Merle Mishel Nursing Theory

Dr. Merle Mishel is an American, nursing theorist who is accredited with the creation of the uncertainty in illness theory and measurement scale. She holds both a master 's degree in psychiatric nursing and a PhD in social psychology. She has accrued many distinguished awards and honors for her works showcasing her expertise in dealing with psychosocial responses to cancer and chronic illness and also the best interventions to manage the hardship and stress that can accompany uncertainty when it comes to illness. Dr. Mishel, currently she holds a position at University of North Carolina at Chapel Hill School of Nursing as a Kenan Professor of Nursing, where she continues her teachings, research and advocating of cancer patients and those with

Mishel defines uncertainty as the inability to structure meaning that may develop if the person does not form a “cognitive schema for illness events” (McEwen &Wills, p.243, 2014). The theory, was developed by Dr. Mishel in the early 1980s, was formally introduced in the late 1980s and revised in the early 1990s. The theory of uncertainty in illness is classified as a middle, middle range theory. It was constructed to explain how uncertainty can impact an individual’s ability to cope with illness and the impact those uncertainties can have on patient outcomes and helps to measure the level in which someone is experiencing uncertainty during either acute or chronic, illness or injury. The theory further explains how clients cognitively process illness-related stimuli and construct meaning from these events (McEwen & Wills, p.243, 2014) because in times of illness, uncertainty can be created due to the unknown. This uncertainty can spread into all aspects of a person’s daily life, changing behaviors and ways of thinking. The theory, uncertainty in illness sets out to explain this phenomena and share interventions that can be used to lessen the impact of this

Dr. Mishel’s model describes the concepts as: “stimuli frame”, “cognitive capacities”, and “structure providers”, (Mishel, p.225, 1988). The first concept, stimuli frame, refers to the form, composition and structure of the stimuli that the person perceives and is composed of three components: symptom pattern, event familiarity and event congruency (McEwen & Wills, p.243, 2014). Here we examine the consistency of symptoms, regularity of occurrence and the consistence between what is expected and experienced. According to Mishel, the next two concepts, cognitive capacities and structure providers, influence the stimuli frame. When dealing with illness, there is often times an abundance of information being shared with the ill and those affected. At a certain point, individuals can become overload with information and reach their cognitive capacity, causing a decreased in the amount of information that can be processed, directly effecting the stimuli frame. Next, structure providers, are those ‘pillars’ in an individual’s health journey that provide education to enhance a person’s knowledge base, provide social support (friends, family, or spiritual support) and provide credible authority (knowledgeable, trustworthy healthcare personnel, such as doctors and nurses). Other concepts include appraisal, inference (danger or opportunity), illusion and coping mechanisms”