In contrast to the all-encompassing grand theories, middle-range theories have a narrower scope and focus purely on particular nursing phenomena. However, their role is to bridge the gap between abstract concepts and practical applications. Through these targeted lenses, the current abstraction level can be better controlled, which will be helpful in research activities and clinical practice (Peterson & Bredow, 2020). Middle-range nursing theories have been created through research, well-known grand theories, or other disciplines. So, these theories provided the means of information comprehension about particular aspects of patient care, which, in turn, helped develop evidence-based practice within the nursing profession. Utilizing the nursing theories at the middle level in nursing research provides certain benefits that include connecting the gap between the prominent theories’ generalizations to specific practice models. These theories, with the narrow scope of the phenomenon, serve to create a framework that is easily applicable in research endeavors; it helps to choose relevant variables and to develop testable hypotheses (Peterson & Bredow, 2020). These researchers, in turn, can use these target interventions to study particular phenomena in nursing practice in more detailed and precise ways, leading to knowledge that can be directly applied in real-life patient care situations. Vaughn et al. (2021) study was the one that intended to find out whether mobile health (mHealth) technology can be an option for tracking symptoms in children and teenagers who are being diagnosed with even more severe illnesses such as cancer and blood and marrow transplantation. Therefore, the study was based on the Theory of Unpleasant Symptoms (TOUS) since this theory was a paradigm for describing the dynamics of the symptoms experienced by children and adolescents diagnosed with life-threatening illnesses. The Theory TOUS is used as the theoretical foundation of nursing research because it describes the multidimensional perceptions of patients’ symptom experiences, which is the basis upon which interventions can be improved and may be better tailored to enhance symptom management for different illnesses.
The Theory of Unpleasant Symptoms
The TOUS is a knowledge base between the two poles of the nursing science knowledge hierarchy. As Peterson and Bredow (2020) have noticed, the TOUS theory is unique because it was the first to discover that the symptoms might be experienced together. Also, they may be connected. Hence, having a single symptom may also work for many other symptoms, enabling comprehensive care and thus yielding better patient outcomes. The authors also propose the TOUS as a platform where knowledge of treating several symptoms or a single symptom can be obtained. The TOUS can be described as a theoretical framework for describing patient symptoms in circumstances such as cancer, heart failure, and transplant surgery, according to Peterson and Bredow (2020).
The theory focuses on the relationships between biological, psychological, and situational factors and their influence on symptom response and perception. The TOUS posits a bidirectional relationship: symptoms can adversely affect functional capacity, and a parallel relationship also exists between functional capacity (like activity level) and the severity of symptoms (Kang & Kim, 2022). This focus on the interrelatedness among these factors means that TOUS is a good tool for understanding/sorting out various symptom manifestations in patients.
By understanding that the symptoms include emotional, situational, and external stimuli, the TOUS incorporates facts from physiology, psychology, and situational factors. The theory posits a tripartite structure: the symptoms as well as the individual, personalized treatment, and the events that can result from the disorder (Peterson & Bredow, 2020). At the start, it was a view that the symptoms worsened the concentration and coordination symptoms, and it was one-way, but later revision made room for the reciprocal relationship. This dynamic view appreciates that the performance of any activity, be it reduced physical activity because of pain, can also aggravate the symptom picture. The TOUS framework, a well-known product, is continuously undergoing improvement and provides the basis for evaluating symptom management strategies and patient outcomes (Peterson & Bredow, 2020).
Thus, the theory’s focus on the multifaceted nature of symptoms provides a platform for nursing research (Peterson & Bredow, 2020). This theory focuses on the complex relationship between physiological, psychological, and situational factors influencing a patient’s interpretation of symptoms like pain, fatigue, or nausea. Using logic to guide the investigations of these interactions, the theory helps in the formulation of intervention programs that act against the symptoms and the causes that may escalate or prolong the problem. Moreover, the nursing professionals underlining the holistic approach can significantly impact the health of patients and the effectiveness of nursing care.
The proper theoretical framework for nursing research is the most crucial thing and works as a foundation that defines the study process (Nguyen et al., 2022; Peterson & Bredow, 2020). A suitable framework is responsible for formulating research questions by presenting central notions and theories that outline the subject matter. Now, the framework plays a role in forming the hypotheses’ propositions that also come from the theory itself (Hancock et al., 2021). Ultimately, the theoretical framework leads to the choice of data collection method. Stating the critical variables and showing their relationships suggests better ways to collect and analyze the data. Thus, research will be based on the chosen theory, which makes the study results more robust and well organized.
Research Article Analysis
Vaughn and his colleagues (2021) explored the possibility of using mobile health (mHealth) technology to assess symptoms in outpatient pediatric and adolescent patients with life-threatening illnesses. The study on health utilization in patient-generated symptom data and patient perception of symptom management employed wearable and smartphone applications using a mixed methods approach. The research sought to enhance the response to signs and symptoms of the unique population, hence improving the implementation of more advanced and targeted interventions.
