Mishel’s Uncertainty in Illness Theory and Reconceptualized Uncertainty in Illness Theory

Contributor: Jacqueline Fawcett
May 24, 2020

Author – Merle H. Mishel, PhD, RN, FAAN

Year First Published – 1988, revised in 1990
Major Concepts

Original theoryUncertainty

  • Antecedents of uncertainty — stimuli frame (symptom pattern, event familiarity, event congruence), cognitive capacity, and structure providers (education, social support, credible authority)
  • Appraisal of uncertainty — inference or illusion, valuing of uncertainty as a danger or opportunity
  • Coping with uncertainty — danger, opportunity, coping (mobilizing strategies and control situation when uncertainty is regarded as danger; building strategies when uncertainty is regarded as opportunity), adaptation

Reconceptualized theory – Uncertainty

  • Antecedents of uncertainty — stimuli frame (symptom pattern, event familiarity, event congruence), cognitive capacity, and structure providers (education, social support, credible authority)
  • Self-organization
  • Probabilistic thinking
  • Formation of a new life perspective — prior life experience, physiological status, social resources, health care provider
Typology

Middle-range theory — Applicable to people of all ages and all phases of illness from initial symptoms to outcome(s)

Description

Mishel’s original uncertainty in illness theory is an explanation of “how patients cognitively structure a schema for the subjective interpretation of uncertainty with treatments and outcomes. . . . The desired outcome . . . is a return to the previous level of adaptation or functioning” (Clayton Dean, & MIshel, 2018, p. 49).

The reconceptualized uncertainty in illness theory “addresses the process that occurs when a person lives with unremitting uncertainty found in chronic illness or in illness with a potential for recurrence . . . The desired outcome . . . is a growth to a new value system” (Clayton et al., 2018, p 49).
When the theory was reconceptualized, the concepts of self-organization, probabilistic thinking, and formation of a new life perspective were added, and appraisal of uncertainty and coping with uncertainty were eliminated.

The concepts of the theory of uncertainty in illness are measured by the Uncertainty in Illness Scale (Mishel, 1981). The original scale includes 33 items; the scale has been revised for specific populations, including community-dwelling adults (23 items), cancer survivors (22 items), children and adolescents (22 items), parents of hospitalized children (31 items), and 5-item short form for adults (Clayton et al., 2018; Mishel, 1983).

Primary Sources

Clayton, M. F., Dean, M,, & MIshel, M (2018), Theories of uncertainty. In M. J. Smith & P. R. Liehr (Eds.). Middle range theory for nursing (4th ed., pp. 49-81). New York, NY: Springer.

Mishel, M. (1981). The measurement of uncertainty in illness. Nursing Research, 30 258-263.

MIshel, M. H. (1983). Parents’ perception of uncertainty concerning their hospitalized child. Nursing Research, 32, 324-330.

Mishel, M. H. (1988). Uncertainty in illness. Journal of Nursing Scholarship, 20, 225-231.

Mishel, M. H. (1990). Reconceptualization of the uncertainty in illness theory. Journal of Nursing Scholarship. 22, 256-262.

Application Source

See Clayton, M. F., Dean, M,, & MIshel, M (2018), Theories of uncertainty. In M. J. Smith & P. R. Liehr (Eds.). Middle range theory for nursing (4th ed., pp. 49-81). New York, NY: Springer,for a comprehensive discussion of application of the theory and an extensive list of references.

Author

Merle H. Mishel (1939-2020)

Merle H. Mishel

Education
Boston University – BS (Nursing)
UCLA – MS (Nursing )
Claremont Graduate University – PhD (Social psychology)

Faculty Positions
California State University, Los Angeles
University of Arizona College of Nursing
University of North Carolina at Chapel Hill School of Nursing, 1991-2014

Honors
Fellow, American Academy of Nursing
Kenan Distinguished Professorship, University of North Carolina at Chapel Hill School of Nursing
Research Merit Award, Friends of National Institute of Nursing Research
Nurse Researcher Hall of Fame, Sigma Theta Tau International, 2011

Content from Merle H. Mishel obituary published in the Hartford [CT] Courant, April 28, 2020 (see https://www.legacy.com/obituaries/hartfordcourant/obituary.aspx?n=merle-h-mishel&pid=196085424&fhid=4309) and from Carolina Nursing (see https://nursing.unc.edu/remembering-son-faculty-alum-and-renowned-researcher-merle-mishel/)