Mishel Uncertainty Research Articles

Application of family empowerment model in patients with laparoscopic surgery for early rectal cancer

Objective To explore the effects of family empowerment model in patients with laparoscopic surgery for early rectal cancer. Methods From January 2017 to December 2017, we selected 94 early rectal cancer patients with laparoscopic surgery at a hospital by convenience sampling. All of the patients were divided into observation group and control group according to the admission order, and 42 cases remained in each group after being eliminated due to abscission. Patients of control group received routine nursing care. On the basis of that in control group, observation group carried out family empowerment model. The intervention effects were evaluated with the Chinese version of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30) , Chinese version of Mishel Uncertainty in Illness Scale (MUIS) and Social Support Rate Scale (SSRS) . Results After intervention, the score of cognitive function of QLQ-C30 of patients in observation group was higher than that in control group; and the score of insomnia in observation group was lower than that in control group; the differences were all statistical differences (P<0.01) . After intervention, the scores of uncertainty and unpredictability in MUIS of patients in observation group were lower than those in control group with statistical differences (P<0.01) . Besides, the score of utilization of social support in SSRS of patients in observation group was higher than that in control group with a statistical difference (P<0.01) . Conclusions Health education based on family empowerment model for patients with laparoscopic surgery for early rectal cancer helps to improve sleep quality and cognitive function of patients after surgery, and reduce the illness uncertainty, and raise the level of social support. Key words: Rectal neoplasms; Quality of life; Family; Empowerment model; Illness uncertainty; Social support

Prenatal Coping Patterns Mediate The Effect of Uncertainty and Perceived Social Support on The Psychological Well-Being of High-Risk Pregnant Women

Background: High risk pregnancy can introduce additional psychological stress on the pregnant women. Also, poor coping skills during pregnancy are associated with negative outcomes. The effects of perceived social support and uncertainty on the psychological well-being of high risk pregnant women can be mediated by their prenatal coping patterns. Aim: This study aimed to assess the mediating effects of prenatal coping patterns of the perceived social support, and uncertainty on the psychological well-being of high-risk pregnant women. Design: A cross sectional, correlational study design was utilized on 162 high-risk pregnant women according to certain inclusion criteria and who were attending outpatient clinic in Obstetrics and Gynecology Hospital affiliated to Ain Shams University Hospitals. Tools of data collection: The data was collected using an interview questionnaire that included five sections as the following: 1) patient's demographic characteristics and obstetric history 2) The Mishel Uncertainty in Illness Scale; 3) The Medical Outcomes Study (MOS) Social Support Survey; 4) The Prenatal Coping Inventory; 5) and The Psychological General Well-Being Index. Results: data and path analysis revealed that, planning/preparation for motherhood negatively mediated the effect of uncertainty on psychological wellbeing of high-risk pregnant women; planning/preparation for motherhood mediated the effect of perceived social support on psychological wellbeing of them; and perceived social support had direct effect on psychological wellbeing of the studied subject. Regarding the psychological well-being, perceived social support, uncertainty, and prenatal coping pattern of the studied high-risk pregnant women, less than half of them had moderate psychological distress, less than two third of them had high perceived social support, more than two third of them reported low level of uncertainty, the majority of them reported less use of avoidance, less than two third of them reported less use of spiritual coping, whereas more than three quarters of them reported frequent use of planning/preparation for motherhood. Conclusion: The study concluded that prenatal coping patterns (problem focused coping) mediated the effects of uncertainty and perceived social support on the psychological well-being of the studied high-risk pregnant women. Recommendation: Incorporating psychosocial assessment in routine prenatal screening for women experiencing medically complex pregnancies with continuous and routine screening for depression and anxiety

Uncertainty in Young Adult Survivors of Childhood and Adolescent Cancer with Lower-Extremity Bone Tumors in Japan.

