Adjusting the fit: development of uncertainty scales for specific clinical populations.
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Nursing Care↗
Biomedical subjects
M H Mishel
Publications and source records attributed to M H Mishel.
Crisis theory and crisis therapy applied in a nurse-patient situation.
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Nurse-Patient Relations↗
Self-Help Intervention Project. Women receiving breast cancer treatment.
PURPOSE: The purpose of this study was to determine the efficacy of self-care/self-help promotion and uncertainty management interventions offered by the Self-Help Intervention Project (SHIP) for women receiving chemotherapy, radiation therapy, or hormone therapy for breast cancer. DESCRIPTION OF STUDY: One hundred ninety-three women were randomly assigned either to one of three intervention groups (self-help course, uncertainty management, or self-help course plus uncertainty management) or to a control group. Data were analyzed by a repeated measures multivariate analysis of variance procedure using a two-level blocking factor (high and low resourcefulness) and four outcome variables (self-care, self-help, psychological adjustment, and confidence in cancer knowledge). Data were collected at baseline (T1), which was after initiation of adjuvant therapy, allowing for the emergence of treatment-related side effects; 6 to 8 weeks after T1 (T2); and 3 months after T2 (T3). RESULTS: At baseline, women having high resourcefulness compared with women having low resourcefulness evidenced greater self-care, self-help, psychological adjustment, and confidence in cancer knowledge. Participation in SHIP interventions resulted in higher levels of self-care, self-help, psychological adjustment, and confidence in cancer knowledge by time effect in a significant number of women regardless of their baseline resourcefulness. Women participating in SHIP interventions who had low baseline resourcefulness demonstrated the greatest change over time in the outcome variables. Post hoc results indicated that the effect primarily was the result of changes in psychological adjustment, confidence in cancer knowledge, and self-care. CLINICAL IMPLICATIONS: The findings of this study address both the treatment effect for supportive care interventions and the needs that have emerged from review of the last 20 years of supportive care research. Some SHIP interventions evidenced more strength than others; data indicated that large percentages of women with low resourcefulness who received no SHIP interventions experienced a decrement in self-care, self-help, confidence in cancer knowledge, and psychological adjustment over the time that they received adjuvant therapy. Women's level of confidence in their knowledge about cancer being sufficient for self-management and self-help activities was not linked to baseline resourcefulness level. Thus, inherent resourcefulness was not a factor in need for supportive services that could maintain or increase confidence in cancer knowledge usefulness for self-management and self-help. Healthcare providers should note that although the women with low resourcefulness benefited the most from the interventions, women who evidenced high resourcefulness at baseline reported the same level of need for confidence in cancer knowledge and for self-help.
Adaptation, Psychological↗
Uncertainty in prostate cancer. Ethnic and family patterns.
PURPOSE: Prostate cancer occurs 37% more often in African-American men than in white men. Patients and their family care providers (FCPs) may have different experiences of cancer and its treatment. This report addresses two questions: 1) What is the relationship of uncertainty to family coping, psychological adjustment to illness, and spiritual factors? and 2) Are these patterns of relationship similar for patients and their family care givers and for whites and African-Americans? DESCRIPTION OF STUDY: A sample of white and African-American men and their family care givers (N = 403) was drawn from an ongoing study, testing the efficacy of an uncertainty management intervention with men with stage B prostate cancer. Data were collected at study entry, either 1 week after post-surgical catheter removal or at the beginning of primary radiation treatment. Measures of uncertainty, adult role behavior, problem solving, social support, importance of God in one's life, family coping, psychological adjustment to illness, and perceptions of health and illness met standard criteria for internal consistency. Analyses of baseline data using Pearson's product moment correlations were conducted to examine the relationships of person, disease, and contextual factors to uncertainty. RESULTS: For family coping, uncertainty was significantly and positively related to two domains in white family care providers only. In African-American and white family care providers, the more uncertainty experienced, the less positive they felt about treatment. Uncertainty for all care givers was related inversely to positive feelings about the patient recovering from the illness. For all patients and for white family members, uncertainty was related inversely to the quality of the domestic environment. For everyone, uncertainty was related inversely to psychological distress. Higher levels of uncertainty were related to a poorer social environment for African-American patients and for white family members. For white patients and their family members, higher levels of uncertainty were related to lower scores on adult role behavior (shopping, running errands). For white family members, higher levels of uncertainty were related to less active problem solving and less perceived social support. Finally, higher levels of uncertainty were related to the importance of God for white patients and family care providers. CLINICAL IMPLICATIONS: The clearest finding of the present study is that there are ethnic differences in the relationship of uncertainty to a number of quality-of-life and coping variables. This has immediate implications for the assessment of psychosocial responses to cancer and cancer treatment. Much of what is in curricula is based on clinical and research experience primarily with white individuals. The experience of uncertainty related to cancer and its treatment is influenced by the cultural perspectives of patients and their families. To assist patients and families with the inevitable uncertainties of the cancer experience, healthcare providers need to reconsider their ethnocentric assumptions and develop more skill in assessing patient and family beliefs, values, cultural perspectives, and the influence of these on patient and family uncertainties.
Adaptation, Psychological↗
Uncertainty in illness theory: a replication of the mediating effects of mastery and coping.
The purpose of this investigation was to replicate a test of the mediating functions of mastery and coping and to determine whether the relationships found in the initial test of the model would hold with a sample more heterogenous than the original sample. One hundred women receiving treatment for gynecological cancer participated in the investigation. Of the 14 relationships in the model, only 5 replicated significant paths and had overlapping confidence intervals. Two moderators were proposed to explain the differences between the initial and replication tests of the model and to improve the specificity of the theory.
