CONCEPT ANALYSIS UNCERTAINTY

Concept analysis can be defined as a mean to break down complex idea to simpler and understandable notion through research processing. In my own opinion, it is an analytical method of studying complex theory in health delivery and how they are interrelated. The basic purpose of concept analysis is to clarify ambiguous concepts in a theory, and to propose a precise operational definition which reflects its theoretical base (Walker, 198 3, 27-28). Concept analysis helps to clarify any opposite views that may exist among the professionals about a particular concept. It is a mean of developing interdisciplinary mutual relationship which leads to an application of up to date scientific and technological application. For example, through clinical scientific research in nursing managed care concept, a standardized patient assessment was established to be use during nursing care process. So, why am I doing a concept analysis beside earning a credit? It is a way to discover which area of nursing research that are of interest to me. Concept analysis enables nursing researchers to understand and promote further research. The outcome of concept analysis can be incorporated into my clinical skills thus helping me to provide evidence-based health care delivery to my patient and care for the needs of the patient’s family. Thereby, improving the quality of patient’s life through advance health management, advance health promotion and advance health maintenance. In addition, concept analysis helps to identify irrelevant concepts that are not productive in health care delivery. According to Walker and Avant, the purpose of concept analysis is “to distinguish between defining and irrelevant attributes of a concept and to determine likeness and unlikeness between concepts” (p.185) I choose Uncertainty out of the 4 concepts of: trusts, hope, suffering and Uncertainty. What is uncertainty? According to Webster dictionary, it is defined as the quality or state of being in doubt. Uncertainty is not having knowledge of the course and the treatment for an illness. I will be using Merle Mishel theory of uncertainty in illness to support my discussion. She developed the theory of uncertainty in illness to identify and address factors causing stress to patients during period of illness. In her research, she developed an assessment tool composed of fifty-four questions (54) known as Mishel Uncertainty in Illness Scale (MUIS) which was used on her assigned patients for the research.Mishel states that “Uncertainty is the inability to determine the meaning of illness-related events, occurring when the decision maker is unable to assign definite value to objects or events, or is unable to predict outcomes accurately (Mishel; 1988). Oxford dictionary states simply that “Uncertainty is a state of being uncertain” that is unsureness. Spence, Lachlan & Burke sees uncertainty as an occurrence of unexpected crisis. “A crisis is an unexpected, but specific and non-routine series of events or an event creating high levels of uncertainty which threaten or are perceived to potentially threaten high priority goals such as security of life, property security or even the well-being of individual or community” (Spence, Lachlan, & Burke, 2007). Cambridge dictionary defines uncertainty as “a situation at which something is not known or something that is not known or certain” McCormick in describing uncertainty explain that “Uncertainty occurs when sufficient cues are lacking causing the person not to be able to adequately categorize or structure an event” (McCormick, 2002). When the outcome of unexpected crisis such as illness, natural disaster such as flood and motor vehicle accidents cannot be predicted, it is said to be in a state uncertainty. Uncertainty is not being capable of assigning probabilities for outcomes (Vaismoradi, Salsali, & Ahmadi, 2011). Uncertainty in illness “Questions about inconsistent tests results, diagnoses, which treatments to pursue and even what foods to eat can consume a patient with worry (Spivey, 1997, p3). And American thesaurus, defines uncertainty as “unpredictability, doubt and unsureness, a state of powerlessness”The clinical Model scenario that I will use to illustrate uncertainty in illness and explain the attributes of uncertainty: Probability, Perception and temporality is based on Mishel’s theory is a case of 39year old man who was recently diagnosed with stage 4 prostate cancer. The cancer has metastasis to the bones and brain. Chemotherapy, radiation and lastly surgical procedure had been be done but the chance of survival has been put to 30% by the oncologist specialist. The patient had just completed a year wedding anniversary before the discovery. Last month, patient’s wife was confirmed pregnant after a series of miscarriages. As I explain step by step analysis of uncertainty in illness, I will be constantly referring to this case scenario. Mishel’s: Uncertainty of illness compose of three major themes which are: Antecedents of uncertainty, Appraisal of uncertainty, Coping with uncertainty and Adaptations. Firstly, the antecedents of uncertainty entail stimuli frames, cognitive capacities and structure providers. Stimuli frame focuses on the patient’s past experience to the illness such as pain, the perception of the illness and the ability to agree with the crisis. Cognitive capacities refer to the effect of the uncertainty on the physiological and cognitive functioning of the patient. And structure providers entail the support and the credibility of clinical specialist to prescribe a diagnostic test for their illness. The understanding of such tests will depend on the patient ability to adequately process and understand information’s about their illness. For example, in the case scenario of 39-year-old man the outcome of the treatments may be unknown. The stress and the fear of what the future holds, may affect patient thinking capability. The thought of what the outcome of this diagnoses will bring to the wife, the unborn child and the probability that he might not be alive to witness the birth of the unborn child will elicit stress and have a negative effect on the patient cognition. This is agreeable with Mishel’s initial reason of conducting the research, that was to identify the key factors causing stress in a patient during illness.Secondly, appraisal uncertainty of illness refers to inability of the patient to determine the illness related events. The danger, inference & illusion and opportunity encounter by the patient during the period of the illness. Danger in the sense that uncertainty can lead to depreciation in intellectual functioning. A state of prolong stress has been shown to affect biological components of the brain tissues which may be presented as cognition impairments. Inference & illusion refers to recalling of memories based personal experience and exposure in relation to the uncertainty in illness. In the case of the clinical model case sample, the 39year old cancer patient might start wondering where, how and what lead to the cause of his illness. His mood might range from feeling guilty, to self-blame and eventually doubt. In addition, the fact that the brain tissues have been affected will have impact on the patient physiologically and psychologically.Thirdly, copping with uncertainty. This is made up of coping mobilizing strategy, adjustments and coping buffering strategies. For example, in the case of the 39 year old cancer patient, strategies such as positive thinking, meditation and journaling to reduce any emotional stress caused by the illness might be put into use. However, the ability to apply these tools will depend on the patient resources for support and knowledge of the illness. In reality, it is always difficult to apply copping strategies without a source of encouragement due to the fear and stress that the illness comes with, and the state of uncertainty overshadows the patient thinking and reasoning ability.And lastly adaptation, this focus on what measures the patient is using to adapt positively to the illness. Nurses should encourage their patients to verbalized and made their fear known about uncertainty. This is the first step in designing a coping strategy that could be helpful during uncertainty in illness. In my model case scenario and generally, patient has to reach Kubler Ross stage of acceptance before the option of adaptation can come to effect. In other words, sick patient with hopelessness as per the cure of the illness may find it very difficult to think or use any adaptation method.In summary, uncertainty in illness is a constant occurrence from the diagnosis to living with a chronic illness. It affects both the patient and the immediate family and could be very distressing to the patient during the diagnosis phase. Though, as discussed above not all cases of illness do Mishel’s uncertainty in illness is applicable. Merle H. Mishel’s theory of Uncertainty in Illness was initially focused on the person’s ability to resolve the uncertainty. Although, she reevaluated and added the notion that uncertainty may never resolve, but will become part of the person’s identity and affect their perceptions and quality of life.

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