Illness Theory Essay

PROPOSITIONS Propositions are statements that establish the relationships between concepts. Within the mentioned theory, there are many propositions that can be established. One such proposition is that uncertainty in illness results from a lack of cognitive schema development when a person has an illness related event. Another proposition would be that individual cognitively process illness-related stimuli and structure meaning from the events (McEwen & Wills, p.243, 2014). It can also be said that changes in uncertainty occur over time, either creating positive or negative assessment of uncertainty. Lastly, the theory proposes that uncertainty is an opportunity. Meaning that being uncertain “opens up the consideration of multiple possibilities
since certainty is not absolute”, (Mishel, p.260, 1988). This in itself, opens the individual to many possibilities and choices and enables the person to live life more fully.
In this theory the person is defined as the individual who experiences the uncertainty that accompanies illness and is also an “open system of interchanging energy within the environment”, (Mishel, p.258, 1988). It is also to be noted that within the person questions arise as illness invade aspects of life and progress. And here the theory seeks to explain changes and assist with coping. Health, within the theory, is defined as where a person may be in reference to acute or chronic illness and where they may be, cognitively, in dealing/coping with their illness. The environment consists of varying healthcare settings, such as clinics, hospitals, long term care facilities, etc. Currently the theory has been used in a variety of settings from children to adults, acute to chronic illness and injury. Nursing can be viewed as a credible authority, as nurses can educate on illness progression and can assist an individual in coping with uncertainty by increasing knowledge, providing social support and linking patient’s with appropriate services. While culture is not specifically addressed within the theory, we can surmise that we are addressing the healthcare culture which is made up of healthcare professionals and support staff, patients and family support. And being that everyone who experiences illness has some level of uncertainty, the theory can be used across cultures and disciplines. Caring, here, can be described as the decreasing of uncertainty which untimely leads to positive healthcare outcomes for patients.
EVALUATION
The uncertainty in illness theory has a substantive foundation being that there will always be varying levels of uncertainty when stricken with illness.
The theory is rooted in research as Mishel developed and tested several research instruments, uncertainty scales. These scales include:
“The Adult Uncertainty in Illness Scale and the Adult Uncertainty in Illness Scale- Community Form; the Parents’ Perception of Uncertainty in Illness Scale; the Parents’ Perception of Uncertainty in Illness Scale-Family Member; and the Uncertainty Scale for Kids (McEwen & Wills, p.244,
2014)”.
Which were developed by Mishel to further explain and validate her research findings. The theory is mainly within the focus of the nursing discipline, but carries elements of other disciplines such as psychology. In nursing, we evaluate the whole person for healing and mental processes must be evaluated as well to ensure positive patient outcomes.
Within the theory, the assumptions can be inferred and are congruent within the focus of the theory. For instance, the assumption that states uncertainty is a state of inadequate, cognitive function in relation to illness-related situations most certainty falls with the discipline of nursing. As nurses, we are often tasked with teaching our patients about disease processes and management of illness through proper medication regimen, proper diet and exercise. Often times, all these things together, work to decrease a large portion of anxiety and uncertainty in illness. This theory also provides substantive explanation of phenomenon at a middle range level by addressing concerns at a focused level through concrete concepts that are defined and can be tested using Mishel’s uncertainty scales.
The uncertainty theory is structurally sound as the three major concepts: stimuli frame, cognitive capacities, structure providers are clearly presented and defined within the research.
In describing the first two concepts they seem to be on the middle level, however structural providers are at a practice level being that the providers are physicians, nurses and other knowledgeable, support staff. The theory is parsimonious is its research, the reader is able to grasp the concepts and there are no more than needed to explain the theory. And lastly, the concepts and relationships have been logically represented within the theory and a model was created to showcase. For example, the relationship between an individual’s cognitive capacities and uncertainty. If a person is given more information than they can process at a given moment, it can lead to increased
uncertainty.
The theory is also functionally adequate. It can be applied to both practice environments and client groups as the scale developed from Mishel has been used in both settings. Mishel has used the developed theory and aforementioned scale to gauge uncertainty in cancer patients and implement strategies to decrease uncertainty. However, while Mishel has developed a measurement scale to accompany the theory there are no actual empirical indicators or instruments within the theoretical concepts to measure action. There are many published examples of the theory in both research and practice which has helped the theory to evolve over time with the addition of the chaos theory inclusion. Mishel’s theory has been used, tested and validated in numerous publications such as the Journal of Nursing Scholarship and it has also been used and tested in numerous scholastic institutions and healthcare facilities.