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Biomedical subjects

M H Mishel

Publications and source records attributed to M H Mishel.

14 recordsLinked to original sources
PubMed1992

Uncertainty, appraisal and quality of life.

This study evaluates the influence of different factors in the adaptation process activated by uncertainty in illness on health-related quality of life. The sample included 100 women (mean age = 52.1 years) receiving treatment for newly diagnosed (M = 5.1 months) gynaecological cancer (38 cervical, 26 ovarian, 24 endometrial, 7 uterine, 4 vulvar, and 1 vaginal). Stepwise regression analyses identified mood states, ambiguity about illness-wellness state, danger-focused appraisal and mastery as key predictors of four health-related quality of life scores. The variance accounted for by those variables is reflected in cumulative multiple R2 of 0.56 for total quality of life score, 0.57 for psychosocial well-being, 0.235 for physical well-being and 0.25 for disease/symptom distress. These variances do not reflect the contribution of age, time since diagnosis, metastasis and stage of cancer which were forced to enter the regression equation first. The latter set of variables accounted for a smaller portion of the variance in health-related quality of life (R2 = 0.03-0.195). Coping strategy did not predict health-related quality of life. These findings provide beginning support for conceptualizing health-related quality of life as the outcome of an adaptation process explained by the uncertainty in illness theory. However, uncertainty in illness theory may not be sufficient to predict quality of life outcomes. Future research should consider the addition of discrepancy theory to guide the selection or development of a health-related quality of life measure, to account for the perceived discrepancy between actual experience and expected well-being.

Adaptation, Psychological↗
PubMed1991

Depression assessment and management: evaluating a community-based mental health training program for nurses.

This mental health training program was designed to increase primary care nurses' knowledge and skills about depression. The program emphasized criteria for assessing depression, presented psychopharmacologic and psychotherapeutic content, discussed care coordination among several agencies and providers, and addressed referral resources. Cultural and developmental issues were highlighted. The 237 participants had significant knowledge gains after the program on comparison of pretest and posttest measures. Client record audit found significant increases in the assessment of and intervention with depression. The training program successfully increased primary care nurses' abilities to use knowledge about depression in clinical practice.

Adult↗
PubMed1990

Assessment and management of depression: an imperative for community-based practice.

The purpose of this mental health training program was to increase primary care nurses' knowledge and skills about depression. The program emphasized criteria for assessing depression, presented psychopharmacological and psychotherapeutic content, discussed care coordination among multiple agencies and providers, and addressed referral resources. Highlighted were cultural and developmental issues for Native Americans, Mexican-Americans, the elderly, and adolescents. The training program successfully increased primary care nurses' knowledge about depression and their abilities to use this knowledge in clinical practice.

Adult↗
PubMed1990

Reconceptualization of the uncertainty in illness theory.

The theory of uncertainty in illness has its strongest support among subjects who are experiencing the acute phase of illness or are in a downward illness trajectory (mishel, 1988a). The theory has not addressed the experience of living with continual, constant uncertainty in either a chronic illness or in an illness with a treatable acute phase and possible eventual recurrence. Since uncertainty characterizes many, most prevalent, long-term illness conditions, there is a need to reconceptualize the theory of uncertainty to include the experience of living with continual uncertainty. A close examination of the theoretical statements and the empirical data reported by Mishel resulted in the identification of areas of the theory that could be expanded and reconceptualized. The reconceptualization effort was primarily fueled by questions about the outcome portion of the uncertainty theory. To provide a contest for the expansion and reconceptualization of uncertainty, applicable parts of the theory are summarized below.

Adaptation, Psychological↗
PubMedDate not supplied

Uncertainty in illness theory: a replication of the mediating effects of mastery and coping.

The purpose of this investigation was to replicate a test of the mediating functions of mastery and coping and to determine whether the relationships found in the initial test of the model would hold with a sample more heterogenous than the original sample. One hundred women receiving treatment for gynecological cancer participated in the investigation. Of the 14 relationships in the model, only 5 replicated significant paths and had overlapping confidence intervals. Two moderators were proposed to explain the differences between the initial and replication tests of the model and to improve the specificity of the theory.

Adaptation, Psychological↗
PubMedDate not supplied

Uncertainty in gynecological cancer: a test of the mediating functions of mastery and coping.

The purpose of this study was to test a portion of the uncertainty in illness model to determine whether mastery would be strengthened or weakened under conditions of uncertainty, and to test the ability of mastery and coping to function as mediators in the model. Mastery was proposed to mediate the relationship between uncertainty and the appraisal of danger and opportunity. Coping was proposed to mediate the relationships between danger or opportunity and emotional distress. Data were collected on a sample of 131 women receiving treatment for gynecological cancer. Findings support mastery as weakened under conditions of uncertainty and functioning as a situationally specific personality factor. Mastery was a significant mediator of the relationship between uncertainty and the appraisal of danger and opportunity; although the mediation effect for the relationship between uncertainty and danger was stronger. While two coping strategies were found to function as significant mediators between danger or opportunity and emotional distress, the mediation effect was very small.

Adaptation, Psychological↗
PubMedDate not supplied

Family adjustment to heart transplantation: redesigning the dream.

The processes family members of heart transplant recipients use to manage the unpredictability evoked by the need for and receipt of heart transplantation were explored. Twenty family members were theoretically sampled using the grounded theory approach. Three separate family support groups, each of 12 weeks duration, provided data for constant comparative analysis. Redesigning the dream was identified as the integrative theme in the substantive theory that described how family members gradually modify their beliefs about organ transplantation and develop attitudes and beliefs to meet the challenge of living with continual unpredictability. The theory consists of three concepts--immersion, passage, and negotiation--which parallel the stages of waiting for a donor, hospitalization, and recovery.

Adaptation, Psychological↗
PubMedDate not supplied

Finding meaning: antecedents of uncertainty in illness.

In this study a portion of the uncertainty in illness model was tested. Antecedents to uncertainty tested were the stimuli frame variables of symptom pattern and event familiarity and the structure provider variables of education, social support, and credible authority. Data were collected on a convenience sample of 61 women with gynecological cancer at the time of major treatment effect. Findings supported the proposed model with an empirically generated revised model presenting the influence of antecedents on specific areas of uncertainty. Divergent paths for reducing uncertainty were found. Social support, credible authority, and event familiarity had the greatest influence on lowering the level of uncertainty. Event familiarity and credible authority were primarily effective in reducing the complexity surrounding treatment and the system of care. Social support functioned to decrease the level of ambiguity concerning the state of the illness. Findings generally support the proposed explantation for uncertainty arousal and have substantive significance in identifying the sources of stimuli leading to uncertainty arousal and modification.

Adult↗