The theory of unpleasant symptoms is a middle-range theory that argues that symptoms are multidimensional and share various similarities. Lenz (2018) establishes that the theory was developed to guide the nursing practice in understanding and to improve the various aspects of the symptoms experienced by the individual. It establishes that symptoms are a complex phenomenon as perceived by the patient; secondly, various influencing factors make an individual experience the symptoms the way they do and the consequence of the symptom (Lenz, 2018). The theory focuses on the individual and their symptoms to guide the whole treatment process; thus, it can be used as an effective assessment tool.
As an assessment tool, it is important to look at the individual’s symptoms as explained or perceived by the patient. Based on the theory, the nurse is prompted to argue that symptoms occur due to various interacting factors; however, they should understand the symptoms presented by the patient. Therefore, the assessment tool would look at the severity of the symptoms by asking questions like scaling their pain levels. With the symptoms scaling higher, it may give the healthcare professional an idea of the dosage needed for relieving that particular intensity of the symptoms.
Secondly, as an assessment tool, understanding the timing of the onset of the symptoms and the duration is essential. This is because it guides the nurse to understand how long the patient has been suffering, which may guide the treatment process as it also highlights the symptoms’ persistence and frequency (Gomes et al., 2019). Consequently, an assessment tool should evaluate how the patient perceives the symptom. This entails understanding the nature of the symptoms experienced. Patients presenting pain symptoms can be required to describe the kind of pain they are experiencing, for example, a burning or cramping pain. These are essential elements to look for in an assessment tool: its ability to understand the symptoms from the patient’s perspective and the symptoms’ timing, quality, and intensity.
Palacios-Ceña et al. (2021) establish that an assessment tool should not only identify the symptoms as explained by the individual but also interpret the potential outcome for any intervention implemented. Interpretation of the symptoms also involves comparing and contrasting the most severe and ordinary symptom patterns. This is because the theory establishes that symptoms manifest differently depending on the associating factors, which differs with the individual. Therefore, as a practical and effective assessment tool, the nurse should be able to interpret the symptoms as presented by the patient based on their experience and nursing knowledge. This entails understanding that each individual is exposed to different aspects of life that contribute to their symptoms; thus, intervention should be individual-specific based on the specific symptom interpretation.
A practical assessment tool should also evaluate how the symptoms bother the patient. For example, if the pain is manageable or not is an essential factor to consider when assessing. Srivastava and RM (2021) argue that this element of the assessment tool influences important procedures like triage during a medical emergency. Also, an effective assessment tool would look at the contributing factors to eliminate the risks that may worsen the situation. This aligns with the theory’s second component, which argues that patient experiences symptoms influenced by their psychological, physiological, and situational factors.
The psychological factors involve the individual’s mental state. Kalantar-Zadeh et al. (2022) argue that a person’s mental state plays an important role in their perception of disease and the healing process. As an assessment tool, it will evaluate factors like the individual’s understanding of their symptoms, illness, or mood. This is because such factors can play an essential role in influencing the symptoms. For example, when an individual considers their symptoms attributed to death, treatment will involve measures to address this perception.
On the other hand, physiological factors entail external issues that may affect the body and influence the symptoms experienced. Lenz (2018) argues that the physiological factors include age or gender and other variables related to health. This is because such factors influence how different diseases manifest in the body, including the symptoms presented. For example, an older woman may suffer from a simple cold but have intense symptoms compared to a middle-aged woman because of the immunocompromised situation of the older woman due to her age. Also, such factors influence how the body reacts to different medications, creating importance in an assessment tool.
Situational factors are factors that do not involve the individual directly. These are his external environment that has the potential to explain their symptoms or influence their manifestation of them (Lenz, 2018). These situational factors may include lifestyle behaviors, social support systems, or accessibility to care that affect the individual’s symptoms. For example, a person who could receive immediate care after an accident due to situational factors like reduced accessibility can lead to amputation because of the spread of the bacteria or virus, which healthcare experts could have controlled immediately if the individual had been brought to the hospital. Therefore, an effective assessment tool should assess the disease and symptoms beyond the physical care domain.
Further, to determine the effectiveness of an assessment tool is its ability to recognize the individual’s performance in relation to physical or cognitive functioning. For example, the tool should assess how the symptoms affect the individual’s ability to perform their daily activities, meaning they will have to depend on others which may affect the manifestation of their symptoms, especially for the worse. This is highlighted by the theory that argues that symptoms may affect the individual’s performance contributing to the complexity of the symptoms presented (Srivastava and RM, 2021).
When measuring the consequences of the symptoms, frequent individual monitoring is necessary. Mikšić et al. (2018) establish that frequent monitoring highlights whether the symptoms are getting worse since the patient’s last interaction with the healthcare personnel. This is especially necessary for monitoring the effects of a particular intervention in addressing the symptoms presented, similar to how the theory suggests frequent monitoring of the performance of the symptoms. Monitoring the performance helps diagnose, which is the main function of any assessment tool.
