• Lisa A Cranley, Diane M Doran, Ann E Tourangeau, Andre Kushniruk, and Lynn Nagle.
• Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta, Alberta Canada. lisa.cranley@nurs.ualberta.ca
• Worldviews Evid Based Nurs. 2012 Aug 1; 9 (3): 149-58.

BackgroundThere 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.PurposeThe purpose of this study is to develop a substantive theory to explain how staff nurses experience and respond to uncertainty in their practice.MethodsBetween 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.FindingsThe 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.DiscussionStudy 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.ImplicationsTailored 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.ConclusionsThis 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.©2012 Sigma Theta Tau International.

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