Middle range theory utilization & application

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Identify regulatory agencies that regulate health and the health care system within the US, create a table listing your 5 regulatory agencies and address the following:

1. Describe the agency, level of regulatory authority (local, state, federal), scope of regulatory authority, and role within the US healthcare system.

2. Address relevance of the organization or the organization’s authority to the APRN/DNP graduate.

3. Describe relevance to specialty area, area of practice, or setting of practice. For an example, mental health. 




Mishel’s middle-range nursing theory of uncertainty in illness

Sanna-Kay K. McGregor

Department of Nursing, Saint Thomas University

NUR 501: Philosophical & Theoretical, Evidence-Based Research

Dr. Tina Robert

July 7, 2022


With the wide variety of problems that might arise throughout the course of a nurse’s work, the profession requires a high level of expertise. Improving nursing practice may be achieved using by models such as middle-range nursing theories, which serve as a meeting place for the profession’s most cutting-edge researchers and practitioners. For those constantly faced with difficulties, this may help them better grasp how to handle them. In addition, if nurses use these models, they may be able to better cope with stressful events in the workplace. Mishel’s idea of sickness uncertainty is widely accepted as a middle-range hypothesis. This approach aims to improve patient care and outcomes by looking for treatment-related uncertainty. This paper discusses the components of Mishel’s theory of uncertainty in illness, the structural aspects, and the use of this theory in clinical practice. This paper also identifies the Intensive Care Unit as an area of practice that this theory could be applicable. Finally, the evaluation of Mishel’s theory of uncertainty in illness is also discussed.

Keyword: Mishel’s theory of uncertainty in illness, middle-range theory, nursing, ICU

1. Components of the theory

According to Mishel’s theory, the most critical factor is the generation of antecedent doubt. The three central concepts of the Theory of Uncertainty in Illness are “antecedents of uncertainty, appraisal of uncertainty, and coping with uncertainty” (Bailey, 2021, p.503). Uncertainty Antecedents are instances that take place prior to disease and have an impact on the patient’s inference; among them are pain and perception (Fitzpatrick, 2020). Uncertainty Appraisal is used when putting a value on an ambiguous circumstance (Fitzpatrick, 2020). Managing uncertainty consists of the techniques or actions used to manage Uncertainty (Fitzpatrick, 2020). Mishel explained uncertainty as not being able to establish a connection between illness-related occurrences (Bailey, 2021). Uncertainty can arise due to several things, such as the severity of an illness, the treatment course, and how a particular disease affects an individual’s life’s goal (Bailey, 2021).

When a patient is unfamiliar with the experience, which is frequent in an inpatient setting, new stimuli related to the patient’s ailment might generate uncertainty. Suggestion frameworks, such as symptoms pattern, event familiarity, and congruence, are all examples of the antecedent that causes doubt (Bailey, 2021). Practitioners may also be affected if their patients’ expectations do not match their actual experiences. The patient’s cognitive ability and the organizational structure of the nurses influence the analysis of illness-related stimuli. In other words, a patient’s ability to grasp triggers is enhanced by a strong cognitive capacity (Bailey, 2021). In addition, the structural provider impacts how the patient interprets inputs. Patients’ perceptions and interpretations of inputs may be influenced by the actions of nurses, thereby reducing ambiguity (Bailey, 2021). Hospitals may better prepare for the unexpected by using patient boards and bedside shift reports, which can help patients feel more at ease throughout their hospital stay.

Philosophical doubt regarding disease diagnosis may arise from a person’s inability to classify illness-related experiences resulting from disinformation (Bailey, 2021). To reduce ambiguity regarding a new topic, philosophy urges practitioners to explain it in detail. For an investigation, disease theory’s uncertainty offers an appropriate and intellectual foundation that establishes the framework for determining the root cause of a particular illness. Nurses may utilize this strategy to deal with problems that seem complex to others who aren’t in the medical profession.

2. Structural aspects of the theory

In 1988, nursing theorist Merle Mishel created the Uncertainty in Illness Theory (Fitzpatrick, 2020). This middle-range theory considers uncertainty as a cognitive stressor that sickness places on patients and their families (Fitzpatrick, 2020). The notion of disease uncertainty is based on the idea of evaluating and dealing with the uncertainty of the condition. Mishel created the Uncertainty in Illness Scale, which assesses the degree of uncertainty in patients ranging from the patient’s illness to the treatment and understanding of the disease process (Bailey, 2021).