Purpose: Childhood and adolescent survivors of cancerous lower-extremity bone tumors may be at unique risk of uncertainty about their future because of their specific cancer and/or physical disabilities secondary to treatment. This study aimed at clarifying survivors' uncertainty and related factors, including physical functioning, limb pain, and management of affected limbs. Methods: Self-administered questionnaires were distributed at two cancer hospitals in Japan. Thirty-six survivors diagnosed with osteosarcoma or Ewing sarcoma were included in our study. Uncertainty was evaluated by using Mishel's Uncertainty in Illness Scale-Community Form (MUIS-C), and physical functioning was evaluated by using The Toronto Extremity Salvage Score (TESS). Results: The average score of MUIS-C was lower that than reported for other previously studied childhood cancer survivors. Uncertainty was significantly higher in survivors who had lower levels of education, pain in their limbs, and difficulty managing their affected limb. Correlational analyses indicate that high scores for TESS, less limb pain, and high ability to manage affected limbs were related to low uncertainty. Conclusion: Health care providers need to assess survivors' degree of limb pain and their self-management for general health and affected limbs. It might be possible to improve their daily life. Assisting childhood and adolescent survivors of bone tumors to manage affected limbs and limb pain could prevent chronic uncertainty.

Illness uncertainty, social support, and coping mode in hospitalized patients with systemic lupus erythematosus in a hospital in Shaanxi, China.

ObjectiveTo analyze the relationships between illness uncertainty, social support, and coping mode in hospitalized patients with systematic lupus erythematosus (SLE).MethodsThe General Health Questionnaire, Mishel Uncertainty in Illness Scale, Social Support Rating Scale, and Medical Coping Modes Questionnaire were to the hospitalized patients with SLE (N = 200) in a tertiary hospital in Shaanxi.ResultsThe hospitalized patients with SLE showed a moderate level of illness uncertainty. Furthermore, illness uncertainty was negatively correlated with support availability (r = -0.161, P = 0.023) and facing coping mode (r = -0.231, P = 0.001), and was positively correlated with the yielding coping mode (r = 0.249, P < 0.001).ConclusionThese findings suggest that support availability and coping modes were associated with moderate level of illness uncertainty, indicating that support availability support should be strengthened in hospitalized patients to actively face their disease. This subsequently improves their treatment compliance and quality of life.

Factors That Predict Overall Patient Satisfaction With Oncology Hospital Care in Bulgaria

BackgroundThe relevance of studies focusing on patient satisfaction becomes imperative for patients with cancer, who often face major changes in their lifestyles. Their perceived uncertainty in illness and their personal experiences with the services received are crucial factors for a qualitatively adequate assistance. ObjectivesTo assess the determinants of patient satisfaction, using a sample of 306 Bulgarian oncology outpatients. MethodsThe hypotheses tested concern the extent to which patient satisfaction depends on the uncertainty in illness; the patients' assessment of technical and interpersonal skills of nurses and medical staff; the information provision; and some organizational aspects. Patients were asked to answer a questionnaire composed of internationally validated scales assessing the determinants of patient satisfaction (measured through the European Organization for Research and Treatment of Cancer), uncertainty in illness (assessed through the Mishel Uncertainty in Illness Scale), and patients' health status (assessed through the EuroQol 5-dimensional questionnaire and the visual analogue scale). An ordered logit model was run, using the level of overall patient satisfaction as a dependent variable. ResultsThis is one of the first studies carried out in Bulgaria for oncology patient satisfaction of subjective factors related to the frailty of the oncology patient status such as age, self-assessed health-related quality of life, and uncertainty in illness. Nevertheless, other determinants, reflecting the quality of the care provided, also have an impact on patient satisfaction, namely, the assessment of the nonmedical personnel, the perception of medical technical skills, and the access to a medical center. ConclusionsResults stress the relevance of reducing uncertainty in illness in patients with cancer by implementing a satisfactory patient-physician relationship in the management of the disease.

Uncertainty and Quality of Life in Systemic Lupus Erythematosus: A Cross-sectional Study.

