Uncertainty in Illness Theory Analysis

Uncertainty in Illness Theory Analysis UNCERTAINTY IN ILLNESS THEORY MIDDLE RANGE THEORY ASSIGNMENT BYÂ  STEPHANIE MORRIS Background and credentials Merle Mishel strives to enhance patient outcome and care during uncertainty by identifying uncertainties and addressing them. Mishel has a Bachelor of Science degree in nursing from Boston University and Master of Science in nursing from the University of California. She also has a Master of Arts degree in psychology and a postgraduate degree in psychology (Bailey Stewart, 2014). Mishel had an experience with uncertainty via her father. Mishel’s father had colon cancer and his experience influenced her to develop the theory of uncertainty in illness. Mishel’s father was not able to understand what was happening to him and was unable to cope with the disease. Mishel’s father tried to control some aspects of his life while dealing with uncertainty of his disease. Mishel started focusing on uncertainty after she began her doctoral study in psychology. Her dissertation focused on the development of uncertainty measures and testing of the measures (Polit Beck, 2008) . She developed the theory of uncertainty in illness to understand how patients can deal with uncertainty caused by their illness. Mishel described the patients experience as ambiguity over uncertainty. She developed a scale to test perceived ambiguity in illness and later renamed the scale to Mishel Uncertainty in Illness Scale (MUIS) (Bailey Stewart, 2014). Middle range nursing theories provide clear guidance for nursing practice and they are less conceptual and abstract as compared to other theories (Alligood, 2014). The uncertainty in illness theory is considered a middle range theory as it fits into the definition above. Mishel used scientific and empirical evidence to develop the theory and the MUIS tool (Bailey Stewart, 2014). Theoretical source and empirical evidence Mishel used empirical and scientific evidence to develop the theory. Study findings on uncertainty were used to develop the antecedents of the uncertainty in illness theory. Research in cognitive psychology and uncertainty in diseases was useful in developing the antecedent concept. The appraisal concept was developed utilizing clinical data and discussion with friends. Clinical data showed uncertainty was a preferred state in some situations. She also used empirical evidence on stress and coping to develop the theory (Liehr Smith, 2014). Primary sources Mishel used different sources to develop the theory of uncertainty in illness. She combined research in different areas including managing dangerous events, cognitive processing and uncertainty. She used studies published before on stress and coping that examined uncertainty as a stressful event. She reevaluated her previous concept and used existing models from Warburton (1979). She used various different other studies and research such as Budner’s (1962) study which analyzed a certain event as the cause of uncertainty. Mishel significantly considered the stress-coping-adaptation method of Lazarus and Folkman (1984) in her theory. (Bailey Stewart, 2014). These theorist’s views influenced how she viewed uncertainty as a cognitive state instead of an emotional response, and helped her to examine uncertainty as a complex cognitive stressor. Basic considerations The main concept in the theory of uncertainty of illness is uncertainty. Uncertainity is the lack of ability to determine the meaning of events related to a disease. For instance, patients are unable to determine the outcomes correctly and assign value. Another concept is cognitive schema. Cognitive schema is an individual’s subjective interpretation of events related to the disease. There are three major themes related to the concepts identified above (Polit Beck, 2008). They include antecedents of uncertainty, appraisal of uncertainty and coping with uncertainty. Antecedents of uncertainty refers to things that happen before the disease experience that impact the patient’s thinking. They include pain, perception and earlier experiences. Appraisal of uncertainty entails placing value on the uncertain circumstance. Coping with uncertainty refers to activities the patient uses to deal with the uncertainty (Liehr Smith, 2014). Mishel has discussed the metaparadigm concepts in her theory including the environment, health, nursing and person. A person is an individual who experiences uncertainty in diseases. The uncertainty affects interpersonal relationships as the body changes. The environment refers to the healthcare environment where the theory is applicable. Uncertainity caused by diseases affects a patient’s health and patients should develop coping mechanisms to cope with the uncertainty. Healthcare professionals use MUIS tool to identify areas of the disease that are causing uncertainty. Then they address the areas to help the patient develop coping mechanisms that will enhance his health. Nursing is aimed at helping patients and families comprehend uncertainty in diseases and learn new ways of life. Nurses play a critical role in helping patients understand uncertainty in diseases and cope (Liehr Smith, 2014). Mishel made various assumptions when developing the theory. She assumed uncertainty is a cognitive state that represents insufficiency of a current cognitive schema to support the interpretation of events related to a disease (Polit Beck, 2008). Besides, she assumed that uncertainty was a neutral experience not harmful until it is appraised as harmful. She also assumed that individuals can cope with uncertainty in diseases and hence improve their outcome and quality of life. She also claimed that people do not function in an equilibrium state and they need time to concentrate on self. Thus, they are unable to incorporate the uncertainty into their view of life if there is not enough time (Liehr Smith, 2014). The uncertainty in illness schema consists of different themes related to the main concepts. The themes are antecedents of uncertainty, appraisal of uncertainty and coping with uncertainty. The antecedent theme comprises of stimuli frame, structure providers and cognitive capacity. Stimuli frame refers to the form and structure of the stimuli an individual perceives. The stimuli frame consists of symptom pattern, event knowledge and event congruence (Polit Beck, 2008). Symptom patterns imply the extent to which symptoms have a pattern. Event familiarity is the extent to which a situation has recognized cues. Event congruence implies the consistency between the expected disease related events and the events experienced. Cognitive capacity and structure providers impact the stimuli frame. Cognitive capacity refers to a person’s ability to process information (Liehr Smith, 2014). Logical Form The development of nursing theories should follow a logical process and must be in line with the underlying objectives (Polit Beck, 2008). Concepts and sub concepts should be clearly stated and described consistently without ambiguity. The uncertainty in illness theory is well developed as the concepts are clearly presented and easily understood. After Michel reexamined her concept in 1990 the uncertainty of illness theory became deductive due to her using qualitative studies and chaos theory. These research studies lead her to change the direction of the theory. The theory now states that people’s uncertainty is always changing due to major life events and illnesses (Bailey Stewart, 2014). Relationship to Research, Education and Advanced Practice in Nursing The theory of uncertainty in illness can be applied in different areas including education, nursing research and advanced nursing practice. The theory is used in advanced nursing practice to address uncertainty in different diseases and hence patient concerns regarding their diseases. This improves their outcome and quality of life. Patients learn how to cope with uncertain events by understanding the disease process. The theory can be applied in nursing research as it helps researchers understand experience of patients with chronic and terminal diseases (Polit Beck, 2008). The uncertainty in illness theory has been used in studies that focus on uncertainty related to cancer to understand sources of uncertainty in the population how to resolve them. It also used in education to equip nursing students with knowledge and skills required to understand disease uncertainty and coping mechanisms. Implications The uncertainty in illness theory has implications on advanced nursing practice. The theory influences caring of patients as it permits nurses to offer information to patients and families with uncertainty about the disease. Nurses are supposed to provide support to patients and families with uncertainty about their diseases. As a result, patients become emotionally and physically healthier and have strength to cope with the disease. The empowerment offered to patients and families enables them view life differently and increases quality of life (Liehr Smith, 2014). The uncertainty in illness theory can be used to care for a cancer patient the theory is useful in helping a cancer patient cope with the disease and eliminating uncertainty. Cancer can lead to stress because of the uncertainty around the disease, treatment and side effects. Cancer patients are unable to understand events related to the disease and these results to uncertainty and negatively impact their health. The theory can be used to help the patient understand the disease situation and make meaning and thus participate in the plan of care. Therefore, the theory is useful in educating the patient about cancer and addressing their concerns (Liehr Smith, 2014). Summary Merle H. Mishel’s theory of Uncertainty in Illness was initially focused on the person’s ability to resolve 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. The uncertainty in illness theory is essential in transforming patient care and experience. The theory helps patients understand uncertainty related with their illness and address the causes of uncertainty. They developing coping skills and hence are able to cope with the disease. The concepts are clear and well described. The theory can be used in nursing practice, nursing research and education as it is easy to understand and apply. References Alligood, M.R. (2014). Nursing theorists and their work. (8th ed.) St. Louis, MO: Mosby Inc. Bailey, Jr., D. E., Stewart, J. L. (2014). Uncertainty in Illness Theory. In M. R. Alligood, Nursing Theorists and Their Work (8th ed., pp. 555-573). St. Louis, MO: Elsevier Mosby. Liehr, P.R.., Smith, M. J. (2014).Middle range theory for nursing. New York, NY: Springer Polit, D.F. Beck, C. T. (2008).Nursing research. Philadephia: Lippincott Williams and Wilkins Appendix A: Schematic