An assessment occurs when a cognitive process is used to discover the root cause of danger. The solution-finding process has just begun. An opportunity may be created by the mystery surrounding the disease’s genesis if it is seen as such. The concept of coping is a fundamental part of sickness theory (Fitzpatrick, 2020). In order to effectively deal with stress, one must use both mental and physical strategies (Fitzpatrick, 2020). How people deal with the stress of illnesses affects their perceptions of ambiguity. People become more active when they see uncertainty as a threat. Nursing staff may turn to experts to assist patients in coping with the anticipation of a new condition. Consistently delivering Medication Administration Records to patients in the surgical ward, for example, is an easy way to provide comfort (Fitzpatrick, 2020). Incorporating patients within the treatment plan has reduced anxiety and preconceptions about common diseases in these facilities (Fitzpatrick, 2020).

3. Identify an area of your practice where this theory could be applicable

Patients’ homeopathic, psychological, and social complexity is considered when interpreting ambiguity in sickness in the intensive care nursing (ICU) context. With regards to the ICU, for example, this strategy aids with a patient’s knowledge of potentially complex circumstances. In sickness theory, uncertainty gives a framework for understanding how to analyze a condition, such as patients recovering from a cardiac arrest. Mishel’s theory of uncertainty of illness can help providers obtain answers from patients regarding their illness by asking how much they understand about the disease process, how the disease affects their lives, and if they believe they will get better (Bailey, 2021). This theory has been moved from research to practice by many clinicians. By utilizing the uncertainty theory, nurses were able to identify patients’ fears of participating in physical activities due to vague physical symptoms post-cardiac arrest (Fitzpatrick, 2020). By using this theory to assess patients’ uncertainty, nurses were able to educate patients on how physical activity is vital for their health and provide appropriate interventions that will benefit the patient (Fitzpatrick, 2020).

This theory is appropriate and applicable for practice. Mishel’s theory can guide nurses in helping patients understand and cope with their uncertainty in illnesses (Bailey, 2021). Adapting this theory in practice can only help nurses aim for the best patient outcome. Nurses understand that a disease is more than just a physical condition and that physiological health is just as important as physical health. Using this theory to help patients cope and understand their disease process will help improve patient outcomes in the clinical settings.

One of the strengths of Mishel’s theory of uncertainty is that it allows practitioners to assess a patient’s uncertainty while also selecting the best interventions that will help improve both physical and physiological doubts that patients experience during times of sickness (Fitzpatrick, 2020). ICU nurses benefit greatly from uncertainty in sickness theory because it helps them build coping strategies that reduce ambiguity when confronted with a new situation.

4. Use of theory in clinical practice

The Theory of Uncertainty in Illness has become an important subject in clinical practice. Research by Fernandez-Araque et al., looked at how nurses deal with ambiguity in various conditions by this model (2020). According to the findings of this study, nurses who develop coping skills based on the uncertainty in sickness theory may improve the quality of life of their patients (Fernandez-Araque et al., 2020). Furthermore, this study proved that Mishel’s theory is a valuable tool for nurses and the interdisciplinary team as it allows for early identification of doubts and planned interventions, which will help reduce uncertainty and improve patient outcomes (Fernandez-Araque et al., 2020).

5. Evaluation of theory

It is clear from this example that nursing practice relies heavily on the idea of sickness. Nurses may use the model to help them better understand how to treat a new ailment, which in turn determines the kind of action they can take to manage it better. Risks can be reduced by selecting the optimum coping mechanism for each situation, and this technique helps practitioners do just that (Bora & Buldukoğlu, 2021). This one has advantages and disadvantages in terms of a nursing paradigm. When faced with a new situation, choosing an acceptable coping method is one of the most challenging things to do (Bora & Buldukoğlu, 2021). When faced with a novel situation, practitioners may be unable to determine the most effective way to deal with it, leading them to dread the consequences (Bora & Buldukoğlu, 2021). As a result, nurses must be educated on how to carry out this notion in hospitals. Nurses given the proper training in this area may find it easier to put the notion into practice. There will be a push to use the model, which is a way to deal with everyday and emerging issues that can be applied across a wide range of healthcare settings.


