The Theory of
The discussion is about The Theory of
Unpleasant Symptoms and how to guide an assessment of patients. The learning
outcomes addressed are evaluating academic foundations of nursing theories,
conceptual models, grand and mid-range theories, and the structure of a nursing
theory on behalf of modern professional nursing practice. The main points
explained are the concept of the theory, models expanding or modifying it,
assessment, and empirical testing.
The Theory of Unpleasant Symptoms (TOUS) was
developed in 1995 by Linda Pugh and Audrey Gift, and it is a middle-range
theory (Peterson & Bredow, 2020). This theory allows understanding of the
relationship among multiple symptoms and how to manage their adverse effects to
better patient outcomes. In the beginning, the approach was limited to one
symptom. However, in 1997 it was modified to include interactions, synergism,
and intricacy among various symptoms, thus showing the patient as a whole
(Lee et al., 2016).
The TOUS is structured in the preceding
factors, symptoms, and performance. Otherwise, the preceding factors are
physiological, situational, and psychological. Symptoms include four
categories: intensity, quality, timing, and distress. Moreover, the combination
of unpleasant symptoms can affect the patient’s physical or cognitive
performance (Yang & Kang, 2018). A variety of preceding factors like
stress, excessive work, and personal predisposition to migraine can lead to a
migraine crisis. If the headache is intense and extended in time can provoke
enough distress to keep the patient in bed and interfere with physical and
Nurses should ask about environmental,
psychological, or physiological factors or antecedents during the assessment,
beginning with the influenced factors. Some studies have determined that those
factors significantly impact symptoms and performance (Blakeman, 2019). Thus,
they have a priority position during the assessment questions. Next, nurses
should have asked about symptoms, timing, intensity, their relation, and how
they affect the quality of life and physical and mental activities.
Empirical testing of The Theory of Unpleasant
symptoms showed that like other middle-range theories, has excellent
applicability in Nursing nowadays, becoming a tool for performing clinical
assessments, interventions, and symptoms management. TOUS has practical use,
especially in the elderly or patients with multiple concomitant diseases.
Symptoms can be insignificant or crucial for diagnosis and treatment.
Therefore, a good study and knowledge using The Theory of Unpleasant Symptoms
should be a priority for any nurse.
Blakeman, J. R. (2019). An integrative review
of the theory of unpleasant symptoms. Journal of Advanced Nursing, 75(5),
Lee, S. E., Vincent, C., & Finnegan, L.
(2016). An Analysis and Evaluation of the Theory of Unpleasant Symptoms. Advances
in Nursing Science, 40(1), 1.
Peterson, S. J., & Bredow, T. S.
(2020). Middle range theories: application to nursing research and
practice (5th ed.). Wolters Kluwer.
Yang, I.-S., & Kang, Y. (2018). Self-care
model is based on the theory of unpleasant symptoms in patients with heart failure. Applied
Nursing Research, 43, 10–17.
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The Theory of