Wk. 6.
Uncertainty
Uncertainty
Chronic illness brings a prolonged state of
impending adversity.
Uncertainty persists over the trajectory of a
disease.
Uncertainty in Ch. illness is certain and
Individuals with Ch. illness seek to manage their
uncertainty.
Uncertainty is one of the greatest challenges in
successfully adapting to Ch. illness.
Uncertainty
Definition:-
- “ Uncertainty is a psychological state in which
individuals initially perceive it and respond
relative to how they believe it will impact them”
( Mishel as cited in Zhang).
Uncertainty is the inability of an individual to
understand the meaning of illness-related events
such as disease process or treatment and one’s
perceptions of ambiguity, complexity,
inconsistency and unpredictability associated with
illness and illness-related events ( Mishel, p. 208)
Concept-Uncertainty
Defined as the ‘inability to determine the meaning
of illness-related events and accurately anticipate
or predict health outcomes’( Mishel as cited in
Zhang. 2017. pg. 645)
Uncertainty is the
- ‘inability of an individual to understand the
meaning of illness-related events such as
disease process or treatment and one’s
perceptions of ambiguity, complexity,
inconsistency and unpredictability associated
with illness and illness-related events ( Mishel,
p. 208)
Uncertainty
‘ Apprehension, Uncertainty, Waiting, Expectation,
Anxiety, Fear of surprise do a patient more harm
than any exertion. Remember he is face to face
with his enemy all the time’
(Florence Nightingale)
Uncertainty
Uncertainty influences :
The way in which individuals respond to a
diagnosis, deal with illness symptoms, manage
treatment regimens and maintain social
relationships.
Influences coping and adjustment to chronic
illness.
Increases psychological and emotional distress.
Diminishes quality of life.
Theoretical Explanation of Uncertainty
Mishel’s Uncertainty Theory- Mid range
theory(Zhang; Neville).
- “ Uncertainty occurs when there is difficulty
constructing a cognitive schema- a person’s
subjective interpretation of illness
events”(Mishel, p 212).
Antecedents of uncertainty Stimuli frame consists
of :- Symptom pattern,
- Event familiarity;
- Event congruence.
Stimuli Frame is influenced by
- the individual’s cognitive capacity and interaction
with Structure health providers.
Client appraises\consider the illness situation.
Interventions-Coping and Adaptation
Mishel’s Explanation of Uncertainty-Zhang
Uncertainty in Illness-Zhang
Uncertainty in illness in clients with Cancer.
Consist of
1. Antecedents-
o Stimuli frame-
o Cognitive capacities
o Providers
2. Client’s inference-How does the client perceive the
illness?
o As a Threat(negative) OR as an
opportunity(positive)
3. Result –Coping and\or
o Adaptation or Maladaptation.
Role of the nurse- Assess how the client perceives their
illness; how they cope or not with the illness situation.
Theoretical Explanation of Uncertainty
1. Uncertainty as opportunity:-
As a useful coping mechanism.
Enable individuals with Ch. Illness to reevaluate
their lives, enables greater self-acceptance,
increased tolerance and acceptance of others.
2. Uncertainty as harm(danger):- The Ch. illness
experience can trigger perceptions of harm that
increase illness uncertainty.
Factors include:- Stress;
Anxiety;
Loss of control-External and internal locus of
control
Waiting &
Lack of information.
Uncertainty- Neville
o Uncertainty in illness is generally perceived as a
significant stressor,
o Uncertainty has been defined in the broad
context of risk, choice, probability and decision
making.
o Uncertainty in ch illness remains a constant in
pts experience. Unlike an acute illness where
the uncertainty is short term or vacillates
periodically.
Uncertainty- Neville
Uncertainty exists when individuals are unable to
form a cognitive schema for understanding their
situation and thus believe that they are unable to
predict the outcomes of their behaviours.
Temporal uncertainty is defined
- as ‘not knowing when an inevitable harm will
occur, whereas
Event Uncertainty is a situation
- where the time of occurrence is known but
where the Probability of occurrence may vary.
Sources of Uncertainty-Neville
Sources of Uncertainty-
Sources of medical uncertainty-
- Clinical and functional Uncertainty.
Personal sources of uncertainty
Uncertainty- Neville
Appraisal of Uncertainty by the client is influenced
by
o The client’s cognitive capacities
o Structure providers
Appraisal of Uncertainty is an ongoing, evolving
process and changes with the course of the
illness.
Uncertainty- Neville
Coping and Adapting to Uncertainty
Reducing Uncertainty: Interventions
Interventions
1.Cognitive strategies
2.Emotional Regulation (Emotive strategies)
3.Self-Management (Behavioral strategies)
Intervention-
1.Cognitive Strategies(cont.).
o Education
o Know thy illness
o Symptom management
o Designing and adapting routines
o Social support
2.Emotional Regulation (Emotive strategies)
o Normalization
o Cognitive reframing- next slide. Robson article
o Control emotion
o Formulate cognitive schema
o Trust and confidence in healthcare providers
o Becoming engaged
o Mindfulness
3.Self-Management (Behavioral strategies)
o Activities of daily living
o Focus on daily routines and expectations
reduces uncertainty and anxiety.
o Managing unpredictability: anticipatory guidance
o Interventions designed to enhance and prolong
independence.
Adaptation to Uncertainty
Accepting uncertainty is an adaptive
mechanism.
Negative effects of uncertainty can be reduced
by anticipating and understanding individual
needs across disease course.
o Nurses work with persons with chronic illness to:
1.Modify negative outcomes of the illness
experience
2.Promote positive perceptions of uncertainty
o Nurses provide support, assessment, and
theory-based uncertainty interventions.
Cognitive reframing-Robson et al
In Nursing ,Cognitive reframing is defined as
o “ probabilistic thinking to reframe uncertainty
by encouraging clients to view their situation
from a positive perspective” (Robson. p. 56).
Ex The RN enables the client to view the
diagnosis and thinking of positive outcomes.
o “ as a method by which a person learns to
stop his\her negative thought processes and
substitute the negative thoughts by more
positive self-talk” ( pg. 56). Ex- motivations
of the client.
Operational definition- Cognitive reframing is a
therapeutic technique use to alter or self-alter
perceptions of a negative, distorted or self-
defeating belief with a goal of changing
behaviours and \or improving well-being.
Cognitive Reframing-Robson et al
Concept analysis consist of the following
o Defining attributes-
o Antecedents-5 antecedents
o Consequences- An altered more positive perception.
Strategies- Shifting perspectives,
