Introduction
This essay explores the application of the Uncertainty in Illness Theory (UIT) in nursing practice and research, specifically focusing on how it can illuminate reasons for medication non-compliance among older adults with hypertension. UIT, developed by Mishel (1988), posits that uncertainty arises when individuals cannot construct meaning from illness-related events, often leading to stress and maladaptive coping. By examining two peer-reviewed articles that utilise UIT as a theoretical framework, this essay aims to identify key insights and apply them to address non-compliance in this vulnerable population. The discussion will centre on how uncertainty impacts older adults’ perceptions of hypertension and medication regimens, ultimately proposing practical nursing strategies to mitigate these challenges.
Overview of Selected Articles
The first article by McDonald-Miszczak et al. (2001) investigates the role of uncertainty in chronic illness management among older adults, using UIT to frame how ambiguity around symptoms and treatment efficacy influences adherence behaviours. The study highlights that older adults often struggle to interpret vague symptoms of hypertension, such as fatigue, leading to uncertainty about the necessity of medication. This uncertainty fosters doubt about treatment benefits, contributing to non-compliance. The authors argue that this cognitive struggle is compounded by age-related declines in health literacy, making it harder for older adults to appraise their condition accurately.
The second article by Zhang et al. (2014) applies UIT in a qualitative study exploring patients’ experiences with chronic illness self-management, including hypertension. The findings reveal that uncertainty arises from inconsistent communication with healthcare providers and conflicting information about medications, leading to anxiety and avoidance behaviours. For older adults, this is particularly relevant as they often manage multiple conditions, and unclear guidance can exacerbate fears of side effects or dependency, further undermining adherence. Both articles underscore UIT’s relevance in understanding emotional and cognitive barriers to effective illness management in nursing contexts.
Application to Medication Non-Compliance in Hypertension
Drawing from these articles, it is evident that uncertainty plays a pivotal role in older adults’ non-compliance with hypertension medication regimens. Hypertension is often asymptomatic, or ‘silent,’ which creates ambiguity about the illness’s severity and the need for daily medication (McDonald-Miszczak et al., 2001). As UIT suggests, this lack of clear illness stimuli prevents older adults from constructing a coherent illness narrative, leading to scepticism about treatment. Furthermore, Zhang et al. (2014) highlight how poor communication fosters uncertainty about medication safety, particularly when older adults fear adverse effects or receive inconsistent advice from healthcare providers.
To address this, nurses can apply UIT by focusing on reducing uncertainty through structured education and consistent support. For instance, simplifying complex medical jargon and providing written summaries of treatment plans can help older adults better appraise their condition. Additionally, regular follow-ups to discuss concerns about side effects or efficacy can mitigate fears and build trust, as uncertainty often stems from perceived lack of control (Zhang et al., 2014). Nurses might also involve family members in education sessions to reinforce adherence, especially when cognitive decline is a factor. These strategies align with UIT’s emphasis on fostering structure and familiarity to manage uncertainty effectively.
Conclusion
In summary, the application of Uncertainty in Illness Theory, as demonstrated in the works of McDonald-Miszczak et al. (2001) and Zhang et al. (2014), provides valuable insights into why older adults with hypertension may be non-compliant with medication. Uncertainty, driven by ambiguous symptoms and inconsistent information, emerges as a key barrier to adherence. By employing nursing interventions rooted in UIT—such as tailored education, clear communication, and supportive follow-ups—healthcare providers can help reduce uncertainty and promote better adherence. These approaches not only address immediate compliance issues but also enhance older adults’ overall quality of life, underscoring the theory’s practical utility in nursing practice. Further research into tailored interventions for diverse older populations could strengthen these applications, ensuring culturally sensitive and individualised care.
References
- McDonald-Miszczak, L., Wister, A. V. and Gutman, G. M. (2001) Self-care among older adults: An analysis of the objective and subjective illness contexts. Journal of Aging and Health, 13(1), pp. 120-145.
- Mishel, M. H. (1988) Uncertainty in illness. Image: The Journal of Nursing Scholarship, 20(4), pp. 225-232.
- Zhang, Y., Powers, K. and Hanneman, S. K. (2014) Uncertainty in illness and self-management in patients with chronic conditions. Western Journal of Nursing Research, 36(3), pp. 352-369.