Monitoring the performance also highlights what the patient is willing to accept so as to receive appropriate help. For example, during monitoring, when pain does not subdue even after the use of painkillers, the nurse could recommend a high dose that can cause the patient to become drowsy, which some patients do not agree with as they want to know everything concerning their treatment and sleeping is not an option. Therefore, the theory highlights the importance of monitoring to understand the patient and how much they can take to receive the appropriate help.
The theory establishes that symptoms presented are because of an interaction of different aspects of the individual’s life. As established, an effective assessment tool should guide the treatment process so that there is no disease recurrence. This can be established by incorporating different professionals and individuals necessary to address all the causative agents and the influencing factors. For example, a nurse taking up the educator role to advice the patients on proper nutrition in addressing all symptoms associated with obesity prevents future readmissions, which is important when developing a treatment plan as directed by the assessment tool.
The theory centers its argument on the patient, which is essential in an assessment tool and the shift in the healthcare system to patient-centered care. This is evidenced by the theory’s insistence on understanding symptoms and all associated factors from the patient’s perspective. This is because different people experience symptoms differently and what they are willing to do to eliminate the unpleasant symptoms (Mikšić et al., 2018). For example, patients who observe certain religious practices like not allowing blood transfusion or the use of particular drugs may not be willing for such interventions to be involved. Thus, the nurse has to come up with an alternative option. This is because the theory recognizes the psychological influence on an individual’s health, including their beliefs which may negatively affect the outcome of the intervention or worsen the symptom. Therefore, an effective assessment tool should be individual-specific.
Further, an effective assessment tool should not provide one particular intervention measure due to the diversity of individual symptoms, including their manifestation. For example, throughout the theory of Unpleasant Symptoms, the developers do not develop any intervention or recommend any particular way of treatment (Kalantar-Zadeh et al., 2022). This is because different symptoms indicate different dysfunctioning of the body, and thus, applying one particular intervention may not be effective. Thus, the theory provides effective guidance in developing an essential and effective assessment tool due to its comprehensiveness. This is evidenced by the careful selection of the appropriate questions to ask as guided by the proven reliable and practical theory and minimizes the caregiver’s burden in providing optimal care and the patient receiving the care.
Thus, the theory guides in highlighting the different components that should be included in an assessment tool. This includes the ability of the tool to evaluate the individual’s symptoms in detail, provide care beyond the physical realm and understand the individual’s performance in relation to the symptoms presented (Palacios-Ceña et al., 2021). All these are necessary for implementing a plan of care for optimal health as it will address all components that interact to produce the manifested symptoms reducing the possibility of recurrence. It also sets the pace for the recovery process; for example, when the individual’s situational factors include a social support system, early discharge and self-care recovery interventions may be included.
Conclusively, the various components of the theory of unpleasant symptoms provide an overall ideology of what an effective assessment tool should look for and evaluate. Impressively, the theory’s ability to guide interventions beyond the physical realm of care is an important aspect of an effective assessment tool. However, further published accounts of the use of the theory to guide the assessment process are necessary not only because of the diverse theories in the nursing practice to choose from but also for the development of nursing knowledge. Published accounts and experiences when dealing with different patients and symptoms will facilitate the theory’s improvement, thus improving and refining its guidance towards an effective intervention tool.
References
Gomes, G. L. L., Oliveira, F. M. R. L. D., Barbosa, K. T. F., Medeiros, A. C. T. D., Fernandes, M. D. G. M., & Nóbrega, M. M. L. D. (2019). Theory of unpleasant symptoms: a critical analysis. Texto & Contexto-Enfermagem, 28. https://www.scielo.br/j/tce/a/kBHmH49RwkkYGkN5wzGXxjP/?format=html&lang=en
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. https://www.nature.com/articles/s41581-021-00518-z
Lenz, E. R. (2018). Application of the theory of unpleasant symptoms in practice: A challenge for nursing. Investigación En Enfermería: Imagen Y Desarrollo, 20(1). https://www.redalyc.org/journal/1452/145254388001/145254388001.pdf
Mikšić, Š., Bošnjaković, M., Simić, I., Stanić, B., Stanković, M., & Stojkov, Ž. (2018). Theory of Unpleasant Symptoms and Concept of Nursing Support. Southeastern European Medical Journal: SEEMEDJ, 2(2), 17-22. https://hrcak.srce.hr/file/319193
Palacios-Ceña, D., Talavera, B., Gómez-Mayordomo, V., Garcia-Azorin, D., Gallego-Gallego, M., Cuadrado, M. L., & Guerrero-Peral, Á. L. (2021). Understanding the diagnoses and medical care experience of patients with new daily persistent headache: a qualitative study in Spain. BMJ open, 11(8), e048552. https://bmjopen.bmj.com/content/11/8/e048552.abstract
Srivastava, S. P., & RM, N. T. (2021). Insight into the theory of unpleasant symptoms. https://www.researchgate.net/profile/Saumya-Prakash-Srivastava/publication/351613547_Insight_into_the_theory_of_unpleasant_symptoms/links/60a0a25192851cfdf3381647/Insight-into-the-theory-of-unpleasant-symptoms.pdf
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