Healthcare and Uncertainty in Illness its Causes and Impact

Afza.Malik GDA

Causes and Impact of Healthcare and Uncertainty in Illness

Healthcare and Uncertainty in Illness its Causes and Impact

Whats is Uncertainty in Illness,Illness Uncertainty as Psychological Issue,Parents Perception About Illness,Nursing Research and Uncertainty,Research Designs for Illness Uncertainty,Antecedents or Modifiers of Uncertainty,Chronic Illness and Uncertainty,With Uncertainty,Negative Impact of Uncertainty on Health and Life.

Whats is Uncertainty in Illness

    Uncertainty in illness has been defined by Mishel (1988) as the inability to determine the meaning of illness related events; this occurs in situations where the decision maker is unable to assign definite value to objects and events or is unable to accurately predict outcomes due to lack of sufficient cues. 

    The uncertainty theory by Mishel explains how uncertainty develops in patients with an acute illness and how it is proposed that patients deal with uncertainty. Mishel further defined the original theory to refer to chronic illness in 1990.

Illness Uncertainty as Psychological Issue

    Uncertainty regarding an illness has been identified as the greatest single psychological stressors for the patient with a life-threatening illness ( Koocher , 1984). 

    Uncertainty is not the total experience in acute and chronic illness, yet it is a constant occurrence from diagnosis through living with a long-term illness or condition. Study of uncertainty dates back to some of the early work by Davis (1960), where he detailed the difference between clinical and functional uncertainty and tied the experience to the delivery of care and the agenda of health care providers. 

    From 1960 through 1974, other classic pieces on uncertainty emerged, which included the work by McIntosh (1974, 1976) on the desire for information among patients with cancer. This work provided some of the first ideas about the ambiguity surrounding diagnosis and prognosis and the impact of this ambiguity upon the patient's psychological state. 

    Work by Wiener in 1975 explored the topic of uncertainty in chronic illness. This classic work on living with uncertainty brought home the invasion of uncertainty into multiple aspects of life and the strategies to tolerate the uncertainty.

Parents Perception About Illness

    Since the publication of the Mishel Uncertainty in Illness Scale (MUIS) (Mishel, 1981), the Parents Perception of Uncertainty Scale (PPUS) (Mishel, 1983b), the exploration of uncertainty scales for specific populations (Mishel, 1983a), along with early conceptualization of the variable within illness (Mishel, 1981), the study of uncertainty has expanded considerably. 

    Both qualitative and quantitative work in nursing and in other fields added to the knowledge on uncertainty in illness. The research has spread to practice through clinical publications (Hilton, 1992; Righter, 1995; Wurzbach, 1992). 

    A second instrument on uncertainty in illness has been developed by Hilton (1994). This instrument is based on the stress and coping framework by Lazarus and Folkman (1984) and is not derived from a nursing theory of uncertainty in illness.

 Nursing Research and Uncertainty

    A number of reviews of the research on uncertainty in illness have been published. The first review by Mast (1995) used the uncer- tainty in illness theory as the framework for the review of research on uncertainty. 

    Similarly, the two reviews by Mishel (1997 and 1999) also used the Uncertainty in Illness theory published in 1988 as the framework for review although Mishel (1999) also included the uncertainty theory published in 1990 to evaluate the qualitative work done on uncertainty in chronic illness. 

    Stewart and Mishel (2000) reviewed the research on parent and child uncertainty. Other recent reviews of the research and theory on uncertainty include the review by Neville (2003) with a focus on application to orthopedic conditions and the chapter by Barron (2000) on stress, uncertainty, and health. 

    Further work on the concept of uncertainty has been published by McCormick (2002) and by Babrow (2001) from the field of health communication. Discussion of the theory of uncertainty has appeared in two sources on nursing theory ( Aligood &Tomey , 2002; Mishel & Clayton, 2003).

