Theory of Unpleasant Symptoms

1. Theory of Unpleasant Symptoms Mary Hefferan Ferris State University

2. Objectives • Overview of the theory • Metaparadigm concepts • Person, environment, health, and nursing as defined by theory • Brief analysis • Basic concepts and description of components

3. Objectives • Exploration of theory through research • Description of research article • How the theory is reflected in research • What the theory adds to the study • Application to nursing practice • Importance of theory to nursing practice

4. Overview • Theory of Unpleasant Symptoms • Created by Elizabeth Lenz and Linda Pugh in 1995 • Objective is to “integrate existing knowledge about a variety of symptoms” (Lenz, Pugh, Milligan, Gift, & Suppe, 1997, p. 14) • Improve understanding of the experience of symptoms in various contexts • Three major concepts: • The actual symptoms • Influencing factors • Performance outcomes

5. Metaparadigm Concepts: Defined by the Theory • Person: the patient who is exhibiting the symptoms and to whom the nurse is giving care • May also include family and/or friends • Environment: where the care is taking place and situational factors that contribute to the symptom experience • Employment status, marital status, social support, access to health care

6. Metaparadigm Concepts: Defined by the Theory • Health: absence of unpleasant symptoms • Symptoms are: “perceived indicators of change in normal functioning as experienced by patients”(Lenz, Pugh, Milligan, Gift, & Suppe, 1997, p. 14) • Nursing: care taker and evaluator of symptoms and contributing factors • Establishes a relationship with the patient to better evaluate symptoms

7. Analysis of the Theory of Unpleasant Symptoms • Three Major Concepts: Symptoms, influencing factors, and performance outcomes • 1. The symptoms: • Change in normal functioning • More often occur simultaneously • Multiple symptoms occurring together results in a multiplying effect • Measured by their intensity, timing, and level of distress perceived

8. Analysis of the Theory of Unpleasant Symptoms • Influencing factors: • Physiological, psychological, and situational • Influence the symptoms alone or in concurrence • Performance outcomes: • Results of the symptom experience • Impact on ability to perform activities of daily living

9. Theory in Research Application of the Theory of Unpleasant Symptoms (TOUS) in Bariatric Surgery • Uses the TOUS during the management of patient post bariatric surgery • Case study of a 29 year old woman post bariatric surgery • Explored how the influencing factors affected her post-op outcomes • Showed that her situational factors contributed greatly to her overall health

10. Theory in Research TOUS in Application • Evaluated the factors • Physiological • Dehydration, malnutrition • Gastrointestinal dysmotility • Psychological • Adjustment to dietary changes • Situational • Lack of social support, work stressors, finances • In concurrence prolonged her recovery period

11. Source: https://fsulearn.ferris.edu/courses/1/XLIST_81147.201308/groups/_10477_1//_492347_1/Theory%20of%20unpleasant%20symptoms%20bariatric%20surgery.pdf

12. Theory in Research Differences the TOUS Made • Created a framework for the evaluation of symptoms and their contributing factors • Helped in the approach to alleviating her unpleasant symptoms • Created a new method for treating symptoms rather than medication or hospitalization

13. Theory in Research Differences the TOUS Made • Once the factors were addressed • Symptoms improved • Assessment of entire picture • Created awareness to approach willingness to change “Understanding where patients are in their willingness to change those factors…will assist clinician in understanding expectations and moving patients to healthier levels of recovery” (Tyler, R., & Pugh, C. L., 2009, p. 276) • Manages expectations of health outcomes

14. Use in Practice Neonatal Nursing Environment • Evaluation of family impact on health outcomes • Nervousness, uncomfortable with their baby • Could have a negative physiological impact • Aids nurse with appropriate interventions

15. Use in Practice Neonatal Nursing Environment • Manages expectations of outcomes • Less social support may change health outcomes • Guides appropriate creation of goals • Allows for a different perspective on assessing symptoms • “Symptom clusters” • Catalyzing effect of symptoms

16. Source: http://rnspeak.com/fundamentals-of-nursing/what-is-a-nursing-theory/

17. Importance to Nursing • Nurses assess and approach symptoms differently than other members of the healthcare field • Holistic approach • Guides nurse-patient interactions • View patients in an interactive-integrative view versus isolated cause effect health interactions

18. Importance to Nursing • Broad but focused theory • Can be used as a base for designing interventions • Uses subjective symptom experience data • Creates connections between social environments and symptom experience

19. References 1, Haworth, K. S., & Dluhy, M. N. (2001). Holistic symptom management: Modeling the interaction phase. Journal of Advanced Nursing 36(2), 302-310. Retrieved from: http://0-onlinelibrary.wiley.com.libcat.ferris.edu/doi/10.1046/j.1365-2648.2001.01972.x/pdf 2. Lenz, R. E., Pugh, L., Milligan, A. R., Gift, A., Suppe, F. (1997). The middle range theory of unpleasant symptoms: An update. Advances in Nursing Science, 19(3), 14-27. Retrieved from: http://0-ovidsp.tx.ovid.com.libcat.ferris.edu/sp-3.10.0b/ovidweb.cgi 3. Liehr, P. (2005). Looking at symptoms with a middle-range theory lens. Advance Studies in Nursing, 3(5), 152-157. Retrieved from: http://www.snjourney.com/PDFs/asin_3_5_p152_157.pdf 4. Tourville, C., & Ingalls, K. (2003). The living tree of nursing theories. Nursing Forum, 38(3), 21-36. Retrieved from: http://ferris.libguides.com/er.php?ecid=9581 5. Tyler, R., & Pugh, C. L. (2009). Application of the theory of unpleasant symptoms in bariatric surgery. Bariatric Nursing and Surgical Patient Care. 4(4), 271-276. doi: 10.1089/bar.2009.9953