Bailey, D. E. (2021). Illness Uncertainty at 40. Western Journal of Nursing Research, 43(6), 507–508. https://doi.org/10.1177/0193945921989236

Bora, S., & Buldukoğlu, K. (2021). Using the Uncertainty in Illness Theory to provide care for the caregiver: A case report. Journal Of Psychiatric Nursing, 11(1), 70-77. http://doi.org/10.14744/phd.2019.44365

Fernandez-Araque, A., Gomez-Castro, J., Giaquinta-Aranda, A., Verde, Z., & Torres-Ortega, C. (2020). Mishel’s Model of Uncertainty Describing Categories and Subcategories in Fibromyalgia Patients, a Scoping Review. International journal of environmental research and public health, 17(11), 37-56. https://doi.org/10.3390/ijerph17113756

Fitzpatrick J. J. (2020). The Value of Uncertainty. Archives of psychiatric nursing, 34(4), 150-191. https://doi.org/10.1016/j.apnu.2020.07.025



Agency Synopsis

Sanna-Kay K. McGregor

Department of Nursing, Saint Thomas University

NUR 506: Influencing Health Policy

Dr. Teran Doris

July 7, 2022


Some of the responsibilities of public health that can be characterized by the spectrum of operations carried out by health agencies include assessment, the formulation of policies, and leadership, in addition to providing access to services in the areas of environmental, educational, and personal health. The public health system throughout the country is significantly influenced by the activities and policies of the federal government. Its mission includes, among other things, the conducting of research in the medical field, the establishment of standards, the enactment of legislation, the provision of funding for and on occasion the delivery of personal health services, the provision of technical assistance, and resources for state and local healthcare systems. This paper discusses five different agencies of health authorities at the federal, state, and local levels, including the activities they carry out and how their jobs affect APRN and those with mental health.

Keywords: agency, federal, government, health

Department of Health & Human Services (HHS)

The United States Health and Human Services (HHS) serves as a government agency charged with improving the health of Americans. Health outcomes are the agency’s primary emphasis in more than 100 initiatives that are available to the public. Aside from making health laws and guidelines, the agency has also been granted the authority to regulate the health industry and public health programs. It has enacted rules such as the HIPAA Privacy Rule, which protects personal health information and provides individuals with a number of rights.

Food and Drug Administration (FDA)

This organization is known as the Food and Drug Administration, or FDA for short. In addition to medical devices, this agency is responsible for regulating things such as food, drugs, cosmetics, and similar products. In order to protect the health of the general population, it is the responsibility of the agency to investigate and confirm that these products are both safe and effective. Graduates of APRN and DNP programs should be aware of the Food and Drug Administration (FDA) since it sets guidelines for the safety and effectiveness of pharmaceuticals and medical devices. The Food and Drug Administration (FDA) is relevant to advanced practice registered nurses (APRNs) for a number of reasons, the most important of which is that it establishes guidelines for the safe and effective use of pharmaceuticals and other types of medical technology.

Health Insurance Portability and Accountability Act (HIPAA)

There is a regulatory body inside the government that is in charge of health insurance and the provision of medical services. Within the United States’ national healthcare system, this agency is responsible for ensuring the confidentiality of patients’ medical records. Because it creates criteria for preserving the privacy of patient health information, HIPAA is a significant piece of legislation for graduates of APRN and DNP programs. Because it specifies guidelines for the exchange of patients’ health information, the Health Insurance Portability and Accountability Act (HIPAA) is related to APRNs.

The National Institutes of Health (NIH)

This organization is formally known by its full name, which is “The National Institutes of Health” (NIH). The agency’s scope of control extends to include biomedical research as well as research that is relevant to health. Research into the causes, diagnosis, prevention, and treatment of diseases and disorders within the healthcare system of the United States is one of the core functions of the agency, which is also responsible for providing funding for such research.

The National Institutes of Health (NIH) is an organization that is pertinent to the APRN/DNP graduate since the NIH funds and conducts research on the health care needs of the community. The fact that the NIH is both sponsoring and carrying out research to evaluate how effective APRN care is an essential component of the work that it is doing in this area.

