Application of the Theory of Unpleasant Symptoms

Application of the possible action of Unpleasant SymptomsThe Application of the Theory of Unpleasant Symptoms In Pediatric nurse PracticeKrista KellyIntroductionEvery human be regardless(prenominal) of age, ethnicity, socioeconomic status or visible ability leave alone have sex twinge or sulfurous presages at some point in their lives. hassle squeeze out be defined as an unpleasant, essential sensory and ruttish check associated with actual or potential tissue damage (International sleeper for the Study of painful sensation, Subcommittee on Taxonomy, 2008). This definition acknowledges not only the corporeal spirit of the annoying get word, but also recognizes the mental aspect. Pain is a highly subjective experience and endure only be accurately set forth by the person experiencing it. According to the Registered Nurses Association of Ontario (2013), nurses have an ethical office for prizeing and in alleviating pain using appropriate, evidence informed pain management. It also states that nurses be also obligated to advocate for change in the conduct pattern when pain relief is inadequate.The possible action of unpleasant symptoms (TOUS) is a middle-range hypothesis that was create by nurses to enhance the registering of relationships among multiple symptoms and symptom experiences to manage unpleasant symptoms through effective interventions (Lee, Vincent Finnegan, 2017). The TOUS has tether major concepts that will be discussed in further detail throughout this paper. The purpose of this paper is to describe, analyze and treasure the TOUS and its relevance to pediatric treat practice. This paper will key a clinical situation on a pediatric unit and will indicate how the TOUS provides direction for guiding treat practices. Lastly, this paper will assess the receipts, strengths and weaknesses of the TOUS.Description of TheoryAccording to Smith Parker (2010), theories support guide our actions, attention us reach desi red results and give evidence to what has been previously achieved. Specifically, middle-range theories are abstract, yet are concrete enough that it provides a link in the midst of nurse research and practice. The middle-range theory of unpleasant symptoms was introduced in 1995 as a means for incorporating existing information about a variety of symptoms (Lenz, Pugh, Milligan, Gift, Suppe, 1997).The TOUS incorporates iii major components the symptoms that a patient is undergoing, the factors that work on symptoms and that give rise to the disposition of the symptoms, and the effects of the symptom experience. Each individual symptom is considered a flat experience that can be measured together with other symptoms or measured independently (Lopes- Junior, de Omena Bomfim, Nascimento, Pereira-da-Silva, Garcia de Lima, 2015). Although symptoms differ from one another, they share four common land domains including duration, intensity, quality and distress.The duration of a sy mptom refers to the time that the symptom occurs at, or the frequency of the symptom. Intensity indicates the severity, strength or amount of the symptom being experienced by the individual. Whereas, the quality of pain can be apply to describe what the symptom feels like to the individual. For instance, pain can be draw as sharp, dull, achy or throbbing. Lastly, the distress domain of the symptom experience refers to the degree to which the patient is bothered by it (Lee et al., 2017). The same symptom whitethorn be unbearable to some individuals but could be much less severe to others. Thus, it is important to ask patients how much they are bothered by the symptom to gain a better understanding of how they are version the experience and the meaning they associate with it (Lenz, et al.,1997). In the TOUS, there are three factors that influence each of the previously mentioned domains physiologic factors, psychologic factors and situational factors (Lenz, Suppe, Gift, Pugh, Mi lligan, 1995). Physiologic factors allow the figure functioning of the body systems, the presence of any pathology and the individuals energy levels. Psychologic factors incorporate the individuals psychic state and their reaction to their illness. Lastly, situational factors pertain to aspects of the individuals sensual and social environment that can discover their experience and reporting of symptoms. Examples of social environment include modus vivendi behaviours, social support, employment status, and access to health care services. On the contrary, physical environments can include but are not limited to variables such(prenominal)(prenominal) as noise, light, temperature and polluted air/water all of which can influence symptoms (Lenz Pugh, 2014).According to Lenz Pugh (2014), the outcome concept in the TOUS is performance. Performance refers to the outcome or effect of the symptom experience and how it impacts the individuals functional status, cognitive functioning an d physical performance. For example, certain symptoms may affect an individuals ability to perform the activities of daily sprightliness or may castrate their memory, concentration or problem puzzle out skills (Lee et al., 2017).Application to Clinical PracticeThe assessment and management of pain or unpleasant symptoms are essential skills while dealing with the pediatric population. With barbarianren, oddly infants and toddlers who are unable to communicate, it can be extremely challenging to identify the presence of pain, which in turn makes it difficult to treat. Therefore, it is important to assess pain by receiving input from the child and their parents or care givers. In the grammatical case when a child is unable to communicate, their family and caregivers should be able to advocate for competent interventions to manage pain based on what they know about their child and the current situation (RNAO, 2013).The TOUS exemplifies a perspective that not only includes the ph ysical domain of the human experience, but also recognizes the importance influence of mental and situational factors, as well as their interaction on the symptom experience (Lenz Pugh, 2014). The generator was able to apply this theory in the pediatric mise en scene while caring for an eight year-old female patient who was experiencing painful micturition and abdominal pain related to a urinary tract infection. flavour at the physiological factors, this patient had a history of a fever for the past month, lower abdominal pain and a decreased proclivity otherwise her diet was classified as tolerated. Regarding the psychological factors, the patient evince