Get access

Recognizing and Responding to Uncertainty: A Grounded Theory of Nurses’ Uncertainty

Authors

  • Lisa A. Cranley RN, PhD,

    1. Lisa A. Cranley, Post-doctoral Fellow, Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta, Alberta Canada; Diane M. Doran, Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, and Senior Nurse Researcher Ontario Ministry of Health and Long-Term Care, Ontario, Canada; Ann E. Tourangeau, Associate Professor, Bloomberg Professor in Patient Safety, and Senior Nurse Researcher, Ontario Ministry of Health and Long-Term Care, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Andre Kushniruk, Professor, School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada; Lynn Nagle, Assistant Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada.
    Search for more papers by this author
  • Diane M. Doran RN, PhD,

    1. Lisa A. Cranley, Post-doctoral Fellow, Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta, Alberta Canada; Diane M. Doran, Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, and Senior Nurse Researcher Ontario Ministry of Health and Long-Term Care, Ontario, Canada; Ann E. Tourangeau, Associate Professor, Bloomberg Professor in Patient Safety, and Senior Nurse Researcher, Ontario Ministry of Health and Long-Term Care, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Andre Kushniruk, Professor, School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada; Lynn Nagle, Assistant Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada.
    Search for more papers by this author
  • Ann E. Tourangeau RN, PhD,

    1. Lisa A. Cranley, Post-doctoral Fellow, Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta, Alberta Canada; Diane M. Doran, Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, and Senior Nurse Researcher Ontario Ministry of Health and Long-Term Care, Ontario, Canada; Ann E. Tourangeau, Associate Professor, Bloomberg Professor in Patient Safety, and Senior Nurse Researcher, Ontario Ministry of Health and Long-Term Care, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Andre Kushniruk, Professor, School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada; Lynn Nagle, Assistant Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada.
    Search for more papers by this author
  • Andre Kushniruk PhD,

    1. Lisa A. Cranley, Post-doctoral Fellow, Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta, Alberta Canada; Diane M. Doran, Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, and Senior Nurse Researcher Ontario Ministry of Health and Long-Term Care, Ontario, Canada; Ann E. Tourangeau, Associate Professor, Bloomberg Professor in Patient Safety, and Senior Nurse Researcher, Ontario Ministry of Health and Long-Term Care, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Andre Kushniruk, Professor, School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada; Lynn Nagle, Assistant Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada.
    Search for more papers by this author
  • Lynn Nagle RN, PhD

    1. Lisa A. Cranley, Post-doctoral Fellow, Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta, Alberta Canada; Diane M. Doran, Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, and Senior Nurse Researcher Ontario Ministry of Health and Long-Term Care, Ontario, Canada; Ann E. Tourangeau, Associate Professor, Bloomberg Professor in Patient Safety, and Senior Nurse Researcher, Ontario Ministry of Health and Long-Term Care, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Andre Kushniruk, Professor, School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada; Lynn Nagle, Assistant Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada.
    Search for more papers by this author

  • Dr. Cranley wishes to thank her doctoral committee members for their support and guidance. Dr. Cranley acknowledges the financial support of a Doctoral Fellowship from the Canadian Institutes of Health Research. We gratefully acknowledge the unit managers for their time and the nurses who participated in the study for sharing their time, experiences and perspectives.

Dr. Lisa Cranley, Faculty of Nursing, University of Alberta, 8440 112 Street, Clinical Sciences Building Edmonton, AB Canada T6G 2G3; lisa.cranley@nurs.ualberta.ca

ABSTRACT

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 collegial 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.

Ancillary