    As noted by Barron (2000) and Mishel (1997), there has been a strong interest in the study of uncertainty; however, most of it has been atheoretical. Most of the quantitative studies of uncertainty in illness have used one of Mishel's uncertainty scales, but the selection of variables had not been tied to the theory of uncertainty in illness. 

    Most of the research has been on uncertainty in specific clinical populations, with the predominance of the quantitative research on acute illness and with more qualitative work on chronic illness. 

    This may be due to the focus of the uncertainty scales on acute illness and hospitalization, with less accurate measurement available for the study of chronic illness.

Research Designs for Illness Uncertainty 

    In the study of uncertainty, most of the studies are cross-sectional and the findings are associative, although the analyzes in many studies are often considered predictive when causal modeling is used. At this time, some consistent findings have emerged. 

    Across all illnesses studied to date, uncertainty de creases over time and returns on illness recurrence or exacerbation, and uncertainty is highest or most distressing while awaiting a diagnosis. 

    Current evidence is strong for the role of social support in reducing uncertainty among those with an acute illness. Due to consensus of the findings, if further research is done in this area, it should be focused on building on what is known instead of repeating similar findings.

 Antecedents or Modifiers of Uncertainty

    Concerning the role of personality dispositions as antecedents of or modifiers of uncertainty, the evidence is not solid. In acute illness, there is some support for mastery in a mediating role, but the study of personality dispositions related to uncertainty has been limited to a small one number of studies, all with cancer patients receiving treatment. 

    Other acute illnesses require study in order to see which personality dispositions are associated with uncertainty and at which phase in the illness experience. Further research is necessary to determine if the acuity of illness immobilizes personality variables and whether they come into play during the recovery phase or during the management of continual uncertainty in chronic illness.

Chronic Illness and Uncertainty

    In chronic illness, interesting findings are emerging from quantitative studies of perceived personal control as a personality disposition for influencing uncertainty and the relationship between uncertainty and mood state. Likewise, spirituality is also being studied for its potential in modifying the impact of uncertainty in mood. 

    Both of these avenues of study are important and point out that in a long-term illness, personality dimensions may come into play for their ability to reduce uncertainty or to reduce the negative impact of uncertainty.

Copping With Uncertainty

    Studies of coping with uncertainty in persons with acute illness have resulted in consistent findings for the relationship between uncertainty and emotion focused coping. In order to determine if a broader range of coping strategies exists, attention needs to be given to developing instruments that are related to the problem under study. 

    If coping strategies were derived from the setting and population, results may differ from those consistently accrued from global measures of coping.

Negative Impact of Uncertainty on Health and Life 

    There is sufficient evidence that uncertainty has a negative impact on quality of life and psychosocial adjustment in acute illness populations. 

    Uncertainty has consistently been found to be related to depression, anxiety, poorer quality of life, less optimism, and negative mood states. Since the evidence is consistent and strong it provides direction for interventions to target outcome variables. 

    There is some evidence for the effectiveness of supportive educational interventions in modifying the adverse outcomes from uncertainty. Recently, interventions for managing uncertainty in breast and prostate cancer have been published reporting strong intervention effect (Braden, Mishel, Longman, & Burns, 1998; Mishel et al., 2002). 

    Repeated testing of these interventions and the development of other theory and research-based interventions that build on the body of existing descriptive research should be the direction of future research.

    In chronic illness, the work on management of uncertainty has been enriched by the qualitative investigations where a variety of management methods have been found across a number of chronic illnesses. 

    In contrast to the limited and ineffective coping strategies reported from the use of standardized scales, the findings from qualitative studies indicate that people are very resourceful in finding approaches for living with enduring uncertainty. 

    More research is needed in this area with an attempt to replicate findings across studies so that support for particular strategies can emerge. At the present time, the findings are scattered with no attempt to relate findings from one study to another.

    In conclusion, the research on the concept of uncertainty continues to spread across disciplines and countries. Today the uncertainty in illness scales have been translated into more languages and the research continues across all continents.

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