The many meanings of uncertainty in illness: toward a systematic accounting.

Uncertainty is widely believed to be a central feature in illness experiences. Moreover, communication is thought to be essential to the construction, management, and resolution of uncertainty. Not surprisingly, however, there are substantial variations in conceptions and analyses of this focal construct and its relation to communication. In this article, we first argue that understandings of the role of communication in health and illness can be improved substantially--thereby enhancing both theory development and practical applications of health communication theory--by recognizing and reconciling sources of variation in conceptions of uncertainty and by synthesizing various specific conceptions. We then review individual-psychological models. linguistic and discourse analyses, and sociocultural and historical perspectives on uncertainty in illness Following the review, we present a framework that synthesizes many conceptions of uncertainty We close with a discussion of 5 challenges and opportunities for research and application.

Satisfaction with health care of hemodialysis patients.

The purpose of this study was to assess the satisfaction with care of hemodialysis patients, and to explore the relationships between satisfaction with care, quality of life, and background variables. The sample (n = 416) was randomly selected from the adult, in-unit hemodialysis patient population of a north central state. Overall, patients were satisfied with their care (M = 5.04, range = 1 to 6). An ANOVA demonstrated that patients were most satisfied with physician related aspects of care, followed by nursing/dialysis treatment aspects, and least satisfied with financial/transportation aspects (F(2,830) =28.44. p less than .0001). Overall satisfaction with care was most highly correlated with satisfaction with medical (r = .74) and nursing care (r = .74). Satisfaction with care was moderately correlated with quality of life (r = .42) and satisfaction with health and functioning (r = .42). Somewhat weaker relationships were found between satisfaction with care and socioeconomic aspects of life (r = .31), psychological/spiritual aspects (r = .32), and family (r = .27). Patients who had been on dialysis for a shorter length of time or who had less education were more satisfied with care.

Toward a theory of nursing action: skills and competency in nurse-patient interaction.

Existing models of nursing require expansion and refinement to link theory, research, and clinical practice more closely. To accomplish this goal, conceptual models need to integrate a theoretically motivated and clinically useful account of nursing action. One way to do this is to view nursing action as a process of social interaction. Effecting positive changes in patients' health care status depends on nurse-patient interaction that promotes consensus. Consensus is arrived at through the process of negotiation and depends on the nurse's level of interpersonal competence. This article discusses core assumptions about the nature and function of nursing action as viewed through an interactional lens and identifies interpersonal skills suggested by this perspective, which are likely to account for competent nursing action.

The functional message behavior inventory. Linking nursing action with health care outcomes.

In an era where issues concerning cost and quality of care are constantly raised, it will be increasingly important that expanded-role nurses be able to define their unique contributions to primary care. This will require nurses to self-inventory their nursing processes and conduct research that serves to link nursing action processes to health care outcomes. In order to lay the groundwork for accomplishing this goal, this article provides a brief assessment of the strengths and limitations of an existing primary care process measure (the nurse practitioner rating form), and furnishes a conceptual framework for constructing an alternative process measure--the functional message behavior inventory.

Role of strategic communication in nursing theory and research.

Linking the process of nursing with theory and research in interpersonal competence is important in building a comprehensive theory of nursing. One dimension of interpersonal competence is the ability to use communication as a strategic mode of nursing intervention. The study of strategic communication can proceed by identifying communication-relevant nursing objectives, obstacles that inhibit the accomplishment of these objectives, and interpersonal strategies that can be employed to address these obstacles and facilitate goal attainment. The use of free response data collection procedures and theoretically grounded and hierarchically ordered message coding systems represents a viable method to analyze strategic communication.

Interpersonal competence and communication in the delivery of nursing care.

Despite the importance generally attributed to communication in nursing, little systematic attention has been directed toward exploring the interface between communication and the delivery of nursing care. The primary factors that have tended to impede research have been the inability of emerging models of nursing to conceptualize communication from an adequate perspective and level and the lack of theoretic exemplars for guiding specific lines of investigation. This article suggests that one potential exemplar for guiding nursing communication research lies in the area of interpersonal competence. It is suggested that research can be profitably aimed at understanding how the social cognitive and communicative abilities of nurses interrelate with the sociocultural context in health care to influence interpersonal competence.