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1. NURSING THEORIES

2. Carmencita M. Abaquin

3. “To Nursing… may be able to provide the care that our clients need in maintaining their quality of life and being instrumental in “birthing” them to external life.”

4. Carmencita M. Abaquin is a nurse with Master’s Degree in Nursing obtained from the University of the Philippines College of Nursing. An expert in Medical Surgical Nursing with subspecialty in Oncologic Nursing, which made her known both here and abroad. She had served the University of the Philippines College of Nursing, as faculty and held the position as Secretary of the College of Nursing.

5. About her Theory : “PREPARE ME” Interventions and the Quality of Life Advance Progressive Cancer Patients.

6. Basic Assumptions and Concepts: PREPARE ME ( Holistic Nursing Interventions ) are the nursing interventions provided to address the multi-dimensional problems of cancer patients that can be given in any setting where patients choose to be confined.

7. This program emphasizes a holistic approach to nursing care. PREPARE ME has the following components: Presence – being with another person during the times of need. This includes therapeutic communication, active listening, and touch.

8. Reminisce Therapy – recall of past experiences, feelings and thoughts to facilitate adaptation to present circumstances. Relaxation-Breathing – techniques to encourage and elicit relaxation for the purpose of decreasing undesirable signs and symptoms such as pain, muscle tension, and anxiety.

9. Meditation encourages an elicit form of relaxation for the purpose of altering patient’s level of awareness by focusing on an image or thought to facilitate inner sight which helps establish connection and relationship with God. It may be done through the use of music and other relaxation techniques.

10. Values Clarification assisting another individual to clarify his own values about health and illness in order to facilitate effective decision making skills. Through this, the patient develops an open mind that will facilitate acceptance of disease state or may help deepen or enhance values. The process of values clarification helps one become internally consistent by achieving closer between what we do and what we feel.

11. Quality of Life is a multifaceted construct that encompasses the individual's capacity and abilities with an aim of enriching life when it cannot longer be prolonged. This includes proper care of the body, mind, and spirit to maintain integrity of the whole person despite limitations brought by the present situation. This can be seen with the following dimensions brought by the present situation. This can be seen with the following dimensions of man - physical, psychological, social, religious, level of independence, environment, and spiritual.

12. PREPARE ME theory provides a framework on non-pharmacologic, non-surgical approach of care to advanced cases of cancer patients. The focus is not cure but on assisting the patient to explore her humanity and internal serenity as one is faced with the challenge of life and death . Nurses must be seen not as a mere caregiver but facilitators of peaceful acceptance of condition.

13. Merle Helaine Mishel

14. “ My theory can be applied to both practice and research. It has been used to explain clinical situations and design interventions that lead to evidence-based practice. Current and future nurse scientists have and will continue to extend the theory to different patient populations. This work has the potential to transform health care.”

15. Was born in Boston, Massachusetts. She graduated from Boston University with a B.A. in 1961 and received her M.S. in psychiatric nursing from the University of California in 1966. Completed her M.A. and Ph.D. in social psychology at the Claremont Graduate School in Claremont, California, in 1976 and 1980, respectively.

16. Mishel developed her "Uncertainty in Illness Scale" in 1980. Focus of her career has been the development of the middle range theory of uncertainty of illness, which has been translated into more than 17 languages and used around the world

17. Uncertainty in Illness Theory The middle‐range nursing theory of uncertainty in illness is presented from both a theoretical and empirical perspective. The theory explains how persons’ construct meaning for illness events, with uncertainty indicating the absence of meaning . A model of the uncertainty theory displaying the concepts and their relationships forms the basis for the theoretical and empirical material.

18. Discussion of the theory is organized around three major themes: the antecedents of uncertainty the process of uncertainty appraisal coping with uncertainty.

19. It has been defined as the inability to determine the meaning of illness-related events; this occurs in situations where the decision maker is unable to assign definite value to objects and events or is unable to accurately predict outcimes due to lack of sufficient cues. The uncertainty theory by Mishel explains how uncertainty develops in patients with an acute illness and how it is proposed that patients deal with uncertainty. Mishel further defined the original theory to refer to chronic illness in 1990.

20. Uncertainty regarding an illness has been identified as the greatest single psychological stressor for the patient with life-threatening illness. Uncertainty is nt the totl experience in acute and chronic illness, yet it is constant occurrence from diagnosis through living with a long term illess or condition.

