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Preliminary Reference List: Merle Mishel's Uncertainty in Illness Theory

Dianabel Blanco

Florida National University

Nursing Theory-DBX-DL01

Dr.Nora Hernandez-Pupo

July 17, 2026

Preliminary Reference List: Merle Mishel's Uncertainty in Illness Theory

This preliminary reference list is used in conjunction with a Theorist Paper which explores Merle Mishel's Uncertainty in Illness Theory (UIT) and its extended reconceptualization (RUIT) in terms of the lived experience of adults with chronic illness. Mishel's original theory focuses on the meaning of uncertainty in relation to the occurrence of illness events, whereas the reconceptualized theory focuses on the unresolved chronic uncertainty that occurs in chronic/recurrent illness as opposed to a single acute illness. In this reformulation, uncertainty is not necessarily a negative condition that must be resolved; rather, through the process over time, patients may come to value uncertainty as an opportunity, bringing about a change in the way they think about uncertainty and a change in the way they think about themselves.

The following sources were chosen to reflect the use of the theory in diverse populations with chronic diseases such as chronic obstructive pulmonary disease, chronic liver disease, oncology, and professional care taking settings, as well as new theoretical development of the theory. There are also a number of sources that discuss the psychological and behavioral consequences of unmanaged uncertainty, including decreased self-efficacy, psychological difficulties adjusting, and anticipatory grief, as these all relate to assessment and planning for nursing interventions. All sources are peer-reviewed journal articles published since 2021 (which reflects the current standards for evidence-based graduate-level research writing), or books published since 2021, and have been independently verified before use. These references set the theoretical context for UIT/RUIT and the current empirical evidence, and serve as a foundation for the entire Theorist Paper to explore how uncertainty will be created, appraised, and managed throughout the illness journey, and how nursing interventions based on the theory can enhance patient coping, psychological adjustment, and quality of life.

To ensure that authorship, journal, volume, page numbers and digital object identifier information are accurate, a direct database or publisher search was used to locate all nine sources. As per the guidelines for the submission there are no annotations, the citations below are only given as a working reference list for the continued development of the full Theorist Paper.

References

Andrade, C. R. A. G., Costa, L. M. C., Lúcio, I. M. L., Pereira, J. F., Lima, H. N., & Nascimento, R. L. (2024). Uncertainties experienced by nursing professionals who contracted Covid-19: A priori, everyone is human. Revista Brasileira de Enfermagem, 77(3), e20230142. https://doi.org/10.1590/0034-7167-2023-0142

Bao, Y., Yang, L., Zhao, J., Wang, Z., Fu, L., Fang, M., & Lin, J. (2026). The association between chronic disease resource utilization and illness uncertainty in COPD patients: A latent profile analysis. PeerJ, 14, Article e20674. https://doi.org/10.7717/peerj.20674

Eppel-Meichlinger, J., Kobleder, A., & Mayer, H. (2024). Refining Mishel's reconceptualized uncertainty in illness theory: Explaining the development of uncertainty in chronic illness. Research and Theory for Nursing Practice, 38(2), 171–192. https://doi.org/10.1891/RTNP-2023-0068

Farooqui, H. A., Zafar, M. H., Haider, A., Samad, A., Qureshi, S. U. R., Shahid, M. A., Shazib, A., Farooq, A., Naz, N., Saeed, Z. B., & Maaz, M. (2025). Prospective association between illness uncertainty and self-management self-efficacy in patients with early-stage chronic liver disease over a six-month follow-up. Cureus, 17(9), Article e92787. https://doi.org/10.7759/cureus.92787

Grant, J. B., & Johnson-Koenke, R. (2024). Navigating chronic uncertainty: A theory synthesis for nursing communication in life-limiting illness. BMC Nursing, 23, Article 653. https://doi.org/10.1186/s12912-024-02328-7

Guan, T., Qan'ir, Y., & Song, L. (2021). Systematic review of illness uncertainty management interventions for cancer patients and their family caregivers. Supportive Care in Cancer, 29(8), 4623–4640. https://doi.org/10.1007/s00520-020-05931-x

Reinken, D. N., & Reed, S. M. (2023). Mishel's uncertainty in illness theory: Informing nursing diagnoses and care planning. International Journal of Nursing Knowledge, 34(4), 316–324. https://doi.org/10.1111/2047-3095.12406

Skojec, T. A., Davidson, T. M., & Kelechi, T. J. (2025). The relationship between uncertainty in illness and psychological adjustment to chronic illness. Journal of Health Psychology, 30(4), 622–637. https://doi.org/10.1177/13591053241249861

Zhang, N., Li, H., Kang, H., Wang, Y., & Zuo, Z. (2023). Relationship between self-disclosure and anticipatory grief in patients with advanced lung cancer: The mediation role of illness uncertainty. Frontiers in Psychology, 14, Article 1266818. https://doi.org/10.3389/fpsyg.2023.1266818