Center for Disease Control & Prevention (CDC)

As a branch of the federal government, the Centers for Disease Control and Prevention (CDCP) is part of the Department of Health and Human Services (HHS). It contributes to preserving and enhancing the well-being of the American people as well as ensuring their safety. Two more major tasks of the organization are conducting scientific study on emerging health difficulties and providing guidance on how best to address public health concerns. At this time, they are working on implementing regulations and processes that will assist them in controlling the COVID-19 outbreak.

The Agency

Level of authority

Scope of Authority


Relevance to APRN/DNP

Relevance to specialty area (Mental Health)

1. Department of Health & Human Services (HHS)


Focuses on the health and well-being of all Americans of by regulation services to include prevention of epidemics, facilitate research, and social security services.

The institution also manages eleven operating departments including Medicare and Medicaid services, CDC, and Administration for Children and Families.

U.S. HHS’s objective is to improve the health and well-being of the American people by delivering effective health and human services and encouraging sound, long-term improvements in the sciences underpinning medicine, public health, and social services.

This department contains eleven operating departments, including the Center for Medicaid and Medicare services (CMS). This program currently provides health insurance to 1 in every 4 Americans. This affects the APRN because they will be able to provide care to more people and be able to bill CMS directly.

This department ensure that clinical trials employ medications and medical equipment in a safe and effective way by creating rules for their usage.

The CMS also provides health coverage so patients with mental illness can get the care they need and be able to afford their prescriptions.

2. Food and Drug Administration (FDA)


Focuses on food and medication safety legislation.

Supports research and development to improve the safety, cost and effectiveness of foods and medicines to improve public health

The FDA provides APRN with rules and regulations relating to the most current data on foods and medications that are safe and effective to deal with patient’s health.

FDA establishes the guidelines for the use of drugs and medical devices in the treatment of patients with mental health.  

3. Health Insurance Portability and Accountability Act (HIPAA)


The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was a piece of federal legislation that mandated the establishment of national standards with the intention of preventing the disclosure of sensitive patient health information without the patient’s consent or knowledge.

These standards were designed to protect the privacy of patients’ medical records.

Eliminate job-locking due to pre-existing medical issues by ensuring that health insurance is portable.

Reducing healthcare fraud and misuse.

HIPAA ensures that APRNs keep patients’ information regarding their health confidential.

HIPAA also created criminal penalties for the improper disclosure of patient’s information, so APRN must maintain patient’s privacy at all times and follow the appropriate steps when disclosing patient’s information to authorized individuals.

Acts such as HIPAA protect the privacy of patients’ medical records by establishing standards for how they may be shared.

This ensures that patients with mental illness are entitles to their privacy regarding their health.

4. National Institutes of Health (NIH)

National and state

Contributes to the advancement of medical knowledge and treatment by conducting and funding healthcare research.

The NIH also oversees the National Institute of Allergy and Infectious Diseases

Research causes and remedies for both common and uncommon illnesses.

Work to uncover new methods of disease prevention.

Research carried out by the NIH helps the APRN gain knowledge about the most up-to-date treatments available for various conditions.

Research supported by the NIH help to enhance treatments of patients, including those with mental conditions.

5. Center for Disease Control & Prevention (CDC)


Preventing and reacting to new infections is the main focus.

The agency is in charge of keeping track of diseases, birth deformities, and genetics, as well as passengers’ well-being and improving emergency response and readiness.

The CDC is one of the most important agencies in healthcare. They regulate treatment and identify protocols to deal with any and all illnesses. This is important to an APRN because they have to follow and abide by the rules set in place by the CDC for the treatments of various health conditions, for example, controlling the COVID-19 outbreak.

The CDC provides statistics regarding the effect of mental health in the United States.

It also helps with policies regarding new treatments for mental conditions.


Furnival, J., Boaden, R., & Walshe, K. (2018). Assessing improvement capability in healthcare organisations: a qualitative study of healthcare regulatory agencies in the UK. International Journal for Quality in Health Care, 30(9), 715-723.

Macrae, C. (2019). Reconciling regulation and resilience in health care. In Resilient health care (pp. 111-122). CRC Press.

Pesapane, F., Volonté, C., Codari, M., & Sardanelli, F. (2018). Artificial intelligence as a medical device in radiology: ethical and regulatory issues in Europe and the United States. Insights into imaging9(5), 745-753.

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