Topic: Cancer of the urinary bladder affects thousands of Americans every year. Cystectomy with urinary diversion continues to be a mainstay of treatment for patients with muscle invasive disease. Patients diagnosed with bladder cancer and undergoing cystectomy are confronted with many areas of uncertainty during their disease treatment. Uncertainty regarding the outcome of the operation includes the stage of the disease as well as which urinary diversion will result from the operation. There is also uncertainty about the post operative experience including adaptation to a urinary diversion. The WOC nurse plays a role in reducing uncertainty by incorporating teaching through out each phase of the operative experience.

Purpose: Mishel's theory of uncertainty in illness was developed to address uncertainty in illness with the reconceptualized theory addressing those who are experiencing a chronic illness or an illness with the possibility of recurrence. This uncertainty exists in the presence of an ambiguity of the situation, as well as a complexity and unpredictability of the situation. The role of the WOC nurse in reducing uncertainty for patients undergoing cystectomy within the structure provider frame can be accomplished with teaching through out each phase of the operative experience. Patients can benefit from the information that the WOC nurse can provide as a credible authority. This includes written information on the expectations for the pending operation and the experiences through out the trajectory of the operative period.

Objective: To develop tools to decrease the experience of uncertainty in illness when undergoing a cystectomy with a continent urinary diversion.

Outcomes: Theory specific outcomes and goals for the patient undergoing a cystectomy integrate acceptance of health status, knowledge of treatment procedure and knowledge of treatment regimen. These outcomes can be monitored by knowledge and acceptance. Increasing knowledge and acceptance have been identified as measures to decrease uncertainty.