Uncertainty in Illness

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Introduction
Uncertainty in illness is present for both acute and chronic illnesses and can be described as a cognitive stressor, a sense of loss of control, and a perceptual state of doubt which is dynamic in nature. Illness uncertainty can be associated with poor adjustment, but often needs to be evaluated as a threat to have its deleterious effect. For example, illness uncertainty in pain populations is related to increased sensitivity to pain and reduction in tolerance of painful stimuli. Illness uncertainty can result in maladaptive coping, higher psychological distress, and reduced quality of life. Uncertainty can’t be categorized as a good or bad state. It mainly depends on the situations that surround the uncertainty. It can be defined as the inability to understand the meaning of a situation or event and it can develop if the patient doesn’t completely comprehend the total magnitude of the state of his or her illness. The purpose of this paper is to explore the concept of uncertainty in illness and to review three nursing research studies to explain this concept in more detail. Concept- Uncertainty in Illness Nursing interest in the uncertainty associated with life-threatening diseases and chronic illnesses and their treatment technology is growing. Nurse investigators have tried to research variables that precede and influence this uncertainty, as well as how persons evaluate, cope with, and adjust to uncertainty. Mishel has extensively explored the concept of uncertainty in illness since the early1980s. She defines it as “the inability to determine the meaning of illness related events. It is the cognitive state created when the person cannot adequately structure or categorize an event because of the lack of sufficient cues" (Mishel, 1988). The family’s adaptation and coping strategies may prove to be inadequate in managing uncertainty surrounding illness conditions, which continues beyond the critical care stage. Wineman et al. (1996) also found a relationship between the level of one’s education and uncertainty, and those with more education having lower uncertainty levels. There are four basic forms of uncertainty in this theoretical framework: ambiguity surrounding the state of the illness, the complexity of treatment and care, a lack of information about the illness, and the unpredictable nature of illness and treatment (Mishel, 1988). Uncertainty begins with the stimuli frame, which allows patients to cognitively structure their uncertainty based on the form, composition, and structure of a given stimuli. In the uncertainty theory, there are two appraisal processes used to determine the value placed upon the uncertainty –inference and illusion. Both processes can be fostered by the patient, their social resources and health care providers. Inference refers to the evaluation of uncertainty based on examples of related situations. If the inferences are seen as positive, then the uncertainty will be appraised as an opportunity. If the inferences are seen as threatening, then the uncertainty will be appraised as a danger (Mishel, 1981). If uncertainty is appraised as a danger, there is an expectation of a harmful outcome resulting in the activation of coping strategies to reduce the uncertainty. If uncertainty is inferred to be an opportunity, a positive outcome is implied, and coping strategies to maintain the uncertainty are implemented. In an opportunity appraisal of uncertainty, the uncertainty must be maintained because its continuation is necessary for a positive view of the situation to remain viable. If the coping strategies used in either appraisal are effective, then adaptation will occur.

Moreover, people living with chronic or acute illnesses often face uncertainty about their health and about their medical care. Health care providers can affect the uncertainty of patients by providing information about the causes,...
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