İç Hastalıkları Hemşirelerinin Sık Karşılaştığı Bir Gerçek; 'Belirsizlik' Kavramına Kuramsal Bakış
Year 2024,
Issue: 2, 40 - 54, 31.03.2024
Burak Arslan
Abstract
İç hastalıkları hemşireleri akut ve kronik belirsizlik duygusu yaşayan hasta bireylere bakım vermektedir. Belirsizlik duygusu yaşayan bireyin içinden geçtiği süreç ve belirsizliğe adaptasyon geliştirme biçimlerinin tanınması bu alanda çalışan hemşireler için oldukça önemlidir. Hasta bireylerin yaşadığı belirsizlik süreci hemşire kuramcılardan biri olan Merle Mishel tarafından geliştirilen “Uncertainty of Illness\Hastalığın Belirsizliği” teorisi ile aydınlatılmıştır. Teorinin 1988 yılında geliştirilen ilk halinde akut\kısa süreli belirsizlik duygusu yaşayan bireyin adaptasyon süreci ve bu yolda belirsizliğe yüklediği “fırsat” ve “tehdit” anlamları ele alınmıştır. Sonraki yıllarda (1990) yeniden kavramsallaştırılan teoride uzun süreli\kronik belirsizlik yaşayan bireyler için “kesinliğin olmadığı düşüncesi” ve “hayata yeniden bakış” kavramları açıklanmıştır. İç hastalıkları hemşirelerinin akut ve kronik belirsizlik duygusu yaşayan bireylere yardım edebilmesi için ilgili teorinin kavramlarını ve özünü kavraması gerektiği düşünülmüştür. Bu derleme, Mishel’in “Hastalığın Belirsizliği” teorisini açıklamak amacıyla kaleme alınmıştır.
Thanks
Hemşireliğin kuramsal temellerini öğrenmem ve bu alana ilgi duymam hususunda emeği geçen Sayın Prof. Dr. Özen KULAKAÇ’a teşekkürlerimi sunarım.
İç Hastalıkları Hemşireliği alanına olan ilgimin daha da artması, bakış açımın genişlemesi hususunda büyük emeği olan Sayın Doç. Dr. Afitap ÖZDELİKARA’ya teşekkürlerimi sunarım.
References
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- Antonovsky, A. (1987). The salutogenic perspective: Toward a new view of health and illness. Advances, 4(1), 47–55.
- Bower, G. H. (1979). Psychology of learning and motivation. Academic Press.
- Braden, C. J., & Lynn, M. (1987). Antecedents to and outcomes of uncertainty experienced in chronic illness. In Nursing Advances in Health: Models, Methods and Applications, ANA Council of Nurse Researchers 1987 International Nursing Research Conference, Washington, DC.
- Bradley, J. C., & Mikolajczak, M. (1986). The effect of a nursing exit interview on the client's perception of uncertainty in illness. Unpublished manuscript, University of Illinois, Peoria.
- Breznitz, S. (1983). Denial versus hope: Concluding remarks. The denial of stress, 297-302.
- Campbell, L. K. (1986). Hopelessness and uncertainty as predictors of psychosocial adjustment of newly diagnosed cancer patients and their significant others (Doctoral dissertation, University of Texas at Austin).
- Christman, N. J., McConnell, E. A., Pfeiffer, C., Webster, K. K., Schmitt, M., & Ries, J. (1988). Uncertainty, coping, and distress following myocardial infarction: Transition from hospital to home. Research in Nursing & Health, 11(2), 71-82. https://doi.org/10.1002/nur.4770110203
- Çınar, D., Yıldırım, Y., & Aykar, F. Ş. (2020). Kanser tanılı hastanın Merley Mishel’in hastalıkta belirsizlik kuramına göre hemşirelik bakımı. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi, 11(3), 553-559. https://doi.org/10.31067/0.2020.306
- Folkman, S., Schaefer, C., & Lazarus, R. (1979). Cognitive processes as mediators of stress and coping. I: V. Hamilton, & DW Warburton (Eds.), Human stress and cognition: An informational approach.
- Galloway, S. C. (1984). A comparison of the responses of patients with and without a diagnosis of cancer to a bowel resection in the immediate postoperative period. (Unpublished master's thesis, University of Toronto, Department of Nursing).
