Uncertainty in Illness Theory



Uncertainty in Illness Theory

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Diagnosis requires a certain approach to define the exact illness that a patient is suffering from. Complexities create an uncertain environment for the diagnosis of the real illness that one is suffering from. The presence of uncertainty in the diagnosis of an illness has resulted in the emergence of different nursing theories that define diagnostic procedures. For instance, Joan, who is fifty-five years old, was diagnosed with oropharyngeal cancer. Oropharyngeal cancer is an illness that affects the oropharynx. The oropharynx is affected by the growth of malignant cells, causing cancer.

She experienced difficulty swallowing, and, thus, she decided to go to an ENT doctor, who with the help of endoscopy, discovered a large mass of esophageal sphincter. She had to undergo chemotherapy together with radiation treatments as a control measure for oropharyngeal cancer. Joan’s diagnosis presents a nursing theory. The theory of uncertainty in illness is a common nursing phenomenon that is applied in most diagnoses through its application in treatment. The uncertainty in illness theory is applied in terms of attempted approaches used in treatment. Therefore, the research paper aims at discussing the uncertainty in illness theory as presented in Joan’s oropharyngeal case.

Description of the Illness Theory

The uncertainty in illness theory describes the complexities related to determining the meaning of disease-related events. The theory was developed by Merle Mishel, a well-known nursing theorist (Mishel, 1988). The distressing fact of the uncertainty in illness theory applies in the diagnosis phase of an illness. The diagnosis phase is the period when an illness is determined through clinical measures. The distress in the phase is due to the uncertain nature of an illness and the threats that exist due to the selection of a given treatment. It constantly occurs in the diagnosis of chronic illnesses as a doctor has to take risks in determining the effects of a certain approach towards a given ailment. The advantage of the uncertainty in illness theory in the diagnosis of an illness is the fact that the uncertainty decreases over time. Therefore, the theory is mainly involved in defining diagnostic procedures, including the clinical determination of an illness and its treatment.

The middle range theory of uncertainty in illness has also been portrayed in the treatment process through the adaptation of a patient and his/her family to the treatment process. The patient takes time to cope with the treatment. This creates uncertainty in treatment. In addition, the theory illustrates the emotional support that the patient gets (Mishel, 1988). The patient’s emotional support can result in his/her quick recovery. However, the theory reflects the patient`s environment which hinders support provided to him/her. Therefore, emotional support and adaptation of the patient and his/her family to the treatment process contribute to the uncertainty in illness.

The theory has assisted in improving the levels of the nursing provision requiring health practitioners to be very attentive to treatment procedures. The improvement has been realized as the psychological development of health practitioners has been impacted. This is because the uncertainty in illness theory involves models that Mishel used in defining the research that she carried out in the fields of nursing and psychology. The psychological approach of the theory defines the human response to the sensitiveness of an illness (Mishel, 1988).

Because most illnesses create uncertainty during treatment, health practitioners must pay the most careful attention during the diagnosis of an illness. This makes health practitioners more attentive when diagnosing an illness. They work towards the reduction of uncertainty by providing patients with information on the illness. Therefore, the psychology model of the uncertainty in illness theory helps in defining the impact of the diagnosis process on health practitioners.

The theories of uncertainty in illness are aimed at helping health practitioners to cope with and overcome the uncertainty in diagnosis and treatment. The uncertainty in illness theory includes three concepts: antecedents of uncertainty, appraisal of uncertainty, and coping with uncertainty (Mishel, 1988). Antecedents of uncertainty in illness are the perceptions that a patient has toward the illness. These perceptions define the stimuli of these individuals to the illness. The stimuli create the stimuli frame, which consists of three components: symptom pattern, event familiarity, and event congruence (Suzuki, 2012).

According to the uncertainty in illness theory, the components are structured by a patient in a cognitive schema thus creating less sensitivity to illness. Symptom pattern is the degree of presentation of the symptoms present. Event familiarity is the degree to which the illness situation is habitual or repetitive. Event congruence is the consistency between the expected and experienced illness-related events. The three components are crucial in determining the patient’s perception of the illness hence the uncertainty in illness theory is demonstrated (Suzuki, 2012).

