Purpose The purpose of this study was to examine the mediating effects of uncertainty appraisal and self-care behavior on uncertainty and the physiological indexes of hemodialysis patients.
Methods This study used a descriptive correlation design. The participants were 140 patients receiving hemodialysis treatment. Data were collected from July 16 to August 20, 2020. Measurements included Mishel’s uncertainty in illness scale, the uncertainty appraisal scale, and the self-care behavior scale. Data were analyzed using descriptive statistics. The mediating effects were verified by the bootstrapping method using the PROCESS macro for SPSS.
Results The mean scores for uncertainty, uncertainty danger appraisal, uncertainty opportunity appraisal, and self-care behavior, respectively, 2.67±0.42 (range 1~5), 1.34±1.02, 2.17±1.12 (range 0~5), 3.58±0.45 (range 1~5). Uncertainty did not have a direct effect on physiological indexes. However, uncertainty opportunity appraisal and self-care behavior had serial mediating effects on the relationship between uncertainty and physiological indexes of serum phosphate and interdialytic weight gain.
Conclusion To the control physiological indexes of hemodialysis patients, it is necessary to develop a nursing intervention program that can lower the this uncertainty and increase self-care behavior by considering uncertainty to be an opportunity.
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Purpose This study was conducted so as to determine a hypothetical model concerning factors affecting breast cancer patients' resilience.
Methods: Data were collected via a self-administered questionnaire from 212 patients with breast cancer between July 25 and August 24, 2020. The data were analyzed using SPSS/WIN 20.0 and AMOS 21.0.
Results: The model supported 7 of the 11 presented hypotheses for all participants. Test results indicated that “hope”, “uncertainty”, and “symptom experience” all directly affected participants' resilience, and that “uncertainty” also affected participants', “depression” and “hope”. “Spiritual well-being” affected participants' sense of “hope” and “symptom experience”. Of these variables, “hope” had the strongest direct influence on resilience across all participants. “Uncertainty” was found to directly and indirectly affect participants, whereas “spiritual well-being” indirectly affected the resilience of all participants. “Uncertainty” and “spiritual well-being” indirectly affected the resilience of all participants.
Conclusion: These results suggest that management strategies to enhance breast cancer patients' resilience should address patients' uncertainty, spiritual well-being, hope, and symptom experience.
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Purpose This study investigates the mediating effects of self-care competence on the relationship between uncertainty and quality of life in stroke patients.
Methods: This study adopts a descriptive research approach using 158 patients diagnosed with ischemic or hemorrhagic stroke through brain Magnetic Resonance Imaging (MRI) or Computed Tomography (CT). The data collection period was from May 20, 2020 to September 29, 2020. The data were analyzed using descriptive statistics, Pearson’s correlation coefficient analysis, and a three-step regression analysis using Baron and Kenny’s method for mediation.
Results: The mean scores for uncertainty, self-care competence, and quality of life were 3.07±0.49, 3.66±1.07, and 3.54±0.93, respectively. Self-care competence was found to completely mediate the relationship between uncertainty and quality of life (z=-5.31, p<.001), and its explanatory power was 77.2%.
Conclusion: To improve the quality of life among stoke patients in uncertain situations, it is necessary to improve their self-care competence and develop step-by-step and differentiated self-care competence enhancement programs through multidisciplinary collaboration.
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PURPOSE This study aimed to explore the mediating effect of self-care competence on the relationships between uncertainty, self-care competence, and quality of life in patients undergoing hemodialysis. METHODS This study used a descriptive correlation design. Participants were 169 patients who were receiving hemodialysis treatment. Data were collected from November 01, 2017, to June 30, 2018. Measurements included the Patient Assessment of Mishel Uncertainty in Illness Scale, Self-as-Carer Inventory Scale, and the Medical Outcomes Study Short Form-12 (MOS SF-12). The MOS SF-12 comprises the Physical Component Score (PCS) and Mental Component Score (MCS). Data were analyzed using descriptive statistics, Pearson's correlation coefficient analysis, and a three step regression analysis using Baron and Kenny's method for mediation. RESULTS Mean scores were 2.78±0.03 and 3.96±0.07 for uncertainty and self-care competence, respectively. The mean PCS score was 41.90±17.45) and the mean MCS score was 55.23±15.09. Self-care competence had a partial mediating effect (z=−3.50, p<.001) between uncertainty and PCS as well as an explanatory power of 20%. Self-care competence had a partial mediating effect (z=−2.36, p<.001) between uncertainty and MCS as well as an explanatory power of 11%. CONCLUSION To improve the quality of life of hemodialysis patients, developing programs suitable for patients with high uncertainty or programs that increase the self-care competence abilities of the patients should be considered.