- Green, B. L., Lindy, J. D., & Grace, M. C. (1988). Long‐term coping with combat stress. Journal of Traumatic Stress, 1(4), 399-412. https://doi.org/10.1002/jts.2490010403
- Gök, F. (2022). Kronik hastalığa sahip bireylerde sürekli kaygının belirsizliğe tahammülsüzlük ve bilişsel duygu düzenleme stratejileri ile ilişkisi. (Master's thesis, İstanbul Sabahattin Zaim Üniversitesi).
- Gümüş, K., & Sezgin, S. (2016). Multiple skleroz hastalarında belirsizliğe tahammülsüzlüğün intihar düşüncesine etkisi. Journal of International Social Research, 9(47).
- Gürkan C.Ö. (2013). Hastalıklarda belirsizlik kuramı. Hemşirelikte Kavram, Kuram Ve Model Örnekleri. Editör: Ayşe Ferda Ocakçı, Şule Ecevit Parlar. İstanbul Tıp Kitapevi, 101-112. Hemşirelik Yönetmeliği (2011). Ek-2, Türkiye. Erişim: https://www.mevzuat.gov.tr/mevzuatmetin/yonetmelik/7.5.13830-ek-2%20ve%203.htm
- Holmes, D. S., & Houston, B. K. (1974). Effectiveness of situation redefinition and affective isolation in coping with stress. Journal of Personality and Social Psychology, 29, 212-218. https://doi.org/10.1037/h0035912
- Kazer, M. W., Bailey, D. E., Sanda, M., Colberg, J., & Kelly, W. K. (2011). An Internet intervention for management of uncertainty during active surveillance for prostate cancer. Oncology Nursing Forum, 38, 5.
- King, B. (1983). The psychological impact of systemic lupus erythematosus on the primary caregiver. (Unpublished master's thesis, University of Arizona).
- King, B. (1986). Uncertainty appraisal and management in chronic illness. In Paper presented at the Nineteenth Communicationg Nursing Research Conference, 1986. Western Society for Research in Nursing, Portland, Oregon.
- Lazarus, R. S. (1983). The costs and benefits of denial. In S. Breznitz (Ed.), The denial of stress. New York: International Universities Press.
- Leventhal, H., Nerenz, D. R., & Steele, D. J. (2020). Illness representations and coping with health threats. Handbook of psychology and health, 4, 219-252.
- Lien, C. Y., Chen, S. H., Tsai, P. P., Chen, K. M., Hsieh, Y. I., & Liang, Y. (2010). Effectiveness of nursing instruction in reducing uncertainty, anxiety and self-care in breast cancer women undergoing initial chemotherapy. Hu li za zhi The Journal of Nursing, 57(6), 51-60.
- Mandler, G. (1979). Thought processes, consciousness, and stress. Human stress and cognition: An information processing approach, 179-201.
- Mintun, M, K. (1984). Measurement of parental uncertainty in a pediatric intensive care unit. (Unpublished master's thesis, University of Kansas).
- Mishel, M. H. (1981). The measurement of uncertainty in illness. Nursing Rescarch, 30, 258-263.
- Mishel, M. H. (1983). Parents perception of uncertainty concerning their hospitalized child. Nursing Research, 32, 324-330.
- Mishel, M. H. (1984). Perceived uncertainty and stress in illness. Research in Nursing and Health, 7, 163-171.
- Mishel, M. H. (1988). Uncertainty in illness. Image: The Journal of Nursing Scholarship, 20(4), 225-232.
- Mishel, M. H. (1990). Reconceptualization of the uncertainty in illness theory. Journal of Nursing Scholarship, 22(4), 256-262.
- Mishel, M. H., & Braden, C. J. (1987). Uncertainty: A mediator between support and adjustment. Western Journal of Nursing Research, 9, 43-57.
- Mishel, M. H., & Braden, C. J. (1988). Finding meaning: Antecedents of uncertainty. Nursing Research, 37, 98-103.
- Mishel, M. H., Hostetter, T., King, B., & Graham, V. (1984). Predictors of psychosocial adjustment in patient newly diagnosed with gynecological cancer. Cancer Nursing, 7, 291-299.
- Molleman, E., Krobendam, P. J., Annyas, A.A.,Koops,H.S.,& Sleufer, D. T. (1984). The significance of the doctor-patient relationship in coping with cancer. Social Science and Medicine, 18, 475-480.
- Nerenz, D. R., Leventhal, H., Love, R. R., & Ringler, K. E. (1984). Psychological aspects of cancer chemotherapy. International Review of Applied Psychology.
