Date of Award
Fall 11-21-2024
Embargo Period
12-2-2024
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD) in Nursing Science
Department
Nursing
College
College of Nursing
First Advisor
Teresa J. Kelechi
Second Advisor
Tatiana M. Davidson
Third Advisor
Ashley N.D. Meyer
Abstract
There are currently few studies that directly explore the relationship between uncertainty in illness and psychological adjustment to Systemic Lupus Erythematosus (SLE), highlighting a critical gap in understanding how patients cope with and adjust to the emotional and mental challenges posed by this chronic condition. This dissertation comprises three manuscripts focused on filling this knowledge gap. The first is an integrative review guided by Mishel’s Uncertainty in Illness Theory, which examines how uncertainty affects patients' psychological and emotional well-being during illness and explores strategies to manage or reduce this uncertainty. The integrative review included 27 publications that examined uncertainty in illness and psychological adjustment to diseases and chronic conditions such as cancer, diabetes, autoimmune and respiratory disorders. The findings from this integrative review supported Mishel’s theory, showing that uncertainty in illness influences psychological adjustment to illness often resulting in psychological distress rather than adjustment. Psychological distress refers to negative emotional responses, such as anxiety, depression, or frustration, that arise from the uncertainty of illness. Psychological adjustment refers to an individual's ability to cope with and adapt to the challenges of illness. Thus, when uncertainty is high, it often leads to distress instead of successful adjustment, making it harder for patients to manage their illness effectively. Additionally, the integrative review identified a significant knowledge gap regarding the relationship between uncertainty in illness and psychological adjustment, in particular, to SLE. The second and third manuscripts detail the results of a multi-method cross-sectional study that explored the relationship between uncertainty in illness and psychological adjustment to SLE. The findings from the multi-method cross-sectional study showed a positive relationship between uncertainty in illness and psychological distress: as uncertainty increased, symptoms of anxiety and depression increased. Additionally, data from the qualitative analysis revealed the importance of healthcare provider rapport and peer support on decreasing uncertainty and psychological distress to facilitate the development of cognitive capacity, meaning patients are better equipped to understand their illness, manage their emotions, and make informed decisions about their health. Overall, these findings suggest that the relationship between uncertainty in illness and psychological adjustment to SLE is similar to other chronic illnesses. Further, there is preliminary evidence to suggest that the relationship between uncertainty and psychological adjustment can be modified with the help of supportive structure providers, who are individuals or systems that offer guidance, information, and emotional support to patients, including healthcare providers, peer support groups, or counseling services, to help reduce uncertainty and improve psychological adaptation.
Recommended Citation
Skojec, Theresa, "The Role of Uncertainty in Illness: Insights into Psychological Adjustment in Systemic Lupus Erythematosus" (2024). MUSC Theses and Dissertations. 978.
https://medica-musc.researchcommons.org/theses/978
Rights
Copyright is held by the author. All rights reserved.