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PURPOSE The purpose of this study was to investigate the factors that influence health-related quality of life in patients with atrial fibrillation. METHODS The subjects were 150 outpatients with atrial fibrillation who visited the cardiology clinic of a university hospital in U city. The instruments used for this study were Mhel Uncertainty in Illness Scale (MUIS), Center for Epidemiologic Studies-Depression Scale (CES-D), State Trait Anxiety Inventory (STAI), and the Short-Form-36 Health Survey (SF-36) Korean version II. The date were analyzed by ANOVA, Pearson-correlation coefficient, and hierachial multiple regression using SPSS/WIN 18.0. RESULTS The mean score of physical health-related quality of life (PCS) was 38.92 +/- 6.22 and mental health-related quality of life (MCS) was 41.49 +/- 5.71. Physical and Mental health-related quality of life had the significant correlations with uncertainty, anxiety and depression. In multiple regression analysis, physical health-related quality of life was significantly influenced by duration of disease, NYHA class, uncertainty. Mental health-related quality of life was significantly influenced by family income, NYHA class, anxiety and depression. CONCLUSION These results suggest that these influencing factors should be consider in developing the nursing interventions to improve the health-related quality of life in patients with atrial fibrillation.
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PURPOSE S: This study examined uncertainty and nursing need according to illness phases(phase I, II, III) in cancer patients, and investigated relationships between uncertainty and nursing need. METHODS A cross-sectional descriptive study was conducted with a sample of 121 adult cancer patients treated in two hospitals. RESULTS As for the total score, the uncertainty was not significantly different across the subgroups by illness phase. As for the subscale score, however, two sub-scales of the uncertainty were different across the subgroups. 'The unpredictability' was highest in illness phase I and II groups, while 'the lack of information' was highest in the illness phase III group. Nursing need as the total score was not significantly different across the subgroups by illness phase. However, all subscale scores of the nursing need were significantly different across the subgroups. Educational need was highest in the illness phase I group; physical and emotional needs were highest in the illness phase III group. Uncertainty and nursing need were not related to each other at any illness phase. CONCLUSION The results suggest that nursing need and uncertainty may change across illness phases. Clinicians need to consider this pattern in caring for cancer patients.
PURPOSE The purposes of this study were to measure the degree of uncertainty in illness, hope, and spiritual well-being and to examine the relationship among uncertainty in illness, hope, and spiritual well-being of cancer patients. METHOD The data were derived from answers to questionnaires obtained from 93 cancer patients at one general hospital in J area from April 6, 2004 to May 8, 2004. The collected data were analyzed by SSPS 10.0. RESULTS The mean score of uncertainty in illness of cancer patients was 55.96. The mean score of hope of cancer patients was 79.77, and spiritual well-being was 55.20. Uncertainty in illness of cancer patients was related negatively to hope(r=-.57, p=.000). Also uncertainty in illness of cancer patients was related negatively to spiritual well-being(r=-.57, p=.000). However, hope of cancer patients was related positively to spiritual well-being(r=.67, p=.000). CONCLUSION Higher uncertainty in illness was related to lower hope and spiritual well-being of cancer patients. Based upon these results, nurses should help patients to improve their hope and spiritual well-being through mediation of uncertainty in illness.
PURPOSE The purposes of this study were to identify the level of total symptom distress, uncertainty, depression and ways of coping in women with endometriosis based on Mishel's model of Uncertainty in Chronic illness, and to exam the relationships among symptom distress, depression and ways of coping and the mediating effect of ways of coping between uncertainty and depression. METHOD: The research was used for correlational research design and data were collected with 123 women with endometriosis who live in a local area by convenience sampling. RESULTS: The finding showed that the levels of symptom distress and uncertainty were moderate and the depression was above the middle level. There were positive relationships among symptom distress, uncertainty and depression but a negative relationship between problem focused coping and depression. The significant predictors for depression were symptom distress, uncertainty, and problem focused coping with 40% of explained variance. Problem focused coping showed mediating effect between uncertainty and depression. CONCLUSION: Therefore, nursing intervention for the strategy of increasing problem focused coping as well as lowering uncertainty and depression is recommended. Further study is needed to conduct a repetitive study with randomized nationwide population and to evaluate the theory with different outcomes for adaptation versus maladaptation.