she was happy, as she was being discharged that afternoon. While the writer was taking critical signs, the patient was alert, oriented, compliant and aware of why she was in the hospital. As the writer was providing care for this patient, it was evident that there was support from her father, mother and little brother, a ll who provided positive words of encouragement to get well soon.The updated version of the TOUS states that symptoms can occur alone or simultaneously, thus this paper will localize on multiple symptoms experienced by the patient painful micturition and abdominal pain. The patient expressed that she experienced a burning and painful sensation while urinating and that it had been occurring for the previous four days. When asked to rate her pain on a severity scale from 0-10, she rated her pain as a 4. In regards to the distress of her symptom, she mentioned it really bothered her during the night, as she was frequently waking up with the urge to urinate. In regards to the patients performance, she was unable to fulfill her social role as a grade four scholar, piano student and dance student as she stayed in the hospital for five days. She was also unable to embolden her mother and father in playing/ taking care of her jr. brother as she was experiencing abdominal pain that restr icted her from doing so.The TOUS is valuable legal document for nurses as it helps collect the previously mentioned data, which in turn helps nurses individualize interventions that hold out the patients needs and unique pattern of symptoms (Lenz, et al.,1997). In order to manage symptoms effectively, these nursing interventions should include the evaluation of the symptoms individually and as a whole in order to comprehend their interactions (Lopes-Junior et al., 2015). Understanding symptoms of patients is important because experiencing multiple simultaneously occurring symptoms, as opposed to one symptom can have more than shun effects on patient outcomes. Ultimately, understanding these multiple symptoms can help improve clinical management of an illness or disease (Lee et al., 2017). estimation of Overall UtilityThere are both strengths and weaknesses in the utility of the TOUS. The TOUS can be used to improve the understanding of the symptom experience of individuals in va rious scenarios and provides information that is useful for nursing interventions that can decrease, hinder or manage negative symptoms and their unpleasant effects (Lenz Pugh, 2014). However, the TOUS lacks detail that may be useful in working with a specific symptom or illness in a given clinical population, such as pediatrics. Specifically, the TOUS has focused only on subjectively perceived symptoms kind of than objective observable data. Neonates, infants and toddlers or children who are cognitively impaired, are incapable(p) of verbalizing their pain. Therefore, pain or unpleasant symptom assessment should also be based on behavioural and physiological cues rather than just subjective information. For example, an infant may display pain by frowning or clenching their jaw and crying uncontrollably. They may moan, whimper or have a difficult time being consoled by a parent or caregiver. Being agitated, squirmy or rigid can also be asserting(a) of pain or unpleasant feelings in infants and should be noted (Merkel, Voepel-Lewis, Shayevitz Malviya, 1997).The TOUS does an beautiful job at looking at the individual in a holistic manner, such that it considers the interactions between individuals and their environment, the multidimensionality of symptom experiences of the individual and uses a biopsychosocial start (Lee et al., 2017). While constructing an individualistic health care plan for patients, the TOUS does not include an intervention component within the model. This may indicate that the theory is more useful for observing concepts, examining their relationships, and developing tools to measure the concepts/relationships than for developing specific interventions for bad-tempered symptoms (Lenz, et al.,1997). In the future, the theory should include suggestions for interventions on specific symptoms for health care providers to use in practice.ConclusionThe purpose of this paper was to describe, analyze and appraise the TOUS in a clinical ped iatric setting and its connection to nursing practice. The uses, strengths and weaknesses of the theory were also presented. The TOUS is a middle-range theory that emphasizes the importance for nurses to understand that physiological, psychological and situational factors can influence multiple symptoms, which in turn can affect the individuals performance. It is also critical to realize that the performance outcomes can loop back end to impact the symptom experience itself, as well as to alter the influencing factors (Lee et al., 2017). Overall, this theory can be applied in different settings to understand symptoms of individuals, however specific nursing interventions are currently lacking in this theory. With continued research and studies, this theory can only increase in its practicality to health care professionals and caregivers.ReferencesInternational Association for the Study of Pain, Subcommittee on Taxonomy. (2008). Pain terms A list of definitions and notes on usage. P ain, 6, 249.Lee, S.E., Vincent, C., Finnegan, L. (2017). An analysis and evaluation of the theory of unpleasant symptoms. Advances in nurse Science, 40 (1), E16-E39.Lenz, E.R., Suppe, F., Gift, A.G., Pugh, L.C., Milligan, R.A. (1995). Collaborative development of middle-range nursing theories Toward a theory of unpleasant symptoms. Advances in Nursing Science, 17 (3), 1-13.Lenz, E.R., Pugh, L.C., Milligan, R.A., Gift, A.G., Suppe, F. (1997). The middle-range theory of unpleasant symptoms An update. Advances in Nursing Science, 19 (3), 14-27.Lenz, E.R., Pugh, L.C. (2014). The theory of unpleasant symptoms. In M. J. Smith (Ed.), Middle range theory for nursing (3rd ed.), (165-195). New York custom Publishing Company.Lopes- Junior, L.C., de Omena Bomfim, E., Nascimento, L.C., Pereira-da-Silva, G., Garcia de Lima, R.A. (2015). Theory of unpleasant symptoms Support for the management of symptoms in children and adolescents with cancer. Revista gaucha Enfermagem, 36 (3), 109-112.Me rkel, S.I., Voepel-Lewis, T., Shayevitz, J.R., Malviya, S. (1997). The FLACC A behavioural scale for scoring postoperative pain in young children. Pediatric Nursing, 23 (3), 293-297.Registered Nurses Association of Ontario RNAO. (2013). Assessment and management of pain, third edition. 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