Reconceptualization of the Uncertainty in Illness Theory

The theory of uncertainty in illness has its strongest support among subjects who are experiencing the acute phase of illness or are in a downward illness trajectory (Mishel, 1988a). The theory has not addressed the experience of living with continual, constant uncertainty in either a chronic illness or in an illness with a treatable acute phase and possible eventual recurrence. Since uncertainty characterizes many, most prevalent, long-term illness conditions, there is a need to reconceptualize the theory of uncertainty to include the experience of living with continual uncertainty. A close examination of the theoretical statements and the empirical data reported by Mishel resulted in the identification of areas of the theory that could be expanded and reconceptualized. The reconceptualization effort was primarily fueled by questions about the outcome portion of the uncertainty theory. To provide a contest for the expansion and reconceptualization of uncertainty, applicable parts of the theory are summarized below.     

Uncertainty of Illness for Pers with Schizophrenia

This qualitative research report presents an illustration of Mishel's (1990) reconceptualization of uncertainty in illness theory applied to persons with schizophrenia. The researcher interviewed 6 persons with schizophrenia and 5 family members. The informants reported being uncertain about whether their medicine would keep working, whether they would be able to provide for their children, whether they could stay on their medicine, whether their symptoms would improve, when the next relapse would be, and even whether they would survive. They appeared to be experiencing differing degrees of uncertainty and a variety of manifestations of probabilistic thinking. For some, uncertainty provided the opportunity for hope. For others, the uncertainty was perceived as a danger. For all of them, their view of life had changed.     

Parental Uncertainty and Posttraumatic Stress in Serious Childhood Illness

Purpose: To explicate the link between parental uncertainty and posttraumatic stress as a way to stimulate advancement in the design and evaluation of nursing interventions for parents of children with serious illness.
Methods: The literature on Mishel's uncertainty in illness theory and its reconceptualization-parental uncertainty in serious childhood illness-and posttraumatic stress are reviewed and synthesized. Pertinent methodological and sociocultural issues are discussed.
Conclusions: The literature indicates support for the theoretical link between parental uncertainty and posttraumatic stress. This linkage provides direction for the design and evaluation of nursing interventions to support parents of children with serious childhood illness.     

Uncertainty in Illness and Optimism in Couples With Multiple Sclerosis

We examined relationships among uncertainty in illness, optimism, symptom severity, and depression in 18 individuals with Multiple Sclerosis (MS) and their partners. Participants are part of an ongoing study in which they complete assessments every 3 months for approximately 1 year. Preliminary analyses indicate some similarities as well as some differences in responses between individuals with MS and their partners. Specifically, results indicated a very strong positive correlation between patients' and partners' levels of uncertainty regarding the illness. Differences in responding were evident when comparing levels of depression with uncertainty. Levels of depression in patients positively related to levels of uncertainty in their partners. Preliminary results also suggest negative correlations between patients' levels of optimism and levels of uncertainty in both partners. Future analyses will focus on whether these relationships remain constant over time.     

类风湿性关节炎患者疾病不确定感及影响因素分析

目的了解类风湿性关节炎患者疾病不确定感现状并分析其影响因素,为有针对性护理干预措施的制定提供依据。方法采用Mishel疾病不确定感量表（Mishel Uncertaintyin Illness Scale for Adults,MUIS—A）对广东省某三级甲等医院200例类风湿性关节炎患者进行问卷调查。结果类风湿性关节炎患者疾病不确定感得分为（86．72±13．92）分,处于中等水平,其中不明确性得分最高为（34．77±4．24）分,其次为复杂性（21．04±5．66）分,不可预测性得分最低为（15．65±2．59）分。单因素分析显示,不同性别、年龄、婚姻状况、文化程度、个人收入水平、自觉疾病严重程度的患者疾病不确定感水平存在差异（P〈0．05）。经多元线性逐步回归分析,进入疾病不确定感回归方程的有文化程度、收入水平、自觉疾病严重程度。结论类风湿性关节炎患者疾病不确定感处于中等水平,主要影响因素是文化程度、个人收入水平和自觉疾病严重程度。临床护理工作者应采取针对性的护理干预措施,帮助患者降低或更好地应对疾病不确定感,提高生活质量。     

脑卒中患者疾病不确定感与负性情绪体验的质性研究

目的：探讨脑卒中患者的疾病不确定感及其负性情绪的体验。方法采用现象学研究方法,对西安市某三级甲等医院神经内科的31例脑卒中患者进行半结构式访谈,运用现象学分析法对访谈资料进行分析。结果脑卒中患者疾病不确定感的体验包括不明确治疗和护理的相关信息,对关于疾病的相关知识和信息感到困惑,难以预测疾病的预后,对社会支持的不确定;主要的负性情绪体验有4个方面：情绪不稳定易激惹、愧疚自责、焦虑不安、抑郁。结论我国脑卒中患者疾病不确定感体验与Mishel理论的观点基本吻合并具有我国的文化特色,其负性情绪体验是多维的,多种负性情绪共同存在的。     

