Theory of Unpleasant
Symptoms
Mary Hefferan
Ferris State University
Objectives
O Overview of the theory
O Metaparadigm concepts
O Person, environment, health, and nursing as
defined by theory
O Brief analysis
O Basic concepts and description of
components
Objectives
O Exploration of theory through research
O Description of research article
O How the theory is reflected in research
O What the theory adds to the study
O Application to nursing practice
O Importance of theory to nursing
practice
Overview
O Theory of Unpleasant Symptoms
O Created by Elizabeth Lenz and Linda Pugh in
1995
O Objective is to “integrate existing knowledge
about a variety of symptoms” (Lenz, Pugh, Milligan, Gift, &
Suppe, 1997, p. 14)
O Improve understanding of the experience of
symptoms in various contexts
O Three major concepts:
O The actual symptoms
O Influencing factors
O Performance outcomes
Metaparadigm Concepts:
Defined by the Theory
O Person: the patient who is exhibiting
the symptoms and to whom the nurse
is giving care
O May also include family and/or friends
O Environment: where the care is taking
place and situational factors that
contribute to the symptom experience
O Employment status, marital status,
social support, access to health care
Metaparadigm Concepts:
Defined by the Theory
O Health: absence of unpleasant
symptoms
O Symptoms are: “perceived indicators of
change in normal functioning as
experienced by patients” (Lenz, Pugh, Milligan,
Gift, & Suppe, 1997, p. 14)
O Nursing: care taker and evaluator of
symptoms and contributing factors
O Establishes a relationship with the
patient to better evaluate symptoms
Analysis of the Theory of
Unpleasant Symptoms
O Three Major Concepts: Symptoms,
influencing factors, and performance
outcomes
O 1. The symptoms:
O Change in normal functioning
O More often occur simultaneously
O Multiple symptoms occurring together
results in a multiplying effect
O Measured by their intensity, timing, and
level of distress perceived
Analysis of the Theory of
Unpleasant Symptoms
O Influencing factors:
O Physiological, psychological, and
situational
O Influence the symptoms alone or in
concurrence
O Performance outcomes:
O Results of the symptom experience
O Impact on ability to perform activities
of daily living
Theory in Research
Application of the Theory of Unpleasant
Symptoms (TOUS) in Bariatric Surgery
O Uses the TOUS during the management of
patient post bariatric surgery
O Case study of a 29 year old woman post
bariatric surgery
O Explored how the influencing factors affected
her post-op outcomes
O Showed that her situational factors contributed
greatly to her overall health
Theory in Research
TOUS in Application
O Evaluated the factors
O Physiological
O Dehydration, malnutrition
O Gastrointestinal dysmotility
O Psychological
O Adjustment to dietary changes
O Situational
O Lack of social support, work stressors, finances
O In concurrence prolonged her recovery
period
Source:
https://fsulearn.ferris.edu/courses/1/XLIST_81147.201308/groups/_10477_1//_492347_1/Theory%20of%20unplea
sant%20symptoms%20bariatric%20surgery.pdf
Theory in Research
Differences the TOUS Made
O Created a framework for the evaluation of
symptoms and their contributing factors
O Helped in the approach to alleviating her
unpleasant symptoms
O Created a new method for treating symptoms
rather than medication or hospitalization
Theory in Research
Differences the TOUS Made
O Once the factors were addressed
O Symptoms improved
O Assessment of entire picture
O Created awareness to approach willingness to
change
“Understanding where patients are in their willingness to
change those factors…will assist clinician in understanding
expectations and moving patients to healthier levels of
recovery” (Tyler, R., & Pugh, C. L., 2009, p. 276)
O Manages expectations of health outcomes
Use in Practice
Neonatal Nursing Environment
O Evaluation of family impact on health
outcomes
O Nervousness, uncomfortable with their baby
O Could have a negative physiological impact
O Aids nurse with appropriate interventions
Use in Practice
Neonatal Nursing Environment
O Manages expectations of outcomes
O Less social support may change health outcomes
O Guides appropriate creation of goals
O Allows for a different perspective on assessing
symptoms
O “Symptom clusters”
O Catalyzing effect of symptoms
Source: http://rnspeak.com/fundamentals-of-nursing/what-is-a-nursing-theory/
Importance to Nursing
O Nurses assess and approach
symptoms differently than other
members of the healthcare field
O Holistic approach
O Guides nurse-patient interactions
O View patients in an interactive-
integrative view versus isolated cause
effect health interactions
Importance to Nursing
O Broad but focused theory
O Can be used as a base for designing
interventions
O Uses subjective symptom experience
data
O Creates connections between social
environments and symptom
experience
References
1, Haworth, K. S., & Dluhy, M. N. (2001). Holistic symptom
management: Modeling the interaction phase. Journal of Advanced
Nursing 36(2), 302-310. Retrieved from: http://0onlinelibrary.wiley.com.libcat.ferris.edu/doi/10.1046/j.13652648.2001.01972.x/pdf
2. Lenz, R. E., Pugh, L., Milligan, A. R., Gift, A., Suppe, F. (1997). The
middle range theory of unpleasant symptoms: An update. Advances
in Nursing Science, 19(3), 14-27. Retrieved from: http://0ovidsp.tx.ovid.com.libcat.ferris.edu/sp-3.10.0b/ovidweb.cgi
3. Liehr, P. (2005). Looking at symptoms with a middle-range theory
lens. Advance Studies in Nursing, 3(5), 152-157. Retrieved from:
http://www.snjourney.com/PDFs/asin_3_5_p152_157.pdf
4. Tourville, C., & Ingalls, K. (2003). The living tree of nursing theories.
Nursing Forum, 38(3), 21-36. Retrieved from:
http://ferris.libguides.com/er.php?ecid=9581
5. Tyler, R., & Pugh, C. L. (2009). Application of the theory of
unpleasant symptoms in bariatric surgery. Bariatric Nursing and
Surgical Patient Care. 4(4), 271-276. doi: 10.1089/bar.2009.9953