The aim of this study was to explore relationships among health status, uncertainty, and health-related quality of life (HRQOL) in adults with systemic lupus erythematosus (SLE). The study was a Web-based quantitative study using a predictive correlational design, with nonprobability, convenience sampling. Adults (n = 196) with SLE living in 31 U.S. states and Puerto Rico participated in the study. Online data were collected from three regional and one national lupus organization. A correlational design determined relationships among uncertainty, health status, and HRQOL. Regression analysis was completed to identify variations in HRQOL. Demographics were described. As predicted, inverse relationships occurred between HRQOL and uncertainty, and between mental health and uncertainty. Mental health correlated positively with HRQOL. Physical health correlated with lower HRQOL and higher uncertainty level. Health status plus uncertainty predicted variation in HRQOL. Findings support use of Mishel's Uncertainty in Illness Theory for exploring factors related to HRQOL in adults with SLE and for designing theory-based interventions such as support groups and coping strategies. Decreasing uncertainty through education, social support, improvement in health status, and health literacy can positively impact HRQOL in adults with SLE.

Associations among Uncertainty, Depression, and Anxiety in Isolated Inpatients

Purpose: The purpose of this study was to explore uncertainty, depression, and anxiety in isolated inpatients and to identify associations between them, with specific focus on state anxiety. Methods: Data were collected using structured questionnaires and semi-structured interviews, administered to isolated inpatients at an acute care hospital (N=92). The structured questionnaires consisted of the State-Trait Anxiety Inventory, Mishel Uncertainty in Illness Scale, and the Center for Epidemiologic Studies Depression Scale. Multiple linear regression and content analysis were conducted. Results: Isolated inpatients showed significant differences in uncertainty, depression, trait anxiety, and state anxiety according to gender, perception of sufficient information about isolation, and the type of isolation. State anxiety scores increased when sufficient information about isolation was not provided (β=.23, p=.005), with higher levels of depression (β=.24, p=.020) and trait anxiety (β=.49, p<.001). Through the content analysis, three themes were identified regarding patient’s information needs about isolation specifically for disease, explanation, and environment. Conclusion: Based on the findings, it is crucial to improve the awareness of emotional responses of isolated patients experiencing uncertainty, depression, and anxiety. Our study findings are expected to support the development of nursing interventions to provide proper information and mental health support when caring for isolated inpatients.

Study on resilience and influencing factors of young stroke patients

Objective To investigate the level of resilience and influencing factors among young stroke patients, so as to provide theoretical basis for carrying out nursing intervention. Methods A total of 160 young stroke patients hospitalized in Neurology Department of the First People's Hospital of Xuzhou from January 2013 to December 2015 were selected by convenience sampling method. All the research subjects were investigated with the general questionnaire, the Connor-Davidson Resilience Scale (CD-RISC) , Social Support Rat Scale (SSRS) , Self-Perceived Burden Scale (SPBS) and Mishel Uncertainty in Illness Scale for Adult (MUIS-A) . A total of 166 questionnaires were distributed and 160 valid questionnaires were collected. Results The total score of resilience of 160 young stroke patients was (58.70±5.54) . The scores of tolerance, strength and optimism were (29.41±3.51) , (20.24±2.37) and (9.04±1.46) respectively. Univariate analysis showed that there were differences in the resilience scores among young stroke patients with different genders, education levels, marital status and family relationships (P<0.05) . Relevant analysis showed that there was a positive correlation between resilience score and social support, and a negative correlation between resilience score and self-perceived burden and disease uncertainty (P<0.05) . Multivariate regression analysis showed that gender, educational level, family relationship, objective support, subjective support, emotional burden, economic burden and uncertainty and unpredictability were the main influencing factors of resilience. Conclusions The level of resilience among young stroke patients is low and constrained by many factors. Nursing staff should take timely and targeted interventions to improve the level of resilience and promote the prognosis of the disease. Key words: Stroke; Youth; Resilience; Influencing factors

Status quo of uncertainty in illness in family members of ICU patients receiving acute trauma surgery and its influencing factors

