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in
Illness
Theory
Merle H. MIshel
Theoretical Sources
Theoretical Sources
When Mishel started her research into uncertainty, the
concept had not previously been applied in the health
and illness context.
Her original Uncertainty in Illness Theory (Mishel,
1988) drew from existing information-processing
models (Warburton, 1979) and personality research
(Budner, 1962) from psychology discipline, which
characterized uncertainty as a cognitive state
resulting from insufficient cues with which form a
cognitive schema or interpersonal representation of a
situation or event.
She attributes the underlying stress-appraisal-copingadaptation framework in the original theory to the
Cognitive Schema
Is a persons subjective interpretation of illness,
treatment, and hospitalization
Stimuli Frame
Is the form, composition, and structure of the
stimuli that a person perceives, which are then
structured into a cognitive schema
Symptom Pattern
Is the degree to which symptoms occur with
sufficient consistency to be perceived as having a
pattern or configuration
Event Familiarity
Is the degree to which a situation is habitual or
repetitive, or contains recognized cues
Event Congruence
Refers to the consistency between the expected
and the experienced in illness-related events
STRUCTURE PROVIDERS
Are the resources available to assist the person in
the interpretation of the stimuli frame
Credible Authority
Is the degree of trust and confidence a person has
in his or her healthcare providers
Social Supports
Social Supports influence uncertainty by assisting
the individual to interpret the meaning of events
COGNITIVE CAPACITIES
Are the information-processing abilities of a person,
reflecting both innate capabilities and situational
constraints
INFERENCE
Refers to the evaluation of uncertainty using
related, recalled experiences
ILLUSION
Refers to beliefs constructed out of uncertainty
ADAPTATION
Reflects biophysical behavior occurring within
persons individually defined range of usual
behavior
PROBABILISTIC THINKING
Refers to the belief in a conditional world in which
the expectation of continual certainty and
Major Assumptions
Major Assumptions
Mishels original Uncertainty in illness theory,
first published in 1988, included several major
assumptions. The first two reflect how
uncertainty was conceptualized originally
within the psychology disciplines informationprocessing models, as follows:
Uncertainty is a cognitive state, representing the
inadequacy of an existing cognitive schema to
support interpretation of illness related events
Uncertainty is an inherently neutral experience,
neither desirable nor aversive until it is appraised
as such.
Theoretical Assertions
Theoretical Assertions