The researchers’ choice of TOUS as the theoretical framework in their study (Vaughn et al., 2021) was especially perfect because it was precisely related to the research question that was focused on symptom dynamics in an already-specified pediatric population. The TOUS consists of a holistic and organized system of knowledge, which captures all the facets of what it means to experience symptoms, including dimensions such as the symptoms’ timing, intensity, duration they last, distress, and overall quality. Researchers concentrated on TOUS being the main subject of their study since they must grasp the diverse symptoms distress patients go through during the severe conditions they confront when facing life-threatening challenges. Researchers working on the Tous platform took the robust groundwork to further examine their symptom progression as patients’ perception.
Thus, the researchers were guided toward formulating symptom control strategies adapted to the specific requirements of pediatric patients suffering from life-threatening diseases (Kalantar-Zadeh et al., 2022). This theoretical model, as well as the systematic approach it permitted, delivered a thorough understanding of the symptom evolution and, thus, used much information to design evidence-based interventions to improve symptom recognition and management within this population.
The TOUS became the foundation for the theoretical justification of this study, which provided a guideline for investigating symptom dynamics in pediatric and adolescent individuals who are at risk of dying. The researchers operationalized the theory’s basic tenets, such as timing, intensity, duration, distress, and quality of symptoms, by structuring their study to explore each of these aspects separately. Through this, we could examine the lived experiences of these kids and teens through a lens of sophistication. As a result, the study provided a holistic view of the highly complicated problems and distress the members of the patient population have to deal with when managing symptoms.
Besides, the TOUS contributed to the data analysis and interpretation methods achieved through the mHealth system. This approach was stepwise, as we delved deep into the symptom progression and patient perspectives. Moreover, the theory motivated the formation of targeted interventions that focused on the identified symptom management issues from the study. The researchers pointed out that the theoretical framework helped them express the patients’ symptoms and connect the findings with particular strategies. This method can allow participants to recognize their symptoms earlier, tracking, and management. The last part, the TOUS, specifically the health and well-being of children and youth in such circumstances, has been given an emphasis; consequently, the strategy to improve their health and well-being can be established through the research.
Effectiveness of the TOUS in the Study
Vaughn et al. (2021) confirm that besides being just a theoretical model, the TOUS theory allows for a different, holistic understanding of symptomatology in pediatric patients with life-threatening illnesses. The n compile is organized with TOUS’s main features: symptom incidence, severity, duration, bothersomeness, and function. Via this connection, a thorough and complete prognosis is gained, and this is the integration that informs the context in which these young people are raised (Vaughn et al., 2021). Therefore, TOUS is a fabulous tool for all the people who want to gain insight from the given data and understand it. Symptoms can be better understood, and the patient’s subjective experiences can be explored through these tools. In addition, the TOUS platform will be used for the different intervention strategies developed to tackle the changes in symptom management as detected earlier in the study. This method of middle-range theory works is significant for empirical studies. That is the facet through which general ideas are turned into practical methods. These practices offer unique opportunities to improve children’s knowledge about consistent surveillance and autonomy over their health.
Conclusion
However, unlike grand nursing theories, which are broad in their conceptualization, middle-range theories have a narrower scope and thus fill the gap between the theoretical and practical fields. These theories are based on empirical research and offer real-world facts to inform clinical decision-making. Vaughn et al. (2021) use the Middle-Range Theory of Unpleasant Symptoms as a theoretical construct to determine the efficacy of mobile health (mHealth) technology for monitoring symptoms in children and teenagers with life-threatening disorders like cancer and blood and transplantation. The strength of the selected theory is the symptom expression-pattern explanation of the selected population. It provides a complete and systematic framework for documenting the details of the symptom experiences, covering aspects like duration, distress, intensity, timing, and symptom quality. By leveraging such information, practitioners acquire an inclusive perspective of the nature of patient symptoms, providing ground for subsequent interventions that reduce the severity of the symptoms.
References
Hancock, D. R., Algozzine, B., & Lim, J. H. (2021). Doing case study research: A practical guide for beginning researchers.
Kalantar-Zadeh, K., Lockwood, M. B., Rhee, C. M., Tantisattamo, E., Andreoli, S., Balducci, A., … & Li, P. K. T. (2022). Patient-centered approaches for the management of unpleasant symptoms in kidney disease. Nature Reviews Nephrology, 18(3), 185-198.
Kang, J. H., & Kim, M. J. (2022). Factors influencing the health-related quality of life in Korean menopausal women: a cross-sectional study based on the theory of unpleasant symptoms. Korean Journal of Women Health Nursing, 28(2), 100.
Nguyen, T. N. M., Whitehead, L., Dermody, G., & Saunders, R. (2022). Using theory in qualitative research: Challenges, framework development, and exemplar. Journal of Advanced Nursing, 78(1), e21-e28.
Peterson, S.J., & Bredow, T.S. (2020). Middle Range Theories. Application to Nursing Research and Practice (5TH Edition). Wolters Kluwer.
Vaughn, J., Shah, N., Docherty, S. L., Yang, Q., & Shaw, R. J. (2021). Symptom monitoring in children with life-threatening illness: A feasibility study using mHealth. Advances in Nursing Science, 44(3), 268–278.
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