Objective To explore the status quo of uncertainty in illness in family members of ICU patients receiving acute trauma surgery and to discuss its influencing factors. Methods Totally 166 family members of patients receiving acute trauma surgery who were hospitalized in the ICU of 3 ClassⅢ Grade A hospitals in Heilongjiang Province from January 2016 to September 2017 were selected by convenient sampling, and investigated with the general information questionnaire, Mishel Uncertainty in Illness Scale-Family Member Form (MUIS-MF) . Results The MUIS-MF score of the family members of the 138 ICU patients receiving acute trauma surgery was (112.77±8.02) . There were statistical differences in the MUIS-MF scores in the dimensions of respirators used or not, time of admission into ICU and patient's state of consciousness (P<0.05) . There were statistical differences in the MUIS-MF scores between family members with different family monthly income and educational background (P<0.05) . Conclusions Family member of ICU patients receiving acute trauma surgery show severe uncertainty in illness to which clinicians need to pay attention. And clinical workers should provide enough information and communication according to the actual situation of patients and family members to reduce the adverse impacts of uncertainty in illness on family members. Key words: Wounds and injuries; ICU; Uncertainty in illness; Family members

Uncertainty and depressive symptoms as mediators of quality of life in patients with heart failure.

Uncertainty in illness is regarded as a source of stress in many chronic diseases and is negatively related to health-related quality of life (HRQoL). However, studies on the relationship between uncertainty and HRQoL in patients with heart failure are limited. This study used Mishel’s theory of uncertainty in illness to investigate the mediating role of uncertainty in illness and depressive symptoms between symptom distress and HRQoL in patients with heart failure. This study used a cross-sectional correlation design. Participants were recruited by convenience sampling from outpatient services and medical wards of cardiology departments of a medical center in northern Taiwan. Data were collected for uncertainty, depressive symptoms, symptoms distress of heart failure, and HRQoL using self-report questionnaires. Demographics and clinical characteristics were analyzed with descriptive statistics. The mutual effects of disease characteristics, symptom distress, uncertainty in illness, depressive symptoms and HRQoL, as well as the overall model fitness, were analyzed by with structural equation modeling. We collected 147 qualified questionnaires. The mean score for the Mishel Uncertainty in Illness Scale for patients with heart failure was 73.5 (SD = 18.55); 65.3% of participants had a score of ≧13 on the Beck Depressive Inventory-II, indicating mild depression. Uncertainty, depressive symptoms, and HRQoL were directly related to symptom distress. Symptom distress and depressive symptoms were both mediators between uncertainty and depressive symptoms. Depressive symptoms also mediated emotional support and HRQoL. Uncertainty and depressive symptoms were important factors in the pathway between symptom distress and HRQoL for heart failure patients. We suggest providing heart failure patients with tailored interventions for effective self-management of symptoms based on Mishel’s theory of uncertainty in illness, which could help control disease symptoms, alleviate uncertainty and depression as well as improve HRQoL.

Effects of Written Information and Counseling on Illness-Related Uncertainty in Women With Vulvar Neoplasia.

To determine whether written information and/or counseling decreases illness-related uncertainty in women with vulvar neoplasia. 49 women with vulvar neoplasia from four Swiss hospitals and one Austrian hospital. A longitudinal, multicenter, randomized phase 2 study was performed. The written information group received a set of leaflets. The counseling group received five consultations with an advanced practice nurse (APN) from diagnosis to six months postsurgery that focused on symptom self-management, healthcare services, and decision making. Uncertainty was measured as a secondary outcome five times by the Mishel Uncertainty in Illness Scale. Total uncertainty and the subscales of ambiguity, inconsistency, and unpredictability improved significantly over time within the counseling group but not within the written information group. In addition, counseling improved inconsistency over time, and total uncertainty, inconsistency, and unpredictability at distinct time points more efficiently than written information. Counseling can reduce illness-related uncertainty. APNs are valuable healthcare providers who promote women's self-management and may support them in becoming more familiar with illness-related events and common symptoms during this rare disease.

Towards the validation of a new, blended theoretical model of fear of cancer recurrence.