Balance Diet Essay

Research background Eating a balanced diet means choosing a wide variety of foods and drinks from all the food groups. It also means eating certain things in moderation, namely saturated fat, trans fat, cholesterol, refined sugar, salt and alcohol. The goal is to take in nutrients you need for health at the recommended levels. Balance diet among UMS student is importance can be seen every aspect in daily life that can effect academic performance especially for UMS student. Due to this, balance diet can be refers to people ability to maintain the body healthier. In other to maintain this balance diet, it would affect student academic performance beside the quality of their living. There are many ways to balance our diet well that which can disrupt the control of balance. Some researchers were reported that sex differences among men and women affect the ability to maintain balance diet. The researches do exists have used balance test as a secondary measurement within an overall used balanced test as a secondary measurement within an overall study and show that a decrease in dietary intake. The importance of balance diet among student is to maintain health. It provides all the essential nutrients that the body needs to be healthy and can give students more focus during class. Next, the healthy balance diet has a positive effect on a student well-being and on a student performance. There are several problems regarding to research we want to conduct is the food lack of nutrition (Katz DL, Gonzales, 2004). As we can see, the food that serves at UMS cafeteria was lack of nutrition due to they just prepared the food in large scale and mix the food taste too salty or bitter. Then, the students more prefer junk food than balanced diet food (Marion Nestle, 2000). For example, UMS student always tend to eat junk food such as snacks, magi and fast food. Thus, it can affect student performance like did not have enough stamina and at the same time always feel hungry. Other than that, the balance diet among student did not manage meal taken per day properly (Maya W. Paul, Melinda Smith, M.A. and Jeanne Segal Ph. D, 2012). In Ums, some students are studying too much without care about the meal taken. The healthy meal taken every day is 3 times every day. However, the students just eat once or twice times every day. Hence, it can affect the  student performance without the y realized. Research problem Nowadays, the unhealthy balance diet among student especially in UMS, was affect their academic performance. Besides that, the student did not aware about the importance of taking the balance diet in daily life that can give some effect for their academic performance. Then, the quality of food does not guarantee the student’s academic performance. Research objective 1. To examine the relationship between the unhealthy balance diet among students UMS towards academic performance. 2. To examine the relationship between the importance of taking balance diet among student towards academic performance. 3. To examine the relationship between the qualities of food take the students take towards academic performance.

