Theory Of Unpleasant Symptoms

Theory Of Unpleasant Symptoms

What do nurses do? The answer is usually contained within the term “care”; however, another way to describe our role is “symptom management.” Symptoms are defined as “the perceived indicators of change in normal functioning as experienced by patients. They are the subjective indicators of changes in and threats to health” (Peterson & Bredow, 2017). Nurses commonly find patients in a vulnerable state of illness, where our job is to manage its clinical manifestations, known as the signs and symptoms. It can be challenging due to the multidimensional and subjective nature of symptoms. “Theory of unpleasant symptoms” was developed to illuminate the significant features that make up the symptom experience and help guide nursing research and practice.

Linda Pugh and Renee Milligan’s “Theory of unpleasant symptoms” is a nursing theory that was developed in the 1990s (Peterson & Bredow, 2017). The framework of this theory stems from clinical practice, empirical research, and collaboration between researchers (Peterson & Bredow, 2017). Clinical researchers Linda Pugh and Audrey Gift conducted a study focusing on one symptom, fatigue, and dyspnea, respectively (Peterson & Bredow, 2017). Through the study, a model emerged that included elements that had these symptoms in common. Gift paired up with Renee Milligan, a researcher specializing in postpartum fatigue (Peterson & Bredow, 2017). Together, they identified factors that contributed to fatigue in the childbearing period and noticed how the same interventions had been applied in the treatment of dyspnea and fatigue (Peterson & Bredow, 2017). The three researchers were joined by Elizabeth Lenz, as well as Frederick Suppe, a philosopher experienced in scientific theory and nursing science (Peterson & Bredow, 2017). In the final stages of their work, the model was revised to be more reflective of the dynamic and complex real-life clinical situations (Peterson & Bredow, 2017).

The theory presents various ways in which symptoms can be measured (quality, duration, intensity) and asserts that they are additive and multiplicative in nature (Peterson & Bredow, 2017). In addition, it is proposed that symptoms may even act as catalysts for each other (Peterson & Bredow, 2017). Symptoms have factors that are categorized as physiological (i.e., age or gender), psychological (i.e., mood, reaction, or attitude to illness), and situational (i.e., noise, temperature, marital status) (Peterson & Bredow, 2017). It is also hypothesized that symptoms affect functional and cognitive status as well as performance (Peterson & Bredow, 2017). The importance of managing unpleasant symptoms is obvious to nurses in an effort to bring patients to their optimal level of functioning.

I believe that this theory is very helpful in my practice. As a labor and delivery nurse, I am frequently inquiring about the symptoms experienced by my patients. In triage, it is through the careful examination of the reported signs and symptoms that I make the determination about the priority of patients’ treatment. Some reported unpleasant symptoms are fairly benign, while others can be indicative of a very serious underlying pathological process.

I recently took care of a woman who presented to triage with complaints of headache unrelieved by Tylenol, blurry vision, and epigastric pain. She reported that she had been vomiting all day that day, gained ten pounds in the previous three days, and was feeling fatigued but also anxious about her condition. My assessment revealed that she was unmarried, and the prospective father was not supportive of the pregnancy. Understanding the pathophysiology of pre-eclampsia allowed me to recognize the urgency required in triaging this patient. It is also clear from her report how these symptoms are interrelated and how they can compound one another. The fatigue could be explained by the headache and many episodes of vomiting. Anxiety, while it had to be further explored, was completely understandable considering her current physical state and relationship status. This assessment of the symptoms and the factors that contribute to them allowed me to not only give her the best nursing care but also make appropriate referrals to other disciplines.

In conclusion, it is my belief that other nurses will find this theory very beneficial in their clinical practice. The theory takes into account many variables affecting the symptom experience yet provides clear application guidelines for nurses. In conjunction with nursing judgment, it is an invaluable tool in providing competent care.

References

Peterson, S.J., & Bredow, T.S. (2017). Middle range theories: Application to nursing research and practice [Kindle Paperwhite version]. Available from Amazon.com.

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Theory Of Unpleasant Symptoms

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