Fear of cancer recurrence (FCR) is defined as "fear, worry, or concern about cancer returning or progressing". To date, only the seminal model proposed by Lee-Jones and colleagues has been partially validated, so additional model testing is critical to inform intervention efforts. The purpose of this study is to examine the validity of a blended model of FCR that integrates Leventhal's Common Sense Model, Mishel's Uncertainty in Illness Theory, and cognitive theories of worry. Participants (n=106) were women diagnosed with stage I to III breast or gynecological cancer who were enrolled in a Randomized Controlled Trial of a group cognitive-existential intervention for FCR. We report data from standardized questionnaires (Fear of Cancer Recurrence Inventory-Severity and Triggers subscales; Illness Uncertainty Scale; perceived risk of recurrence; Intolerance of Uncertainty Scale; Why do people Worry about Health questionnaire; Reassurance-seeking Behaviors subscale of the Health Anxiety Questionnaire, and the Reassurance Questionnaire) that participants completed before randomization. Path analyses were used to test the model. Following the addition of four paths, the model showed an excellent fit (χ2=13.39, P=0.20; comparative fit index=0.99; root mean square error of approximation=0.06). Triggers, perceived risk of recurrence, and illness uncertainty predicted FCR. FCR was associated with maladaptive coping. Positive beliefs about worrying and intolerance of uncertainty did not predict FCR but led to more maladaptive coping. These results provide support for a blended FCR model.

Asociación entre el nivel de incertidumbre y el tipo de enfermedad en pacientes hospitalizados en UCI

Objetivo: determinar la asociación entre el nivel de incertidumbre y el tipo de enfermedad en pacientes hospitalizados en unidades de cuidado intensivo de Cartagena, Colombia.Materiales y métodos: estudio observacional de corte transversal.La muestra estuvo constituida por 72 pacientes a quienes les fue aplicada la escala de incertidumbre de Merle Mishel. Se estimaron las asociaciones entre el tipo de enfermedad y la incertidumbre mediante la prueba no paramétrica Kruskal-Wallis.Resultados: la edad promedio de los participantes fue 58,3 años (DE = 19,4), con predominio del sexo femenino en el 54,2 %, la mediana de estancia hospitalaria correspondió a seis días. El 27,8 % presentó enfermedades cardiovasculares, seguidas de las metabólicas en un 19,4 %. El nivel de incertidumbre fue regular en el 63,9 % y alto en el 34,7 %. Respecto a la asociación entre variables, no se encontraron diferencias significativas entre los puntajes promedios de la escala según tipo de enfermedad (Prob. de Kruskal-Wallis &gt; 0,05).Conclusión: la complejidad de la situación, las expectativas relacionadas con el compromiso de la salud, la presentación de los síntomas y los tratamientos médicos o quirúrgicos instaurados originaron incertidumbre independiente del tipo de enfermedad

Exploratory Factor Analysis of the Mishel Uncertainty in Illness Scale Among Adolescents and Young Adults With Chronic Medical Conditions

To identify a developmentally relevant factor structure of the Mishel Uncertainty in Illness Scale-Community form (MUIS-C) among adolescents and young adults with chronic medical conditions. Data on college students with a self-reported chronic medical condition (N = 238) were collected between November 2013 and May 2015. Participants completed the MUIS-C as part of a larger questionnaire battery. An exploratory factor analysis and a confirmatory factor analysis were conducted. The exploratory factor analysis resulted in a 22-item model with two factors termed: (a) Ambiguity/Future Uncertainty (α = .93), and (b) Unpredictability (α = .89). The confirmatory factor analysis and a correlated uniquenesses model, which evaluated method effects, supported the two-factor model. These findings highlight the unique nature of illness uncertainty among adolescents and young adults and show the clinical and research utility of the MUIS-C for this population. Future investigations should examine how the two factors relate to distress among adolescents and young adults.

