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.