Uncertainty is defined as the inability to determine the meaning of illness-related events (Mishel, 1984; 1988; Mitchell, Courtney, & Coyer, 2003). A cognitive state created when family members can’t accurately predict outcomes (Mishel & Clayton, 2008), adequately structure or categorize an event because of the lack of sufficient cues’ (Mishel, 1988; p. 225). Stimuli frame, cognitive capacity and structure providers affect uncertainty (Mishel, 1988). Stimuli frame is defined as the perception of stimuli such as patterns of symptoms, familiarity with events or congruence between expected and experienced illness events (Mishel & Clayton, 2008). Cognitive capacity is the information processing ability and structure provides are the resources to assist the family in interpreting the stimuli. Nurses play a key role as structure providers that provide education, social sup- port and credible authority. Those families with high levels of uncertainty have a reduced ability to apply adequate coping mechanisms during the illness situation which has the capacity to negatively impact on patient outcomes (Mishel & Braden, 1988; 1999) and family health (Mishel, 1997; Mitchell, Courtney, & Coyer, 2003; Eggenberger, Meiers, Krumwiede, Bliesmer, Earle, 2011).
Nursing Actions:
- Consistently share information with family in timely ways
- Prepare family members for upcoming events
- Teach family about what can be expected
- Develop therapeutic relationship where family perceives nurses as support
- Implement interventions that directly focus on uncertainty in illness events
- Explore with the family any mixed messages related to the illness or the treatment regime
- Discuss seriousness and prognosis of an illness with all family members and family unit
- Address the symptoms of an illness with family members and family unit; discuss patterns and trajectory changes in illness; examine expected and actual events
- Reassure family of presence of nurse
- Provide factual information
- Help family members structure and attach meaning to events
- Be specific in describing contextual cues such as what patients and families will see, hear and feel during procedures, as well as signs, symptoms, and trajectories
- Help families anticipate changes and predict and manage changes with education and support
- Explore past experiences with health care systems and structure providers that may influence their uncertainty now