Current situation of illness uncertainty and its influencing factors among postoperative patients with colorectal cancer

Objective To explore the current situation of illness uncertainty and its influencing factors among postoperative patients with colorectal cancer. Methods From June 2015 to October 2017, we selected 140 patients with colorectal cancer surgery of a ClassⅢGrade A hospital of Heilongjiang Province by purposive sampling as subjects. All of the patients were investigated with the general information questionnaire, Mishel Uncertainty in Illness Scale Adult (MUIS-A) , Social Support Revalued Scale (SSRS) . Results The average score of MUIS-A of postoperative patients with colorectal cancer was (106.32±10.33) with a middle level. The influencing factors of illness uncertainty of postoperative patients with colorectal cancer included education levels, whether or not to be with enterostomy, complications and to learn about their illness as well as social support (P<0.05) . Conclusions Postoperative patients with colorectal cancer are with a middle level of illness uncertainty influenced by many factors. Health care providers should take individual intervention according to patients'actual situation. Key words: Colorectal neoplasms; Social support; Illness uncertainty

Illness uncertainty, anxiety and depression in Chinese patients with glaucoma or cataract

This study evaluated illness uncertainty, anxiety and depression among glaucoma patients and cataract patients in China. 263 patients with primary glaucoma and 100 patients with age-related cataract were recruited sequentially from Zhongshan Ophthalmic Center between October 2013 and March 2016. All the participants completed questionnaires for socio-demographic information, Mishel Uncertainty in Illness Scale (MUIS) and Hospital Anxiety and Depression Scale (HADS). 25 of the 263 glaucoma patients and 21 of the100 cataract patients finished two copies of the same questionnaires before and after surgery. Statistics were analyzed using SPSS17.0 software. We observed that glaucoma patients had higher MUIS and HADS score than did cataract patients. Multivariate logistic regression analysis indicated risk factors for illness uncertainty, anxiety and depression for glaucoma patients were high HADS score, poor visual acuity (VA) in the better eye and education level respectively. Risk factors for the same parameters of cataract patients were high HADS-A score, poor VA in the better eye and high illness uncertainty respectively. Scores of MUIS and HADS both decreased after surgery, but the change in HADS score among glaucoma patients was not significant. Clinical workers should take these factors into account to improve therapy, especially for glaucoma patients who undergo surgery.

Uncertainty of Acute Stroke Patients: A Cross-sectional Descriptive and Correlational Study.

Uncertainty is a chronic and pervasive source of psychological distress for patients and plays an important role in the rehabilitation of stroke survivors. Little is known about the level and correlates of uncertainty among patients in the acute phase of stroke. The purposes of this study were to describe the uncertainty of patients in the acute phase of stroke and to explore characteristics of patients associated with that uncertainty. A cross-sectional descriptive and correlational study was conducted with a convenience sample of 451 consecutive hospitalized acute stroke patients recruited from the neurology department of 2 general hospitals of China. Uncertainty was measured using Chinese versions of Mishel Uncertainty in Illness Scale for Adults on the fourth day of patients' admission. The patients had moderately high Mishel Uncertainty in Illness Scale for Adults scores (mean [SD], 74.37 [9.22]) in the acute phase of stroke. A total of 95.2% and 2.9% of patients were in moderate and high levels of uncertainty, respectively. The mean (SD) score of ambiguity (3.05 [0.39]) was higher than that of complexity (2.88 [0.52]). Each of the following characteristics was independently associated with greater uncertainty: functional status (P = .000), suffering from other chronic diseases (P = .000), time since the first-ever stroke (P = .000), self-evaluated economic pressure (P = .000), family monthly income (P = .001), educational level (P = .006), and self-evaluated severity of disease (P = .000). Patients experienced persistently, moderately high uncertainty in the acute phase of stroke. Ameliorating uncertainty should be an integral part of the rehabilitation program. Better understanding of uncertainty and its associated characteristics may help nurses identify patients at the highest risk who may benefit from targeted interventions.

Correlation formation in life quality, illness uncertainty, negative emotions and medical coping styles among pulmonary embolism patients