PURPOSE The purposes of this study were to explore the concept of uncertainty and to examine the relationships among uncertainty, appraisal of uncertainty, depression, anxiety, and perceived health status in patients with atrial fibrillation. METHOD: The study utilized a descriptive correlational survey design using a face to face interview method. A convenience sample of 49 subjects were recruited from K university hospital over 8 months. The data were analyzed by t-test, ANOVA, Pearson correlation and partial correlation analysis. RESULTS: 1) Subjects perceived with moderately high uncertainty(M=65.98); moderate physical health(M=39.80), mental health(M=47.38), and general health(M=2.94); moderate anxiety(M= 44.78); and slightly low depression(M=15.33). 2) There were significant differences in uncertainty by gender and education. 3) Uncertainty and danger appraisal were significantly correlated(r=.32, p=.03) while the uncertainty was not associated with opportunity appraisal. 4) Uncertainty was significantly correlated with mental health(r=-.31, p=.04), anxiety(r=.38, p=.01), and depression(r=37, p=.01). CONCLUSION: This study was the first trial to explore uncertainty and to examine the relationships among its associated factors in Korean patients with atrial fibrillation. Thus, based on the findings of this study, directions for nursing practice and further nursing research for patients with atrial fibrillation were suggested.
PURPOSE This research was done to establish a theoretical foundation for the adjustment process of patients with hemophilia. METHOD For this study, 14 patients with hemophilia participated. The data was collected through the in-depth interviews and analysed in terms of Strauss and Corbin's grounded theory methodology. RESULT The core category was identified with "uncertainty". The adjustment process was classified into two stages: the 'unstable stage' before the moment they learn about the Hemophilia Foundation and the 'stable stage' since then. The two stages were further divided into four groups, namely 'the stage of isolation ', 'the stage of maintaining survival', 'the stage of pursuing hope', 'the stage of ambivalence'. The categories of these stages include a series of subcategories to describe the adjustment of patients. The quality of life for these patients has increasingly improved based on support from hemophiliac organizations. But due to the uncertainty of disease, the patients have four stages of adjustment process from the stage of isolation to that of ambivalence and might turn to feedback. CONCLUSION Therefore the nursing interventions reflecting adjustment process of patients with hemophilia should be developed.
The purpose of this study was to understand the nature and structure of "uncertainty of chronically ill patients" by explaining it more scientifically. This study is based on the unique experiences, which individual uncertainty experiences differ from others. In this sense, Q-methodology which includes self-psychology and abductive logics is applied to the study. The results indicate that there are six types of uncertainty of chronically ill patients : my own fault, self-esteem loss, self-care determination, cure-doubt, reality-restructure, and past-tenacity reality-absence. Thus,"uncertainty of chronically ill patients"is defined from the study as the process in which continuous transition and evaluation of possibility cause changes in human recognition, attitude, action, etc.. The significance of the study is threefold : (1) discovery of six types of uncertainty of chronically ill patients in Korean people, (2) the better understanding of "uncertainty of chronically ill patients", (3) possible developments of nursing concept and assessment and intervention technique based on the new dimension of the understanding in uncertainty for nursing of chronically ill patients from this research.
This study has been conducted to identify and describe conceptual systems of uncertainty using qualitative data from a written association test with open ended questions of "Please list three items in order, as they occur to you, when you think about uncertainty". Two open ended questions were added to help the grouping process of the concepts to be more reliable. 336 listed words were collected from 53 non-patients(nurse, professionals, nurse-students, students) and 65 patients. And data analysis involved three levels of increasing complexity and abstractedness, which involved a grouping process of "concept" with "meaning and value" to encompass a more abstract grouping with greater scope. The initial level grouping of the 336 listed words yielded 28 distinct categories: change, time, life, health and illness, relationships, family and person, event, trenscendental being, luck, hope and expection, positive emotion, negative emotion, action, self, nature, information, society, success and failure, non-predictiveness, anxiety, conflict, powerlessness, vagueness certainty not known, undoubtful, incorrectness, undetermined, indefinite. In the 2nd level of abstraction with 28 distinct categories, change/ time/ life/ health and illness/ relationships/ family and person/ event/ trenscendental being classified under the category of objectivity of uncertainty. Self under the category of subjectivity of uncertainty. Luck/ hope and expection/ positive emotion/ negative emotion/ and action were categorized under the category of consequences, and nature under the category of natural environment. Information/ society/ success went into the category of social environment. Unpredictability/ anxiety/ conflict/ powerlessness/ vagueness/ certainty not known/ undoubtful/ incorrectness/ undetermined/ indefinite were classified into the category of concomittent. And finally, the 3rd level of abstraction, with 7 categories, yielded 3 categories of person/ environment/concomittent. The results are significant to refine the concept of uncertainty. These understanding will facilitate the development effective methods of nursing to the uncertainty in chronic illness.
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