High level of conceptual integration is a critical aspect of high quality studies. Polit and Beck (2017) posited that for such studies, the choice of methodology and strategies are linked to expected outcome through a conceptual rationale, all of which should be consistent with existing research. This is of particular interest in the nursing field which is in constant evolution because of the fast-paced developments in the healthcare industry. The implication for nursing is informed by thee increasing need for evidence-based practice to ensure positive patient outcomes, and such evidence can only be generated through high quality studies. As a result, Polit and Beck (2017) offer useful insights into what constitutes a high-quality study through examination of theories, models, and frameworks applicable to the nursing field.
It is imperative to understand that theories and models in nursing are founded on ‘theses’ which link nursing practices with patient outcomes. On the same note, researchers in the field base their studies on these links, which can be influenced through manipulation of specific factors. For instance, the transformational experiences of nurse healers in home-based care settings can be explored using Jean Watson’s ‘Theory of Caring’ which posits that “caring is the moral idea and entails engagement of mind, body, and soul with one another” (Polit & Beck, 2017). Findings of such a study can form a theoretical basis for evidence based practice for future nurses under similar settings.
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A similar approach is applicable to all other theories and models that examine different aspects of nursing practice including theory of human becoming that explores creation of health and meaning as an outcome of the indivisible nature of humans and their environment, theory of science of unitary human beings exploring individuals as unified whole in constant interaction with environment, adaptation model, uncertainty in illness theory, social cognitive theory, and theory of planned behavior among others. The theories and models can be developed and organized into conceptual or schematic frameworks for ease of flow. Researchers employ theoretical and conceptual frameworks to examine the influence of nursing theories and models on the outcome of patient care practices. Therefore, the choice and design of such frameworks is critical for generation of high quality studies to inform evidence based practice.
The occurrence and number of illness related events can be overwhelming to patients in acute phases of the illness, in the downward illness trajectory, or in chronic and recurrent illness. For this reason, Merle Mishel’s Uncertainty in Illness Theory is of specific interest not only because it allows identification of antecedents to uncertainty, the process of uncertainty appraisal, or mechanisms of coping with uncertainty, but also brings to sharp focus the effects of such uncertainty on outcomes of therapeutic and management processes. Mishel (1988) defines uncertainty as the inability of a person to determine the meaning of illness-related events, usually from the difficulty in recognizing and categorizing stimuli. According to Polit and Beck (2017), Mishel’s conceptualizations of uncertainty have largely been applied by researchers in the nursing field.
One of the studies that employ Uncertainty in Illness Theory, conducted by Dudas, Olsson, Wolf et al. (2013), comparatively examined whether “ uncertainty in illness among patients with chronic heart failure is less in person-centered care than in usual care. ” It is evident that the study required determination of levels of uncertainty to illness from the two study settings (person-centered care and usual care). One can argue that conceptualization of the study was largely informed by Mishel’s (1981) conceptual framework, which presented a model for measurement of perceived uncertainty in illness.
Application of uncertainty in illness theory by Dudas, Olsson, Wolf et al. (2013) influenced the structure of their study in a number of ways. In the introductory chapter, it is evident that choice of the theory was informed by existing empirical evidence showing chronic heart failure to be of relevance due to its incidence among the elderly and the commonest cause of hospitalization and readmissions. Consistency is thus established with Mishel’s categorization of illness related events under chronic and recurring illness. For instance, patients with endocarditis have been reported to be incapable of interpreting signals from their bodies or recognizing there is something wrong (Dudas, Olsson, Wolf et al. , 2013). The introduction chapter concentrates on theoretical justification of the choice of uncertainty in illness model. Overall, this chapter highlights that the conceptual framework of the paper has key elements that must be present for development of scientific knowledge namely: simple explanation of observed relations relevant to the phenomena; consistency with observed relations and existing body of knowledge; tentative explanation and means for verification and replication; and stimulates further research (MacMillan & Schumacher, 2001).
Also, one recognizes that the use of participants from two study settings required adoption of participant profiling model for both person-centered and usual care settings. The subsequent chapters of the article emphasize on this aspect of the model. The need for comparative data is evident through description of participants and the study settings, interventions employed, and measures and method used to generate statistical data for the two groups of study participants. Through statistical analysis, Dudas, Olsson, Wolf et al. (2013) are able to distinguish levels of uncertainty in illness for the two groups with participants in patient-centered care admitted for worsening chronic heart failure demonstrating positive outcomes through reduction of self-reported uncertainty compared to those in usual care. The theoretical framework adopted by Dudas, Olsson, Wolf et al. (2013) has elements of descriptive comparative research highlighted in Cantrell (2011) namely: no manipulation of an independent variable; no random assignment to groups; and often inclusion of a control or comparison group.
Review of reading materials offered highlights that strategies for development of conceptual or theoretical frameworks are dependent on review of the knowledge on the specific topic of interest to the researcher. Understanding of the topic aids in formulation of the research problem. For instance, Dudas, Olsson, Wolf et al. (2013) review of chronic heart failure identified gaps in literature on difference in patient outcomes under patient-centered care and usual care, which justified the use of Mishel’s uncertainty in illness theory to statistically examine the extent of such differences.
The article by Dudas, Olsson, Wolf et al. (2013) is conceptualized based on existing literature showing high incidence of uncertainty about treatment and characteristics of the illness among patients with chronic heart failure. Consequently, the researchers identified the gap in literature, hence the aim to examine patient involvement in care. This required descriptive comparison of patient-centered care and usual care settings. Therefore, the researchers employed a controlled before and after design with eligible patients assigned to different settings to facilitate measurement of uncertainty to illness upon discharge. Findings of the study showed participants in patient-centered care to have higher scores than their colleagues in usual care.
It is evident that in addition to comparison of scores for the two groups, Dudas, Olsson, Wolf et al. (2013) actually tested the uncertainty in illness theory, which corroborated the conceptual framework of the study. As noted in Polit and Beck (2017), the uncertainty in illness theory is widely applied by researchers, implying that its significance to evidence based practice cannot be understated. This highlights the importance of using an established model to conduct studies as it does not only corroborate the theory, but provides new insights that can be adopted into actual practice in nursing for better patient outcomes. For instance, Dudas, Olsson, Wolf et al. (2013) findings that patient-centered care yields positive outcomes in reference to uncertainty to illness can influence the decision to admit patients with chronic heart failure to such care rather than usual care, thereby improving treatment and management outcomes.
References
Cantrell, M. A. (2011). Demystifying the research process: Understanding a descriptive comparative research design. Pediatric Nursing, 37(4), 188–189.
Dudas, K., Olsson, L. E., Wolf, A., Swedberg, K., Taft, C., Schaufelberger, M., & Ekman, I. (2013). Uncertainty in illness among patients with chronic heart failure is less in person-centred care than in usual care. European Journal of Cardiovascular Nursing , 12 (6), 521-528.
MacMillan, J. H., & Schumacher, S. (2001). Descriptive statistics. Research in Education: A Conceptual Introduction , 204-236.
Mishel, M. H. (1981). The measurement of uncertainty in illness. Nursing research , 30 (5), 258-263.
Mishel, M. H. (1988). Uncertainty in illness. Journal of Nursing Scholarship , 20 (4), 225-232.
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