- Oishi, A., & Murtagh, F. E. (2014). The challenges of uncertainty and interprofessional collaboration in palliative care for non-cancer patients in the community: a systematic review of views from patients, carers and health-care professionals. Palliative Medicine, 28(9), 1081-1098. https://doi.org/10.1177/0269216314531999
- Painter, P. (1981). Perceived uncertainty and its relationship to perceived recovery and activity in the post myocardial infarction patient. (Unpublished master's thesis, California State University at Los Angeles).
- Pearlin, L., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19, 2-21.
- Richardson, J. L., Marks, G. S., Johnson, GC. A., Graham, J. W., Chan, K. K,, Selser, J. N., Kishbaugh, C., Barronday, Y., & Levine, A. M. (1987). Path model of multidimensional compliance with cancer therapy. Health Psychology, 6(3), 183-207.
- Rosenbaum, M. (1983). Learned resourcefulness as a behavioral repertoire for the self-regulation of internal events: Issues and speculations. Perspectives on behavior therapy in the eighties, 9, 54-73.
- Rotter, J. B. (1966). Generalized expectancies for internal versus external control of reinforcement. Psychological monographs: General and applied, 80(1), 1.
- Rowat, K. M., & Knafi, K. A. (1985). Living with chronic pain: 'The spouse's perspective. Pain, 23, 259-271.
- Angela Sammarco, R. N., & Konecny, L. M. (2010). Quality of life, social support, and uncertainty among Latina and Caucasian breast cancer survivors: a comparative study. Oncology Nursing Forum 37(1), 93.
- Silberfarb, P. M. (1983). Chemotherapy and cognitive defects in cancer patients. Annual Review of Medicine, 34, 35-46.
- Taylor, S. E. (1983). Adjustment to threatening events: A theory of cognitive adaptation. American Psychologist, 38, 1161-1173.
- Warburton, D. M. (1979). Physiological aspects of information processing and stress. Human stress and cognition, 33-65.
- Webster, K. K., Christman, N. J., & Mishel, M. H. (1988). Perceived uncertainty and coping post myocardial infarction. Western Journal of Nursing Research, 10(4), 384-400.
- Wortman, C. B. (1984). Social support and the cancer patient. Conceptual and methodologic issues. Cancer, 53(10), 2339-2362.
- Wortman, C. B., & Dunkel-Schetter, C. (1979). Interpersonal relationships and cancer: A theoretical analysis. Journal of Social Issues, 35, 120-155.
- Yöndem, Z. D. (2002). Stresle baş etme stratejileri ölçeği (SBSÖ): Eleştirel bir değerlendirme. Türk Psikolojik Danışma ve Rehberlik Dergisi, 2(18), 43-47.
A Fact That Internal Medicine Nurses Frequently Encountere; Theoretical View of The Concept of ‘Uncertainty’
Year 2024,
Issue: 2, 40 - 54, 31.03.2024
Burak Arslan
Abstract
Internal medicine nurses provide care to sick individuals who experience acute and chronic feelings of uncertainty. Recognizing feeling of uncertainty and adaptation mechanizm is very important for nurses working in this field. The uncertainty process experienced by sick individuals is illuminated by the theory of "Uncertainty of Illness" developed by Merle Mishel, one of the nurse theorists. In the first version of the theory, developed in 1988, the adaptation process of the individual who experienced a feeling of acute/short-term uncertainty and the meanings of "opportunity" and "threat" he attributed to uncertainty were discussed. In the theory, which was reconceptualized in the following years (1990), the concepts of "probabilistic thinking" and "new view of life" were explained for individuals experiencing long-term/chronic uncertainty. It was thought that internal medicine nurses should grasp the concepts and essence of the relevant theory in order to help individuals experiencing acute and chronic feelings of uncertainty. This review was written to explain Mishel's "Uncertainty of Illness" theory.
Thanks
I would like to thank Prof. Dr. Özen KULAKAÇ, who helped me learn the theoretical foundations of nursing and develop my interest in this field.
I would like to thank Associate Professor Afitap ÖZDELİKARA, who made a great contribution to increasing my interest in the field of Internal Medicine Nursing and expanding my perspective.
References
- Alligood, M. (2014) Nursing Theorists and Their Work. 8th Edition, Mosby, St. Louis.
- Antonovsky, A. (1987). The salutogenic perspective: Toward a new view of health and illness. Advances, 4(1), 47–55.
- Bower, G. H. (1979). Psychology of learning and motivation. Academic Press.