克罗恩病患者疾病不确定感及影响因素分析

目的 了解克罗恩病患者疾病不确定感现状,并探讨其影响因素.方法 采用一般资料调查表、疾病不确定感量表、医学应对问卷对符合纳入标准的144例克罗恩病住院患者进行问卷调查,采用多重线性回归分析克罗恩病患者疾病不确定感的影响因素.结果 克罗恩病患者疾病不确定感总分为(88.27±6.52)分;手术次数、疾病活动度以及医学应对方式(面对、回避、屈服)是患者疾病不确定感的影响因素(P<0.05).结论 克罗恩病患者的疾病不确定感水平偏高,医护人员需关注手术次数多、病情较复杂且不能正确面对疾病的患者,给予患者更多的信息及心理支持,鼓励患者采取积极的应对方式,以降低疾病不确定感对患者的影响,从而改善患者的身心健康及生存质量.     

Validation of a Swedish version of the Mishel Uncertainty in Illness Scale

Uncertainty and fear are realities patients often have to face in illness and hospitalization. Mishel has described how perceived uncertainty under these circumstances can affect the patient's coping strategies. The Mishel Uncertainty in Illness Scale (MUIS), along with a diagnosis-specific version of the MUIS, the Cardiovascular Population Scale, was translated into Swedish with the purpose of testing the usefulness of the scale on a Swedish coronary population. The sample included 60 patients, 40 males and 20 females, with coronary pain, cared for on two intensive coronary care units. The Swedish version of the MUIS seems to be in most instances a reliable instrument for measuring perceived uncertainty. Coefficient alpha was .82, compared with Mishel's reported .84. The reliability of the Cardiovascular Population Scale was .74. Study findings revealed that recency of prior hospitalization was significantly related to perceived uncertainty. Results point to the necessity of further validity testing.     

乳腺癌患者疾病不确定感与社会支持的相关性分析

【目的】了解乳腺癌患者疾病不确定感、社会支持现状,分析二者的相关关系。【方法】对120名乳腺癌患者进行疾病不确定感量表和社会支持量表的问卷调查。【结果】乳腺癌患者疾病不确定感处于中等水平,得分为（98．90±9．66）分;社会支持得分为（49．32±6．32）分;疾病不确定感与社会支持之间存在明显的负相关性。【结论】社会支持会影响乳腺癌患者的疾病不确定感,临床护理人员应根据患者的具体实际情况,提高患者的社会支持现状,从而降低患者的疾病不确定感。     

健康教育路径对抑郁症患者疾病不确定感的影响

目的探讨应用健康教育路径对抑郁症患者疾病不确定感的影响。方法将2010年1—6月在我院心身科病房住院的78例抑郁症患者按入院先后顺序分为观察组40例和对照组38例,观察组采用健康教育路径模式进行健康教育,对照组采用传统教育模式进行健康教育。两组患者均在入院时、住院2周后及出院前1d采用疾病不确定感量表(Mishel uncertaintyin illness scale,MUIS)测评。结果观察组住院后2周及出院前1d的疾病不确定感均比入院前明显下降(P<0.01),与对照组比较,下降幅度差异有统计学意义(P<0.01)。结论对抑郁症患者应用健康教育路径开展健康教育,能显著降低其疾病不确定感。     

The Relationship of Illness Uncertainty, Illness Intrusiveness, and Asthma Severity to Depression in Young Adults with Long-Standing Asthma

This study examined the potential mediating/moderating influence of both illness intrusiveness and asthma severity on the association between illness uncertainty and depression in a college sample of older adolescents and young adults (N = 40) with histories of childhood asthma. There was a significant association between increased illness uncertainty and increased levels of depression. However, analyses indicated that neither illness intrusiveness nor asthma severity served as mediators in the uncertainty–depression relationship. Examination of moderator effects of intrusiveness and severity on the uncertainty–depression relationship revealed an interaction for severity only; thus, the significant effect of uncertainty on depression was at its maximim under conditions of increased illness severity. Results suggest that cognitive appraisal mechanisms involving decreasing ambiguity about illness may be worthwhile targets for intervention.     

