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Mishel's Uncertainty in Illness - Nursing Theory

A mid-range nursing theory, Mishel's Uncertainty in Illness Theory examines how uncertainty can affect a patient's ability to adapt to an illness as well as the outcome of that illness (Neville, 2003, p. 206). Patients facing uncertainty may either have an illness with an uncertain trajectory or may live with the constant possibility that a previous illness could recur (Mishel & Clayton, p. 55). Uncertainty as it relates to illness is defined as "the inability to determine the meaning of illness-related events, assign definite values to objects and events, and/or accurately predict outcomes" (Mishel & Braden, 1988, as cited in Neville, 2003, p. 206). This realm of uncertainty is an uncomfortable one for patients, since there is an inherent desire to know and understand what is happening to one's body. Thus, being forced to deal with the uncertainty of illness is stressful (Neville, 2003, p. 206). Mishel's theory has three primary components-the antecedents that have stimulated the uncertainty, an impaired ability to cognitively appraise the illness, and difficulty in coping with the uncertainty (Neville, 2003, p. 208). To facilitate an appraisal of uncertainty in illness, Mishel developed the Mishel Uncertainty in Illness Scale, which consisted of 30 items that examined the uncertainty in various aspects of a patient's illness, from symptomatology to diagnosis and treatment (Mishel, 1981, p. 258).

The management of uncertainty is an undeniable part of nursing and of the medical profession as a whole. Mishel's framework is valuable in the sense that it outlines the causes and mechanisms of uncertainty and identifies how it can negatively affect the patient. In addition, Mishel's framework promotes management of the negativity of uncertainty.

Uncertainty can be difficult to manage because of its dual aspects, however. As Brashers (2001, p. 291) points out, "In some instances, people may want to reduc...

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