- Braden, C. J., & Lynn, M. (1987). Antecedents to and outcomes of uncertainty experienced in chronic illness. In Nursing Advances in Health: Models, Methods and Applications, ANA Council of Nurse Researchers 1987 International Nursing Research Conference, Washington, DC.
- Bradley, J. C., & Mikolajczak, M. (1986). The effect of a nursing exit interview on the client's perception of uncertainty in illness. Unpublished manuscript, University of Illinois, Peoria.
- Breznitz, S. (1983). Denial versus hope: Concluding remarks. The denial of stress, 297-302.
- Campbell, L. K. (1986). Hopelessness and uncertainty as predictors of psychosocial adjustment of newly diagnosed cancer patients and their significant others (Doctoral dissertation, University of Texas at Austin).
- Christman, N. J., McConnell, E. A., Pfeiffer, C., Webster, K. K., Schmitt, M., & Ries, J. (1988). Uncertainty, coping, and distress following myocardial infarction: Transition from hospital to home. Research in Nursing & Health, 11(2), 71-82. https://doi.org/10.1002/nur.4770110203
- Çınar, D., Yıldırım, Y., & Aykar, F. Ş. (2020). Kanser tanılı hastanın Merley Mishel’in hastalıkta belirsizlik kuramına göre hemşirelik bakımı. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi, 11(3), 553-559. https://doi.org/10.31067/0.2020.306
- Folkman, S., Schaefer, C., & Lazarus, R. (1979). Cognitive processes as mediators of stress and coping. I: V. Hamilton, & DW Warburton (Eds.), Human stress and cognition: An informational approach.
- Galloway, S. C. (1984). A comparison of the responses of patients with and without a diagnosis of cancer to a bowel resection in the immediate postoperative period. (Unpublished master's thesis, University of Toronto, Department of Nursing).
- Green, B. L., Lindy, J. D., & Grace, M. C. (1988). Long‐term coping with combat stress. Journal of Traumatic Stress, 1(4), 399-412. https://doi.org/10.1002/jts.2490010403
- Gök, F. (2022). Kronik hastalığa sahip bireylerde sürekli kaygının belirsizliğe tahammülsüzlük ve bilişsel duygu düzenleme stratejileri ile ilişkisi. (Master's thesis, İstanbul Sabahattin Zaim Üniversitesi).
- Gümüş, K., & Sezgin, S. (2016). Multiple skleroz hastalarında belirsizliğe tahammülsüzlüğün intihar düşüncesine etkisi. Journal of International Social Research, 9(47).
- Gürkan C.Ö. (2013). Hastalıklarda belirsizlik kuramı. Hemşirelikte Kavram, Kuram Ve Model Örnekleri. Editör: Ayşe Ferda Ocakçı, Şule Ecevit Parlar. İstanbul Tıp Kitapevi, 101-112. Hemşirelik Yönetmeliği (2011). Ek-2, Türkiye. Erişim: https://www.mevzuat.gov.tr/mevzuatmetin/yonetmelik/7.5.13830-ek-2%20ve%203.htm
- Holmes, D. S., & Houston, B. K. (1974). Effectiveness of situation redefinition and affective isolation in coping with stress. Journal of Personality and Social Psychology, 29, 212-218. https://doi.org/10.1037/h0035912
- Kazer, M. W., Bailey, D. E., Sanda, M., Colberg, J., & Kelly, W. K. (2011). An Internet intervention for management of uncertainty during active surveillance for prostate cancer. Oncology Nursing Forum, 38, 5.
- King, B. (1983). The psychological impact of systemic lupus erythematosus on the primary caregiver. (Unpublished master's thesis, University of Arizona).
- King, B. (1986). Uncertainty appraisal and management in chronic illness. In Paper presented at the Nineteenth Communicationg Nursing Research Conference, 1986. Western Society for Research in Nursing, Portland, Oregon.
- Lazarus, R. S. (1983). The costs and benefits of denial. In S. Breznitz (Ed.), The denial of stress. New York: International Universities Press.
- Leventhal, H., Nerenz, D. R., & Steele, D. J. (2020). Illness representations and coping with health threats. Handbook of psychology and health, 4, 219-252.
- Lien, C. Y., Chen, S. H., Tsai, P. P., Chen, K. M., Hsieh, Y. I., & Liang, Y. (2010). Effectiveness of nursing instruction in reducing uncertainty, anxiety and self-care in breast cancer women undergoing initial chemotherapy. Hu li za zhi The Journal of Nursing, 57(6), 51-60.
- Mandler, G. (1979). Thought processes, consciousness, and stress. Human stress and cognition: An information processing approach, 179-201.