首问负责制对颈动脉内膜剥脱术患者疾病不确定感的影响

目的探讨“首问负责制”对颈动脉内膜剥脱术患者疾病不确定感的影响。方法共60例颈动脉狭窄患者,常规组30例采用常规的护理程序,改进组30例实行严格的“首问负责制”。采用疾病不确定感量表（MUIS）对两组患者于入院时、手术前、手术后进行疾病不确定感调查。结果入院时两组疾病不确定感得分差异无统计学意义（P〉0.05）;手术后1 d、7 d改进组的疾病不确定感得分明显低于常规组同时段的得分（P〈0.01）。结论“首问负责制”用于颈动脉内膜剥脱术患者,能明显降低其疾病不确定感,促进患者康复。     

心理支持对前列腺癌根治术患者术后疾病不确定感的影响

【目的】探讨心理支持对接受前列腺癌根治术患者疾病不确定感的影响。【方法】72例接受前列腺癌根治术患者,根据患者意愿分为两组,接受心理支持的患者40例（干预组）,不接受心理治疗32例（对照组）。使用一般资料调查表和中文版M ishel疾病不确定感量表（MUIS-A ）对其进行调查,调查时间至少持续至术后3个月。【结果】干预组平均得分为45．65显著低于对照组80．91,双因素方差分析显示心理支持对M ishel疾病不确定感得分有显著影响（ P ＜0．05）。【结论】心理支持是降低患者术后不确定感有效护理措施,值得临床推广应用。     

我国护理领域疾病不确定感随机对照试验文献的评析

目的 分析我国护理领域疾病不确定感随机对照试验(randomized controlled trial,RCT)文献,探讨研究现状.方法 对中国期刊全文数据库、万方数据库、维普信息资源系统中2001-2010年护理领域疾病不确定感RCT文献进行检索、归类与分析.结果 (1)检索出符合要求的文献29篇,文献数量随年度呈增长趋势,但文献质量有待提高.(2)将文献按受试对象、处理因素、效应指标以及是否遵循伦理原则分类后发现,疾病不确定感RCT文献最多关注脉管系统疾病(24%)和生殖系统疾病(17%)的住院患者;干预方法以单一干预方法(62%)为主,但干预方法的针对性、规范性和可重复性不尽如人意;76%的RCT文献将疾病不确定感水平作为唯一的效应指标;45%的RCT文献中未提及患者是否知情同意.结论 关于疾病不确定感的RCT研究已受到护理界的关注和重视,但研究对象人群有待均衡,研究设计有待加强,研究的科学性、规范性以及对医学伦理的重视仍有待提高.     

ICU恶性肿瘤患者家属疾病不确定感现状及影响因素分析

目的：调查ICU恶性肿瘤患者家属的疾病不确定感现状,并探讨其影响因素。方法采用一般资料问卷、中文版疾病不确定感家属量表、简易应对方式问卷对92例ICU恶性肿瘤患者家属进行问卷调查,采用多重线性回归分析家属疾病不确定感的影响因素。结果家属疾病不确定感总分为（88.76±12.22）分;患者入ICU的原因、家属性别、急性生理与慢性健康评分和积极应对方式是影响ICU恶性肿瘤患者家属疾病不确定感的主要影响因素（P<0.05）。结论 ICU恶性肿瘤患者家属的疾病不确定感水平较高;ICU的医护人员应关注他科转入、性别为女性及病情较重的恶性肿瘤患者家属,为家属提供更多的信息和心理支持,鼓励家属采取积极的应对方式,以降低疾病不确定感对家属的影响。     

舌癌患者手术前后家属疾病不确定感调查分析

目的：调查舌癌患者手术前、后,其家属疾病不确定感情况,分析其变化。方法采用一般资料调查表和中文版疾病不确定感家属量表,分别在患者入院时和术后10 d对80名舌癌患者家属进行调查。结果患者家属在入院时的疾病不确定感总分为（103.27±12.21）分,其中7例（9%）处于低水平,67例（84%）处于中等水平,6例（7%）处于高水平;患者术后10 d家属的疾病不确定感总分为（86.27±10.69）分,其中21例（33%）处于低水平,57例（64%）处于中等水平,2例（3%）处于高水平。患者术后10 d,家属的疾病不确定感总分、不明确性维度得分低于入院时,差异均有统计学意义（P＜0.01）。手术前、后,家属在疾病复杂性、信息缺乏性、不可预测性3个维度得分比较,差异均无统计学意义（P＞0.05）。结论大部分家属在舌癌患者手术前、后存在中等及以上水平的疾病不确定感,根据不同维度家属疾病不确定感的变化情况,护理人员应制定系统的家属宣教计划及反馈评价表,使得院内宣教有步骤有计划地进行。在手术前,耐心讲解疾病知识及住院治疗的过程,客观介绍手术风险;在术后结合每项操作讲解术后护理及目的,特别注意采用合适方法注意沟通的有效性;患者出院前护士结合视频和图册形象通俗讲解出院后的家庭护理措施和要点,通过反馈确保家属理解掌握。