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The components of the stimuli frame are influenced by cognitive capacity and structure providers. The two help in determining the nature of perception; whether it will reduce or increase the uncertainty in illness treatment. Therefore, antecedents of the uncertainty in illness theory are the background of the theory.

Appraisal of uncertainty is the process of placing value on the uncertain illness-related situation. This is the most important part of the theory because it determines the approach to uncertainty in the diagnosis of an illness. Therefore, appraisal of uncertainty needs to be valued to reduce the uncertainties in treatment. Appraisal of uncertainty consists of the situations that occur in the course of the illness perception. Such perception creates an event recognition whereby it may be classified correctly or incorrectly. On the other hand, the perception may create a situation of not recognizing the illness (Suzuki, 2012).

Therefore, recognition of the illness uncertainty leads to a better appraisal of the uncertainty situation, thus, reducing uncertainty. If the event is not recognized, uncertainty is not changed and the illness remains undetected, hence, there are inconsistencies in treatment. The concept of coping with uncertainties is the final concept of the theory. After appraisal of uncertainties, the theory insists on the need to cope with them (Suzuki, 2012).

This helps to increase the probability of reduction of uncertainty in treatment. This creates a better platform for the efficient treatment of the illness. Therefore, the theory is aimed at improving the nursing process regarding chronic illnesses. It requires health practitioners in the middle range nursing to be more attentive hence leading to an improved nursing process.

Application of the Theory in Research and/or Practice

The uncertainty in illness theory is highly applied in research and practical work. The research demonstrates that the theory is valid. In the article by Haisfield-Wolfe et al. (2011), the uncertainty in illness theory has been applied in the research on the prevalence and correlation of symptoms and uncertainty in illness among head and neck cancer patients. The uncertainty in the research is involved in the treatment procedures of these patients, who receive radiation treatment with or without chemotherapy. The research was a prospective study aimed at the exploration and description of symptom dimensions and depressive symptoms. The research was meant to explore the uncertainties involved in newly diagnosed oropharyngeal and laryngeal cancer patients during treatment (Haisfield-Wolfe et al., 2011).

The research was practical as it involved a sample of laryngeal and oropharyngeal cancer patients, who received definitive radiation treatment. The patients were tested for approximately eleven weeks. The test measured whether the uncertainties suggested by the theory were present or not. The theory is present in the article where the method of diagnosis was uncertain through the application of definitive radiation as a treatment. The side effects of the method of treatment do not provide a sure treatment to patients suffering from oropharyngeal and laryngeal cancer.

The article by Haisfield-Wolfe, McGuire & Krumm (2012) presented research on symptoms, depressive signs, and uncertainty in new patients diagnosed with oropharyngeal as well as laryngeal cancer. The study showed that out of twenty-one patients under definitive radiation treatment, eleven had a change in symptoms of oropharyngeal cancer and laryngeal cancer. The symptoms that had changed created problematic progression for the patients. Although the symptoms had changed, other symptoms increased their prevalence (Haisfield-Wolfe, McGuire & Krumm, 2012). For instance, depression was one of the symptoms that had increased by twenty-four percent among the patients. Uncertainty in the study was high (above 0.73) (Haisfield-Wolfe, McGuire & Krumm, 2012).

Suzuki (2012) also applied uncertainty in illness theory. The article presents research on the relationship between the perceived engagements in decision making, quality of life as well as uncertainty in individuals suffering from head and neck cancer. The research provided insights into the uncertainty of undergoing treatment. The theory has been applied in the article, thus, a solution to uncertainty in treatment has been provided as adequate information for patient care. The nursing methods were shown to have side effects that ought to be closely examined to be reduced. This will help in the reduction of uncertainties in treatment procedures. Therefore, the research carried out by Suzuki (2012) illustrates the application of the theory of uncertainty in illness in the treatment of oropharyngeal and laryngeal cancer. Moreover, the article provided solutions to the issue of uncertainty.

In practice, the theory of uncertainty in illness has been applied in the treatment of Joan suffering from oropharyngeal cancer. After being referred to an ENT doctor, she was subjected to chemotherapy treatment. Joan’s treatment has had similar side effects as presented in the article by Haisfield-Wolfe et al. (2011), hence creating uncertainty in her treatment process. The chemotherapy treatment offered to Joan had side effects as it created more symptoms. The treatment was also repetitive as it had to be performed several times at a specified rate. Repetitive and side effects in the human body create uncertainty in the treatment process. Therefore, Joan’s case is a practical application of uncertainty in illness theory.

