema for illness occurrences. Within Mishel’s theory, uncertainty is conceptualized through antecedents identified as stimuli frame, which is divided into symptom pattern and event familiarity; and structure providers, which refer to education, social support, and credible authority, which are all needed to decrease uncertainty, indirectly and directly (Guadalupe, 2010). Figure 1 in the appendix provides a visual illustration on how this model fits this process of uncertainty. Many studies have examined the concept of uncertainty and its relationship with illness. I will focus on a select few that have utility in the research arena. First, a qualitative study...
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