Uncertainty is a common human phenomenon experienced during altered states of health. This paper describes a series of studies through which the importance of the concept was identified, the maturity of the concept was analyzed, and then, through a series of small projects, the concept was advanced toward clinical utility.
The identification of a concept for study is often a difficult task for nurse researchers. In this study, the concept of uncertainty arose is a number of projects, demanding the researcher’s further attention. The concept of uncertainty first arose in a grounded theory study of caregivers of older adults who were placing their charge into nursing home care. Uncertainty was a strong and persistent theme that permeated the experience. In other studies of comforting techniques used during nasogastric tube insertion, new caregiving relationships, and long-term caregiving relationships the behavioral state of uncertainty was again revealed. Finally, a close examination of the states of enduring and suffering (as described by Morse) revealed a unique state of being that bridged these behavioral states. That state of being was identified as uncertainty. In that a project, devoted to the development of methods for linking concepts into coherent theory, the concept received more careful analysis and the stage was set for further investigation.
Now focused on the concept of uncertainty, the researcher began investigation with a thorough concept analysis based on the method described in paper 2. Multidisciplinary literature was reviewed to reveal that the concept was partially mature. The body of literature addressing the concept was deemed adequate for use as data, and methods of concept refinement were applied to produce a more coherent theoretical definition that incorporated the major theoretical components identified in the literature. While this refined definition addressed integration of components, a more focused understanding of strategies used to manage or reduce states of uncertainty, and measurement issues, the ‘fit’ of the concept with the experiential perspective known to the researcher through the literature and personal and research insights become apparent. A discrepancy between the probabilistic attitude of the scientific conceptualization and the phenomenological experience of uncertainty became quite clear. Thus, despite these preliminary efforts toward concept advancement, the concept’s utility for practice was limited by its probabilistic orientation.
Since the discrepancy centered around issues of the human experience of uncertainty, a phenomenological study was undertaken to more clearly explicate the essence of this lived experience. Through that study, five essences were revealed: sensing control, feeling confident, reading the situation, regaining a state of normal, and shifting temporality. It was also discovered that varied types of uncertainty were mediated by one’s sense of control and confidence, and that there were two primary modes of uncertainty: situational and existential. This study made a crucial contribution to the advancement of the concept by delineating the existential forms of uncertainty and by clarifying the degree of probability experienced during states of uncertainty.
Geared with these new insights, the process of concept advancement was again resumed. Techniques of concept correction were selected to ‘right’ the scientific conceptualization toward a better representation of the human experience of uncertainty. This study resulted in a more coherent theoretical definition of uncertainty that more accurately described the human condition—a higher state of conceptual maturity. The advanced state of conceptual maturity enabled the development of assessment guides that will enable practitioners to identify types and modes of uncertainty, intervention strategies, and evaluative criteria to monitor the resolution or management of this generally dis-comforting state.
Through this series of integrated studies using multiple methods of concept advancement, the clinical utility of understanding the concept of uncertainty became clear. But, beyond this extension of theory into practice, important methodological considerations arose. It is argued that beyond the pragmatical principle of concept analysis described by Morse and colleagues, the integration of a phenomenological principle would strengthen this method of concept analysis even more. While the pragmatic principle deals with the utility of the concept for the discipline, a phenomenological principle would explicate the utility of the concept in capturing the nature of the human experience—thus, revealing important considerations for concept advancement prior to clinical implementation.
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