Background:
There has been little research to date exploring nurses’ uncertainty in their practice.
Understanding nurses’ uncertainty is important because it has potential implications for how care is
delivered.
Purpose:
The purpose of this study is to develop a substantive theory to explain how staff nurses
experience and respond to uncertainty in their practice.
Methods:
Between 2006 and 2008, a grounded theory study was conducted that included in-depth
semi-structured interviews. Fourteen staff nurses working in adult medical–surgical intensive care units
at two teaching hospitals in Ontario, Canada, participated in the study.
Findings:
The theory recognizing and responding to uncertainty characterizes the processes through
which nurses’ uncertainty manifested and how it was managed. Recognizing uncertainty involved the
processes of assessing, reflecting, questioning, and/or being unable to predict aspects of the patient
situation. Nurses’ responses to uncertainty highlighted the cognitive–affective strategies used to manage
uncertainty.
Discussion:
Study findings highlight the importance of acknowledging uncertainty and having col-
legial support to manage uncertainty. The theory adds to our understanding the processes involved in
recognizing uncertainty, strategies and outcomes of managing uncertainty, and influencing factors.
Implications:
Tailored nursing education programs should be developed to assist nurses in developing
skills in articulating and managing their uncertainty. Further research is needed to extend, test and refine
the theory of recognizing and responding to uncertainty to develop strategies for managing uncertainty.
Conclusions:
This theory advances the nursing perspective of uncertainty in clinical practice. The
theory is relevant to nurses who are faced with uncertainty and complex clinical decisions, to managers
who support nurses in their clinical decision-making, and to researchers who investigate ways to improve
decision-making and care delivery.
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Article first published online: 10 JAN 2012. DOI: 10.1111/j.1741-6787.2011.00237.x
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