Objective To explore the correlation in life quality, illness uncertainty, negative emotions and medical coping modes among pulmonary embolism patients to construct a structural equation model in them. Methods From April 2015 to December 2016, 217 pulmonary embolism patients of Department of Pulmonary in a Class Ⅲ Grade A hospital in Tianjin were selected by convenience sampling. Patients were investigated with the 12-item Medical Outcomes Study (MOS) Short-Form Health Status Survey (SF-12) , Mishel's Uncertainty in Illness Scale (MUIS) , Hospital Anxiety and Depression Scale (HADS) , Medical Coping Modes Questionnaire (MCMQ) . The correlation analysis and structural equation model were used to explore the correlation in life quality, illness uncertainty, negative emotions and medical coping modes and to construct a structural equation model in them. Results In terms of mental health, avoidance of MCMQ had the strongest total effects (-0.95) on it; illness uncertainty had the strongest indirect effects (-0.55) on it. In terms of physical health, confrontation of MCMQ had the strongest direct effects (0.794) . Conclusions Bettering pulmonary embolism patients' illness uncertainty and medical coping modes can effectively improve their life quality. Key words: Quality of life; Pulmonary embolism; Structural equation model

The Relationship Between Fatigue and Uncertainty in Patients With Liver Cirrhosis

Cirrhosis is a chronic, progressive, and currently incurable disease. Cirrhotic patients often experience uncertainty due to poor control of symptoms and disease recurrence. Although fatigue is a common symptom in patients with liver cirrhosis, this symptom is often ignored by healthcare professionals due to the lack of efficacious treatment options. Improper management of fatigue may trigger greater uncertainty and affect adaptation success. To explore the relationship between fatigue and uncertainty and the factors that respectively relate to these two concepts in liver cirrhosis patients. A cross-sectional, correlational design and convenience sampling were used to recruit 76 liver cirrhotic inpatients from one hospital. Three structured questionnaires, including the Personal Demographic Questionnaire, Brief Fatigue Inventory-Taiwan Form, and Mishel's Uncertainty in Illness Scale, were used for data collection. (1) The participants suffered from fatigue at a moderate or higher level, with an average score of 5.39 ± 2.34, which affected their daily activities and greatly impacted their recreational activities. Factors that were found to be associated with fatigue included disease severity, albumin level, total bilirubin level, ascites, and the degree to which fatigue affected the performance of daily activities. (2) Uncertainty was found to be at a moderate or higher level, with an average score of 71.81 ± 10.67. Level of fatigue, the degree to which fatigue affected the performance of daily activities, disease severity, and albumin level were found to relate significantly to level of uncertainty. Fatigue and uncertainty are prevalent and distressing experiences for patients with liver cirrhosis. A comprehensive assessment and broad-based approach to nursing interventions are necessary in order to alleviate fatigue and uncertainty effectively.

Correlation between the uncertainty in illness and anxiety in suspicious malignant patients during the diagnostic period

Objective To study the correlation between the uncertainty in illness and anxiety in suspicious malignant patients during the diagnostic period. Methods Totally 132 suspicious malignant patients hospitalized in Difficult Disease Ward of the Second Xiangya Hospital of Central South University were selected as research objects by convenience sampling method from June to December 2016. Mishel's Uncertainty in Illness Scale for Adults and the Self-rating Anxiety Scale (SAS) were used to evaluate the illness in uncertainty and anxiety of patients in the third day of admission and the first day after diagnosis. SPSS 18.0 statistical software was used to analyze the relation between uncertainty in illness and anxiety by t test, χ2 test and Pearson analysis. Results The differences in the total score of uncertainty in illness, ambiguity, inscrutability, lack of information and score of anxiety were statistically significant before and after the diagnosis (t=7.757, 6.454, 3.979, 6.520, 3.739; P 0.05) . Pearson relevant analysis revealed that before diagnosis, the total score of uncertainty in illness, and the scores of ambiguity and lack of information in patients with suspicious malignant disease were positively correlated with the score of anxiety (r=0.384, 0.336, 0.342; P<0.01) ; after diagnosis, the total score of uncertainty in illness, and the scores of complexity and lack of information were positively correlated with the score of anxiety (r=0.506, 0.365, 0.410; P<0.01) . Conclusions Suspicious malignant patients had a high level of uncertainty in illness and anxiety during the diagnosis, and they were much higher before diagnosis; in addition, they were positively correlated. We should take effective measures to relieve the uncertainty in illness so as to alleviate these patients' anxiety. Key words: Diagnosis; Anxiety; Suspicious malignant disease; Uncertainty in illness