21. The uncertainty in an illness theory proposes that uncertainty exists in illness situations that are ambiguous, complex, unpredictable, and when information is unavailable or inconsistent.

22. The original scale has been used as the basis for the following three additional scales: 1. A community version for chronically ill individuals who are not hospitalized or receiving active medical care 2. A measure of parents’ perceptions of uncertainty with regard to their child’s illness experience 3. A measure of uncertainty in spouses or other family members when another member of the family is acutely ill.

23. Theoretical sources When Mishel began her research into uncertainty, the concept had not been applied in the health and illness context. Her original Uncertainty in Illness Theory drew from existing information-processing models and personality research from psychology that characterized uncertainty as a cognitive state resulting from insufficient cues with which to form a cognitive schema or internal representation of a situation or event.

24. Major Concepts and Definitions Uncertainty 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.

25. Cognitive schema Cognitive schema is a person’s subjective interpretation of illness, treatment, and hospitalization. Stimuli frame Stimuli frame is the form, composition, and structure of the stimuli that a person perceives, which are then structured into a cognitive schema.

26. Symptom pattern Symptom pattern is the degree to which symptoms occur with sufficient consistency to be perceived as having a pattern or configuration. Event familiarity Event familiarity is the degree to which a situation is habitual or repetitive, or contains recognized cues.

27. Event congruence Event congruence refers to the consistency between the expected and the experienced in illness-related events. Structure providers Structure providers are the resources available to assist the person in the interpretation of the stimuli frame.

28. Credible authority Credible authority is the degree of trust and confidence a person has in his or her health care providers. Social supports Social supports influence uncertainty by assisting the individual to interpret the meaning of events.

29. Cognitive capacities Cognitive capacities are the information-processing abilities of a person, reflecting both innate capabilities and situational constraints . Inference Inference refers to the evaluation of uncertainty using related, recalled experiences.

30. Illusion Illusion refers to beliefs constructed out of uncertainty. Adaptation Adaptation reflects biopsychosocial behavior occurring within persons’ individually defined range of usual behavior .

31. New view of life New view of life refers to the formulation of a new sense of order, resulting from the integration of continual uncertainty into one’s self-structure, in which uncertainty is accepted as the natural rhythm of life.

32. Probabilistic thinking Probabilistic thinking refers to a belief in a conditional world in which the expectation of continual certainty and predictability is abandoned.

33. Use of empirical evidence The Uncertainty in Illness Theory grew out of Mishel’s dissertation research with hospitalized patients, using both qualitative and quantitative findings to generate the first conceptualization of uncertainty in the context of illness. With the publication of Mishel’s Uncertainty in Illness Scale, extensive research began into adults’ experiences with uncertainty related to chronic and life-threatening illnesses.

34. Major assumptions

35. 1. Uncertainty is a cognitive state, representing the inadequacy of an existing cognitive schema to support the interpretation of illness-related events. 2. Uncertainty is an inherently neutral experience, neither desirable nor aversive until it is appraised as such.

36. Two more assumptions reflect the uncertainty theory’s roots in traditional stress and coping models that posit a linear stress → coping → adaptation relationship as follows: 3. Adaptation represents the continuity of an individual’s usual biopsychosocial behavior and is the desired outcome of coping efforts to either reduce uncertainty appraised as danger or maintain uncertainty appraised as opportunity.

37. 4. The relationships among illness events, uncertainty, appraisal, coping, and adaptation are linear and unidirectional, moving from situations promoting uncertainty toward adaptation.

38. Reconceptualized Model of Uncertainty in Chronic

39. Acceptance by the nursing community

40. Education The theory has been widely used by graduate students as the theoretical framework for theses and dissertations, as the topic of concept analysis, and for the critique of middle-range nursing theory.

41. Research As described above, a large body of knowledge has been generated by researchers using the Uncertainty in Illness Theory and scales. Mishel’s program of research encompassed testing the psychoeducational nursing interventions derived from the theoretical model in samples of adults with breast and prostate cancers.

42. Further development Mishel and colleagues have used the original theory as the framework for seven federally funded nursing intervention studies . The intervention has increased cancer knowledge, reduced symptom burden, and improved quality of life in Mexican-American, Caucasian, and African-American women with breast cancer, in African-American and Caucasian men newly diagnosed with prostate cancer, and in those with localized, advanced, or recurrent prostate cancer and their family members.