Overview Of Merle Mischel's Theory

Merle Mischel is a Boston native with an impressive CV including a B.A from Boston University (1961), a M.S. from University of California (1966) in psychiatric nursing, and a M.A. and Ph.D. from Claremont Graduate School (1976, 1980) in social psychology (Alligood, 2014, 555). Her diverse professional career spans from psychiatric nursing to teaching at a wide array of academic institutions, most recently as the Kenan Professor of Nursing at University of North Carolina Chapel Hill School of Nursing. Mischel was the director of a research program that was funded for over two decades by the National Institute of Health that worked towards developing evidenced-based interventions for underserved chronically ill patients. Mischel led the Hillman

Her theory constructs a framework that allows a patient suffering from a serious illness to appropriate “uncertainty” and shift their mode of living, trading a lifestyle of relative certainty and reliability for a more variable existence that incorporates uncertainty, and all of its associated unknowns, as part of its foundation. Mischel’s theory grew from qualitative and quantitative research as she worked on her dissertation and observed how acute illness creates a disequilibrium in a patient’s life. She defines the resulting uncertainty as “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 (Mischel, 1988 p ). This state isn’t necessarily desirable or undesirable until a patient, through inference and illusion, assigns a positive or negative association to it (560). If a negative regard for uncertainty is maintained and coping strategies to deal with uncertainty aren’t developed, it can lead to “intrusive thoughts, avoidance and severe emotional distress (561).” Mischel’s theory was first put forth with the Uncertainty in Illness

Its inception was a very specific real-life experience with her father’s battle with cancer. As she watched him struggle with the overwhelming diagnosis, she saw that he hyper-focused on seemingly inconsequential events that allowed him to appropriate the situation as ultimately his focus on small details allowed him to process the larger picture, accepting uncertainty and moving forward with it (561). I experienced my Mother going through a very similar process with a diagnosis of stage IV cancer. When a HCP took the time to help provide detailed and accessible information, as tedious and time-consuming as it might have seemed to them, this helped her conceptualize her smaller-scale uncertainties and contextualize them in the new larger landscape she was having to quickly come to terms with. There is a direct correlation between an increase in patient education and a decrease in uncertainty in a negative capacity. Mischel’s Uncertainty in Illness Scales are still used worldwide as assessment tools that lead to nursing intervention that help patients and their families address and manage their perceptions of uncertainty (Bailey,