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What would you look for in a patient symptom assessment tool, using the theory of unpleasant symptoms as a guide?

What would you look for in a patient symptom assessment tool, using the theory of unpleasant symptoms as a guide?

What would you look for in a patient symptom assessment tool, using the theory of unpleasant symptoms as a guide?

QUESTION
What would you look for in a patient symptom assessment tool, using the theory of unpleasant symptoms as a guide?
What would you look for in a patient symptom assessment tool, using the theory of unpleasant symptoms as a guide?

ANSWER
Nursing care revolves around symptoms. A large portion of what nurses do for and with patients is centered on symptoms: measuring them, assessing factors that may influence changes, developing prevention and management strategies, and assisting patients with ongoing monitoring and self-management. The Theory of Unpleasant Symptoms (TOUS) was created to highlight key aspects of the symptom experience in order 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 is composed of three major components: the symptom(s), the factors that influence the symptom (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, knowledge about and understanding of the illness). 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, which is broadly defined to include physical, cognitive, and social role performance (1,2).

The TOUS highlights the complexities of symptoms while also suggesting potential preventive and management strategies. The three related categories of influencing factors, according to the theory, influence the occurrence of one or more symptoms as well as how they are experienced. In turn, the symptom(s) affect the individual’s performance, which can in turn influence the symptom experience and the influencing factors. The theory excludes explicit 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 some examples of practice applications that would be 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 on a regular basis to track progress.
5. The treatment plan would include short- and long-term symptom and performance monitoring, as well as instruction to encourage patient self-monitoring and self-care.
Those nurses attempting to put the TOUS into practice are likely to face some difficulties. For starters, many practicing nurses do not consider theory to be useful, in part 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, as well as convincing evidence of its utility and ease of comprehension. Second, the TOUS emphasizes that effective symptom prevention and management necessitates going above and beyond standard physical care. Several successful applications of the theory have involved multidisciplinary teams and are quite complex. Teamwork is never easy. It takes more time than individual decision-making and action. It necessitates enthusiastic, dedicated leadership as well as excellent and frequent communication and coordination. Third, because of its complexity, implementing the entire TOUS at once would necessitate 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 a large number of measures that would be repeated over time. As a result, the instruments to be used must be carefully chosen to ensure high reliability, validity, efficiency, and practicability while minimizing patient and caregiver burden.

Because the TOUS’s origins were in practice, it is applicable. Smith and Liehr (3) classify it as a “ready for application” theory. Clinical application examples are expanding to include an increasing number of symptoms, clinical populations, and settings. Despite this progress, the lack of published evidence to guide applications remains a challenge for those wishing to apply the theory. As a result, we encourage nurses and their colleagues to not only use the TOUS in practice, but also to publish accounts of their experiences and findings in clinical and research journals. This information will be critical in refining the theory, advancing symptom science, and improving the lives of patients.

What would you look for in a patient symptom assessment tool, using the theory of unpleasant symptoms as a guide?

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