Better Not to Know in Mishel’s Uncertainty in Illness Theory

Mishel’s (1988) Uncertainty in Illness theory is a mid-range nursing theory that examines how uncertainty can affect patients. In addition, Mishel’s theory identifies causes of uncertainty that negatively or positively affect the patient. If an individual is spiraling down a known path of illness, they may perceive uncertainty as a benefit. However, illness uncertainty causes breakdowns, fear of the illness, emotional distress, loss of control, and inappropriate coping methods (Mishel 1988). These conditions if left untreated will lead to patients that are unable to form cognitive structures for illness related events, develop improper psychological adjustments, poor decision-making, and traumatic stress responses (Mishel 1988). Along with her theory, Mishel (1988) developed a scale to rate uncertainty to measure the degree of an individual’s uncertainty during acute injuries, illness, and recurrence of chronic sickness. There is a desire to know what is happening to one’s body, and not understanding the illness will lead to patients being less comfortable. It is the obligation of the nursing profession to help patients understand what their illness means to them, expect outcomes, and managing the stress of uncertainty. Mishel’s theory (1981) is an important aspect of the nurse’s ability to overcome obstacles in place by uncertainty to benefit the well-being of patients.

Uncertainty in Chronic Diseases

Chronic diseases put people in a state of watchful awareness of their condition. While chronic conditions and the outcomes are well studied, the psychological effects of uncertainty remain in question (Baily, Lawrence, Barroso, Bixby, Michel, Muir, Strickland & Clip, 2009). The intrusion of any chronic sickness is a highly stressfu...

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...essors that invoke a greater perceived severity of symptoms (Johson, Zautra & Davis, 2006). Nurses entering the field of practice must be prepared to encounter and manage peoples varying levels and symptoms from uncertainty.

Managing Uncertainty as Nurses

Levels of uncertainty can lead to an increase in symptoms and many negative psychological effects (Mishel 1988). Nurses entering the field of practice must understand the effects of uncertainty and tailor efforts to help patients with this additional stressor. It is the job of the nursing profession to learn how to create interventions to help patients deal with uncertainty. Using up to date research, effectively informing individuals of outcomes, and teaching self-management techniques is key to lowering the levels of uncertainty in individuals with chronic diseases (McNulty, K., Lineh, H., & Wilson, L. 2004).