Adaptation, Psychological↗
Uncertainty in gynecological cancer: a test of the mediating functions of mastery and coping.
The purpose of this study was to test a portion of the uncertainty in illness model to determine whether mastery would be strengthened or weakened under conditions of uncertainty, and to test the ability of mastery and coping to function as mediators in the model. Mastery was proposed to mediate the relationship between uncertainty and the appraisal of danger and opportunity. Coping was proposed to mediate the relationships between danger or opportunity and emotional distress. Data were collected on a sample of 131 women receiving treatment for gynecological cancer. Findings support mastery as weakened under conditions of uncertainty and functioning as a situationally specific personality factor. Mastery was a significant mediator of the relationship between uncertainty and the appraisal of danger and opportunity; although the mediation effect for the relationship between uncertainty and danger was stronger. While two coping strategies were found to function as significant mediators between danger or opportunity and emotional distress, the mediation effect was very small.
Adaptation, Psychological↗
Family adjustment to heart transplantation: redesigning the dream.
The processes family members of heart transplant recipients use to manage the unpredictability evoked by the need for and receipt of heart transplantation were explored. Twenty family members were theoretically sampled using the grounded theory approach. Three separate family support groups, each of 12 weeks duration, provided data for constant comparative analysis. Redesigning the dream was identified as the integrative theme in the substantive theory that described how family members gradually modify their beliefs about organ transplantation and develop attitudes and beliefs to meet the challenge of living with continual unpredictability. The theory consists of three concepts--immersion, passage, and negotiation--which parallel the stages of waiting for a donor, hospitalization, and recovery.
Adaptation, Psychological↗
Finding meaning: antecedents of uncertainty in illness.
In this study a portion of the uncertainty in illness model was tested. Antecedents to uncertainty tested were the stimuli frame variables of symptom pattern and event familiarity and the structure provider variables of education, social support, and credible authority. Data were collected on a convenience sample of 61 women with gynecological cancer at the time of major treatment effect. Findings supported the proposed model with an empirically generated revised model presenting the influence of antecedents on specific areas of uncertainty. Divergent paths for reducing uncertainty were found. Social support, credible authority, and event familiarity had the greatest influence on lowering the level of uncertainty. Event familiarity and credible authority were primarily effective in reducing the complexity surrounding treatment and the system of care. Social support functioned to decrease the level of ambiguity concerning the state of the illness. Findings generally support the proposed explantation for uncertainty arousal and have substantive significance in identifying the sources of stimuli leading to uncertainty arousal and modification.
Adult↗
Parents' perception of uncertainty concerning their hospitalized child.
The Parent Perception of Uncertainty Scale (PPUS) was developed to measure a perceptual variable believed to influence parents' response to their child's illness and hospitalization. This 31-item Likert-format scale was modified from the original form of the uncertainty scale. The PPUS was composed of four factors measuring the four dimensions of uncertainty consistent with theoretical predictions. Initial testing for reliability found the coefficient alphas and thetas to be adequate for a new scale. Validity testing with theoretically relevant external variables was partially supportive of predictions. Questions remain concerning the adequacy of Factor II. Further testing of the scale is indicated.
Adaptation, Psychological↗
The measurement of uncertainty in illness.
The purpose of this investigation was to explore the role of uncertainty as a significant variable influencing patients' experiences in illness, treatment, and hospitalization. A theory was proposed on uncertainty in illness. Based upon this conceptualization, a 30-item scale tapping the uncertainty in symptomatology, diagnosis, treatment, relationship with care-givers, and planning for the future was developed. The Mishel Uncertainty in Illness Scale (MUIS) was factor analyzed and two factors were extracted from the data. Replication of the factor analysis provided support for the robustness of each factor. The reliability coefficient for each factor of the MUIS was highly adequate for both the initial and replication analyses. Three validation studies were conducted. Initial support for construct validity of the scale was demonstrated by the finding that the MUIS discriminates between treatment groups according to expected differences. Support for theoretical predictions was evidenced by the significant correlation between the MUIS and stress as measured by the Hospital Stress Events Scale. Convergent validity was supported by the finding that the MUIS correlates significantly with lack of comprehension.
Anxiety↗
Side effects burden in women with breast cancer.
PURPOSE: This article describes the side effects burden of 307 women who were receiving treatment for breast cancer. The study provides a description of the impact of side effects burden on adult role activities (self-help), self-care, psychological adjustment, and quality of life. DESCRIPTION OF STUDY: Data to describe the side effects burden characteristics of 307 women receiving treatment for breast cancer were drawn from the Self-Help Intervention Project. Data were collected after medical treatment was underway and treatment-related side effects were evidenced. The impact of side effects burden on adult role activities (self-help), self-care, psychological adjustment, and life quality is described. RESULTS: Fatigue was the most common side effect as well as the most problematic. Number of side effects and increase in side effects were moderately correlated (P < 0.0001) in a negative direction with fatigue and depression. Self-care behaviors also were associated negatively with the extension of side effects and with fatigue and depression (P < 0.001). Psychological adjustment was associated with difficulty sleeping, anxiety, and depression. Overall life quality was noted to be negatively related to depression as was present life quality. CLINICAL IMPLICATIONS: Data support the need for clinical interventions that are individualized to women's side effects experience. Additional research is underway to test the effectiveness of the interventions specified by the overall study.
Activities of Daily Living↗