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Description of the Problem

The problem behind the theory of uncertainty in illness is the uncertain nature of the treatment procedures applied. The uncertainty in the theory is caused by the lack of confidence and knowledge among health practitioners. Depression appeared to be one of the main side effects of chemotherapy that the patients suffering from oropharyngeal cancer go through. The problem of uncertainty in treatment methods is presented by the uncertainty theory as a major challenge in the whole process. This creates an urge to improve the treatment methods used by health practitioners.

Application in Practice

Uncertainty in treatment is a crucial problem and there is a need to ensure that treatment is offered in the best ways available. Joan’s case was a practical example of the problem that the uncertainty in illness presents. The uncertainty theory can be applied in solving the challenges related to treatment through the intervention of the treatment process (Mishel, 1988). Therefore, the theory is applied in form of intervention strategies.

The intervention strategies that the theory applies to provide a solution to uncertainty during treatment impact it in various ways. The main solution to uncertainty is the use of knowledge within the nursing sector to reduce the side effects of chemotherapy used in patients suffering from oropharyngeal cancer (Haisfield-Wolfe, McGuire & Krumm, 2012). According to the theory, the solutions to uncertainty call for in-depth research to ensure that the uncertainty is reduced. In addition, health practitioners are required to use their skills to sort out the problem. Moreover, improving health practitioners’ confidentiality in applying their knowledge in the treatment processes is one of the solutions to uncertainty. This will create a more efficient atmosphere because the nursing processes will involve sure approaches to the problem. As a result, nursing standards will improve hence leading to improvement in treatment processes.

The intervention strategies of the theory have a few desirable outcomes. The nursing process will improve due to the intervention of the process through the enhanced confidentiality among health practitioners created by the theory (Mishel, 1988). The application of the theory to solve the challenges also helps in stabilizing the health sector. This is because the theory calls for constant research on the nursing process hence creating a more reliable treatment process. The reliability contributes to the enhancement of stability in the nursing process. Therefore, the application of uncertainty in illness theory has significant advantages in the nursing process.

Alternate Theory

Middle-range nursing is a field that has been studied due to the complexity of the nursing process. Theories related to middle-range nursing explain the concepts and solutions to challenges that exist in the nursing field. Therefore, alternate theories are present as they seek efficiency in the nursing process. One of the theories is stress theory. It combines physiological and psychobiological aspects of nursing (Mishel, 1990).

The theory comprises a scientific analysis of biological stress that helps in the nursing process. The theory states that an event that threatens an individual`s wellbeing leads to a three-stage bodily response: alarm, resistance, and exhaustion. The stages create a more detailed platform for the definition of the nursing process. The stress theory enhances the nursing process as it helps to realize that there is a probability of having uncertainties in treatment methods (Mishel, 1990). The three stages of the stress theory can be used in solving uncertainties by creating alarm for the challenge, then resisting the effects of the challenge, and finally realization of the nursing process by complete reduction of the uncertainties. Therefore, stress theory is an alternative theory that can be used to approach the uncertainties in treatment.


In conclusion, Joan’s oropharyngeal cancer case presents middle-range nursing. Idle range nursing contains uncertainties that ought to be solved to increase the efficiency of the nursing process. The theory of uncertainty in illness is an efficient approach, which can help to solve the uncertainties in nursing. Therefore, the theory creates an illustrative platform to address the inconsistencies in the treatment process. Chemotherapy used in Joan`s case can be free from uncertainties through the solutions provided by the uncertainty in illness theory and the stress theory. The theories lead to the stability and success of middle-range nursing. Therefore, the treatment of Joan’s case can be more efficient by adhering to the solutions of the theories within the middle range nursing; thus, the theories are responsible for the improvement of the nursing standards in the treatment of illnesses. The stress theory can be used as an alternate theory in this scenario. It involves physiological and psychobiological processes. The stress theory consists of the stages that can help in determining, evaluating, and solving uncertainties in treatment.

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