Nursing Unpleasant Symptoms Middle Range Theory
Unpleasant Symptoms Middle Range Theory
The original theory was published nearly a decade ago (Lenz, Suppe, Gift, Pugh, & Milligan, 1995) as a result of collaboration between faculty and graduates of the doctoral program at the University of Maryland School of Nursing.
Each of the graduates had studied an unpleasant symptom for dissertation research. Gift had studied dyspnea; both Milligan and Pugh had studied fatigue (Lenz & Pugh, 2003). The individuals who developed the theory had collaborated in dyads or triads on various empirical studies and theoretical articles.
They shared geographic proximity, which facilitated collaboration, and, by virtue of their common association with one PhD program in nursing, they also shared exposure to the same philosophical and metatheoretical perspectives regarding the development and substance of nursing science (Lenz & Pugh, p. 70)
Scholarly Work
A philosopher of science who taught in the doctoral program at the University of Maryland, Frederick Suppe, coauthored the manuscript which introduced the theory.
Two years after its first publication, a refined version of the theory,
which emphasized the reciprocity between the concepts of the theory, was
introduced into the nursing literature (Lenz, Pugh, Milligan, Gift, &
Suppe, 1997).
Concepts in the Theory
The theory of unpleasant symptoms has three major concepts: symptoms, influencing factors (physiological, psychological, and situational), and performance outcomes (Lenz & Pugh, 2003).
- A symptom is defined as an individually perceived indicator of aberration in normal function, which may occur in isolation or in combination with other symptoms and is characterized by intensity. distress, duration/frequency, and quality. which refers to the nature of the symptom or how it is manifested (Lenz & Pugh).
- Influencing factors are physiological (e.g., anatomic/ structural, genetic, bodily processes), psycho- logical (affective and cognitive), or situational (social and physical environment) qualities that can influence and be influenced by symptom experience. In addition, the theory suggests that when more than one symptom is experienced, the symptom experiences influence each other, emphasizing a reciprocal nature depicted by the model. The authors (Lenz & Pugh) give the example of nipple pain and fatigue, common symptoms for nursing moms which can exacerbate each other and lead to premature termination of breast feeding, an undesirable performance outcome.
- Performance outcomes are the consequences of the symptom experience. "Quite simply, the theory asserts that the experience of symptoms can have an impact on the individual's ability to function, with function including motor skills, social behaviors and cognition" (Lenz & Pugh, p. 78).
Lenz and Pugh Outcomes
Lenz and Pugh (2003) report that research related to the middle-range theory of unpleasant symptoms is just recently beginning to be reported in the literature, with much of their search being done by the developers of the theory themselves.
Some of this research has examined interventions to diminish symptoms and therefore improve performance outcomes; some has examined the relationship between influencing factors which impact symptom experience.
Some of the unpleasant symptom research completed by people other than the developers of the theory has examined symptoms in cancer patients undergoing chemotherapy, people with heart lung transplants, end stage renal disease patients, and people with Alzheimer's disease (Lenz & Pugh).
Use of the
theory for research has resulted in critique of the theory which was considered
and applied when the developers refined the theory (Lenz et al., 1997).
Limited Area of Theory Implementation
Lenz and Pugh (2003) note that published reports of use of the theory in practice are few. This is surprising given the fact that unpleasant symptoms are a common experience for most patients whom nurses encounter.
Unlike theories at a lower level of abstraction which focus on one symptom, such as pain, the more generic theory of unpleasant symptoms guides approach for more complex symptom combinations, as often occur in real world practice situations.
For instance,
the theory emphasizes the importance of indepth assessment of symptoms which
considers the contribution of influencing factors,
Versatility and Dynamicity of Theory
It suggests that multiple management strategies may need to be applied simultaneously, given the multivariate nature of the factors influencing symptoms.
It also emphasizes the importance of considering the effect of
several symptoms, occurring together, on patient's functioning, and encourages
assessment of functional patient outcomes. (Lenz & Pugh, pp. 85-86)
Final Results
Thus far, the research guided by the middle- range theory of unpleasant symptoms has addressed the symptoms of pain, dyspnea, nausea, vomiting, and fatigue (Lenz & Pugh, 2003). Clearly, there are more symptoms to be explored.
Likewise, there is need for further elaboration of the relationship between the influencing factors and how the factors relate with the symptom experience.
Finally, Lenz and Pugh note the potential for further development of the performance component of the model, suggesting the consideration of primary and secondary outcomes as well as temporally proximal and distal outcomes.
There is no question that the middle range theory of unpleasant symptoms is a work in progress, which could benefit practicing nurses, undergraduate and graduate students, and researchers if used as a guiding frame work.
Likewise, the theory
could benefit from use in practice and research so that continued empirically
based development would further enhance the usefulness of the theory.
Give your opinion if have any.