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The Future Perfect Tense in Spanish

The future perfect tense is normally used to refer to an event or action that hasnt happened yet but is expected or predicted to occur before another occurrence. In a sentence such as By this time tomorrow, I will have left, will have left is in the future perfect tense. In English, the future perfect tense is expressed, as in the example above, by using will have (or shall have) followed by the past participle. The Spanish future perfect tense is formed in much the same way as Englishs: the future indicative form of haber followed by the past participle. So I will have left would be habrà © salido. An Example: Estudiar in Future Perfect Tense Using the past participle of estudiar (to study) as an example, here is the full conjugation of the future perfect tense: habrà © estudiado — I will have studiedhabrà ¡s estudiado — you (informal singular) will have studiedhabrà ¡ estudiado — he, she, you (formal singular) will have studied)habremos estudiado — we will have studiedhabrà ©is estudiado — you (informal plural, seldom used in Latin America) will have studiedhabrà ¡n estudiado — they, you (formal plural) will have studied Examples of the Future Perfect In these sample sentences, the Spanish and English perfect tense are used in much the same way. Habrà © visto  pronto esta pelà ­cula un millà ³n de veces o algo asà ­. (I soon  will have seen this film a million times or something like that.)La universidad habrà ¡ perdido mà ¡s de 6.000 alumnos en el 2016, segà ºn un estudio. (The university will have lost more than 6,000 students by 2016, according to a study.)Si defendemos nuestro paà ­s habremos ganado el futuro. (If we defend our country, we will have gained the future.)Casi 50 millones de trabajadores habrà ¡n muerto de sida en este aà ±o si no mejora el acceso a los medicamentos. (Almost 50 million workers will have died of AIDS this year if we dont improve access to medicine.) Suppositional Use of the Future Perfect Because the future tense in Spanish can sometimes be used to indicate likelihood or supposition, the same is true when haber is used in the future tense. In such cases, the future perfect tense can often be translated as must have, may have, or might have to refer to something that has already occurred: Paula habrà ¡ sabido nada de à ©l. (Paula must have known nothing about him.)Habrà ¡s visto la nueva pà ¡gina web que escribà ­. (You must have seen the new web page I wrote.) ¿Adà ³nde habrà ¡n ido mis caros amigos? (Where might my dear friends have gone to?)No sà © lo que ha pasado. Se habrà ¡ roto el motor. (I dont know what has happened. Perhaps the motor got broken.)  No sà © que habrà ¡ pasado. (I dont know what could have happened.) Note that in these suppositional statements, the grammatical future tense is used to events that happened (or might have happened) in the past. In the negative form, typically by using no, the future perfect forms a sort of rhetorical statement or question. In other words, the statement or question becomes less speculative and assumes agreement by the listener. No habrà ¡n perdido la esperanza en este mundo. (They couldnt have lost hope in this world.)No sà © de dà ³nde habrà ¡n salido estos datos. (I dont know where this data might have come from.)No habremos comprendido la importancia de las instrucciones. (We couldnt have understood the importance of the instructions.) A Related Tense: The Conditional Perfect In Spanish, the future and conditional tenses are closely related; in fact, the conditional tense is sometimes known as the future hypothetical. As such, the conditional perfect is often used in sentences of the type shown in these examples to indicate a conjecture. Si hubià ©ramos comido la pizza, habrà ­amos tenido mà ¡s energà ­a. (If we had eaten the pizza, we would have had more energy.)Si fueran inteligentes, habrà ­an sabido que era una broma. (If they were intelligent, they would have known it was a joke.) As with the future perfect, the conditional perfect as a speculative tense can refer to past events (or supposed past events). Key Takeaways The future perfect is formed by using the simple future tenses of haber followed by a past participle.The Spanish future perfect can be used in much the same way as the English future perfect, which takes the form of will have verb participle.Because the simple future tense can be used in Spanish to make speculative statements, the same can be done with the future perfect.