TRANSITIONS: When the only certainty is uncertainty
Harleah G. Buck PhD, RN, CHPN

July 2012 
Volume 42  Number 7
Pages 12 - 13
  PDF Version Available!

FROM THE BEGINNING, the Transitions column has been a conversation. In my first published piece, I asked you to share your stories and many of you responded to this invitation. In this month's column, with the author's permission, I'm going to share one of those stories.An oncology nurse wrote a deeply engaging account of her family's perspective as they cared for her mother at end of life. (See What if?) I'm going to respond by highlighting some recent nursing science that may help to frame the experience.As I read this nurse's account, what came to mind is a concept, uncertainty, that has been studied extensively by a colleague of mine, Dr. Janice Penrod. She defines uncertainty as a changeable state of mind that arises out of a person's perception that outcomes can no longer be easily predicted.1 Uncertainty results in uneasy feelings that may increase or decrease in response to cognitive, affective, or psychomotor reactions to the situation, changes in perception, or the passage of time.Uncertainty develops when people no longer believe that they can make sense of a given situation and handle it, or that they have some control over that situation (or life in general). The old joke states that the only two certainties in life are death and taxes, but the actual process and timing of death can be highly uncertain. As nurses, we work in settings filled with uncertainty and all of the uneasy feelings that go with it.How do nurses cope with uncertainty? A group of nurse scientists has studied this question and developed an explanatory model of how direct care nurses experience and respond to practice-related uncertainty.2 After analyzing the nurses' responses to questions related to uncertainty in their clinical practice, they concluded that nurses respond to uncertainty in predictable ways: physically (with a fight or flight response) and emotionally (feeling stressed). They also found that nurses manage their uncertainty by developing three strategies: cognitive (critical

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