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(solved) Using The Theory Of Unpleasant Symptoms As A Guide, What Would You Look For In An Assessment Tool For Patient Symptoms

(solved) Using The Theory Of Unpleasant Symptoms As A Guide, What Would You Look For In An Assessment Tool For Patient Symptoms

Using The Theory Of Unpleasant Symptoms As A Guide, What Would You Look For In An Assessment Tool For Patient Symptoms


Nursing care revolves around symptoms. A large portion of what nurses do for and with patients is centered on signs:

  • Measuring them.
  • Assessing factors that may influence changes.
  • Developing prevention and management strategies.
  • Assisting patients with ongoing monitoring and self-management.

The Theory of Unpleasant Symptoms (TOUS) was created to highlight key aspects of the symptom experience to improve understanding and guide nursing research and practice. It’s exciting to see how international interest in the theory and its applications has grown.

The TOUS comprises three major components: the symptom(s), the factors that influence the sign (influencing factors), and the performance outcome. Symptoms are defined subjectively by the theory, as perceived by the patient. Symptoms are proposed to vary in intensity, timing (e.g., time of onset, duration), the patient’s distress, and quality (how they feel). Two or more symptoms can occur concurrently, a phenomenon known as a symptom cluster. Multiple symptoms can have the same or different causes, and their effects can be cumulative or multiplicative. The TOUS encourages thinking beyond the physical realm of care by categorizing influencing factors as physiological, psychological, and situational. Age, gender, and variables related to the illness(es) and treatments are examples of physiological factors. Mood and cognition are two psychological factors (for example, knowing about and understanding the disease). They have a significant impact on symptoms. Situational factors are outside of the individual’s control. They emphasize the potential impact of the patient’s physical and social environments. The symptom experience results in performance, broadly defined as physical, cognitive, and social role performance.

The TOUS highlights the complexities of symptoms while suggesting potential preventive and management strategies. According to the theory, the three related categories of influencing factors influence the occurrence of one or more symptoms and how they are experienced. In turn, the symptom(s) affect the individual’s performance, which can influence the symptom experience and the influencing factors. The theory excludes direct interventions. It is instead assumed that many of the TOUS components and relationships could be targeted for intervention.

Several studies have found the TOUS to be effective in practice. It should be noted that these applications have multiple components, all of which include patient and family caregiver education. The following are examples of practice applications consistent with the theory.

1. Symptom assessment would consider not only intensity but also timing, distress, and quality; it would go beyond the symptoms typically associated with the patient’s presenting illness, and it would be ongoing to monitor change.

2. The intake history would be thorough, addressing potential psychological, environmental, and physiological influences.

3. Interventions would address the modifiable influencing factors, such as psychological issues, particularly anxiety and depression; multiple intervention strategies would most likely be required.

4. Performance outcomes would be evaluated regularly to track progress.

5. The treatment plan would include short- and long-term symptom and performance monitoring and instruction to encourage patient self-monitoring and self-care.


Those nurses attempting to put the TOUS into practice will likely face some difficulties. For starters, many practicing nurses do not consider the theory helpful, partly because many theoretical frameworks are too abstract and esoteric to provide guidance. As a result, the first step would be to provide instruction on the TOUS and convincing evidence of its utility and ease of comprehension. Second, the TOUS emphasizes that effective symptom prevention and management necessitate going beyond standard physical care. Several successful applications of the theory have involved multidisciplinary teams and are pretty complex. Teamwork is never easy. It takes more time than individual decision-making and action. It necessitates enthusiastic, dedicated leadership and excellent and frequent communication and coordination. Third, because of its complexity, implementing the entire TOUS at once would require more effort and expense than is typically feasible. Parts of the theory could be used. Team members should ideally agree on professional and patient priorities before deciding which aspects to apply. Fourth, ideally, applying the theory entails many measures that would be repeated over time. As a result, the instruments used must be carefully chosen to ensure high reliability, validity, efficiency, and practicability while minimizing patient and caregiver burden.

Using The Theory Of Unpleasant Symptoms As A Guide, What Would You Look For In An Assessment Tool For Patient Symptoms


Using The Theory Of Unpleasant Symptoms As A Guide, What Would You Look For In An Assessment Tool For Patient Symptoms

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