- Mintun, M, K. (1984). Measurement of parental uncertainty in a pediatric intensive care unit. (Unpublished master's thesis, University of Kansas).
- Mishel, M. H. (1981). The measurement of uncertainty in illness. Nursing Rescarch, 30, 258-263.
- Mishel, M. H. (1983). Parents perception of uncertainty concerning their hospitalized child. Nursing Research, 32, 324-330.
- Mishel, M. H. (1984). Perceived uncertainty and stress in illness. Research in Nursing and Health, 7, 163-171.
- Mishel, M. H. (1988). Uncertainty in illness. Image: The Journal of Nursing Scholarship, 20(4), 225-232.
- Mishel, M. H. (1990). Reconceptualization of the uncertainty in illness theory. Journal of Nursing Scholarship, 22(4), 256-262.
- Mishel, M. H., & Braden, C. J. (1987). Uncertainty: A mediator between support and adjustment. Western Journal of Nursing Research, 9, 43-57.
- Mishel, M. H., & Braden, C. J. (1988). Finding meaning: Antecedents of uncertainty. Nursing Research, 37, 98-103.
- Mishel, M. H., Hostetter, T., King, B., & Graham, V. (1984). Predictors of psychosocial adjustment in patient newly diagnosed with gynecological cancer. Cancer Nursing, 7, 291-299.
- Molleman, E., Krobendam, P. J., Annyas, A.A.,Koops,H.S.,& Sleufer, D. T. (1984). The significance of the doctor-patient relationship in coping with cancer. Social Science and Medicine, 18, 475-480.
- Nerenz, D. R., Leventhal, H., Love, R. R., & Ringler, K. E. (1984). Psychological aspects of cancer chemotherapy. International Review of Applied Psychology.
- Oishi, A., & Murtagh, F. E. (2014). The challenges of uncertainty and interprofessional collaboration in palliative care for non-cancer patients in the community: a systematic review of views from patients, carers and health-care professionals. Palliative Medicine, 28(9), 1081-1098. https://doi.org/10.1177/0269216314531999
- Painter, P. (1981). Perceived uncertainty and its relationship to perceived recovery and activity in the post myocardial infarction patient. (Unpublished master's thesis, California State University at Los Angeles).
- Pearlin, L., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19, 2-21.
- Richardson, J. L., Marks, G. S., Johnson, GC. A., Graham, J. W., Chan, K. K,, Selser, J. N., Kishbaugh, C., Barronday, Y., & Levine, A. M. (1987). Path model of multidimensional compliance with cancer therapy. Health Psychology, 6(3), 183-207.
- Rosenbaum, M. (1983). Learned resourcefulness as a behavioral repertoire for the self-regulation of internal events: Issues and speculations. Perspectives on behavior therapy in the eighties, 9, 54-73.
- Rotter, J. B. (1966). Generalized expectancies for internal versus external control of reinforcement. Psychological monographs: General and applied, 80(1), 1.
- Rowat, K. M., & Knafi, K. A. (1985). Living with chronic pain: 'The spouse's perspective. Pain, 23, 259-271.
- Angela Sammarco, R. N., & Konecny, L. M. (2010). Quality of life, social support, and uncertainty among Latina and Caucasian breast cancer survivors: a comparative study. Oncology Nursing Forum 37(1), 93.
- Silberfarb, P. M. (1983). Chemotherapy and cognitive defects in cancer patients. Annual Review of Medicine, 34, 35-46.
- Taylor, S. E. (1983). Adjustment to threatening events: A theory of cognitive adaptation. American Psychologist, 38, 1161-1173.
- Warburton, D. M. (1979). Physiological aspects of information processing and stress. Human stress and cognition, 33-65.
- Webster, K. K., Christman, N. J., & Mishel, M. H. (1988). Perceived uncertainty and coping post myocardial infarction. Western Journal of Nursing Research, 10(4), 384-400.
- Wortman, C. B. (1984). Social support and the cancer patient. Conceptual and methodologic issues. Cancer, 53(10), 2339-2362.
- Wortman, C. B., & Dunkel-Schetter, C. (1979). Interpersonal relationships and cancer: A theoretical analysis. Journal of Social Issues, 35, 120-155.
- Yöndem, Z. D. (2002). Stresle baş etme stratejileri ölçeği (SBSÖ): Eleştirel bir değerlendirme. Türk Psikolojik Danışma ve Rehberlik Dergisi, 2(18), 43-47.