The Holistic Theory of Unpleasant Symptoms

This article describes a holistic revisioning of symptom theory for nursing practice. The Holistic Theory of Unpleasant Symptoms (HTOUS), informed by the Science of Unitary Human Beings, describes the complexity of symptom experience and how nursing actions can be associated with its transformation. Existing theories of unpleasant symptoms which broadly describe the antecedents, characteristics, and consequences of symptoms, have been reconceptualized from holistic and integral perspectives. Applying integral concepts such as human energy field and pattern manifestation expands understanding of both symptom experience and the nurse’s response to it. Spirituality is an addition to symptom theory, being seen as a characteristic of Human Energy Field pattern manifestations. The theory’s major concepts are symptom experience manifestations and wellbecoming manifestations. Concepts of the sustaining presence of the nurse and voluntary mutual patterning are explored. Pain, nausea, dyspnea, anxiety, despair, and other symptoms are discussed. Because HTOUS is acausal and nonlinear, it is widely applicable to creative, theory-directed nursing practice and research. Recommendations are made for practice, research, and further theory development.

The Theory of Unpleasant Symptoms in Pediatric Oncology Nursing: A Conceptual and Empirical Fit?

Symptom management knowledge is a priority for pediatric oncology nursing research. Theories and models can frame the studies of symptoms experienced during childhood cancer. This article describes and analyzes the middle-range theory, theory of unpleasant symptoms (TOUS), for its conceptual and empirical fit with pediatric oncology nursing based on its current use in adult oncology research and its limited use to date in pediatric oncology. Searches in PubMed and CINAHL databases using the keywords theory of unpleasant symptoms and cancer and covering the time period 2000 to 2017 yielded 103 abstracts for review. Twenty published reports met eligibility criteria for review; only one included pediatric oncology patients. No study to date has tested all the components of the TOUS in pediatrics. The TOUS component of performance appears to be underaddressed across completed studies that instead include a focus on patient-reported quality of life rather than on perceived behavioral or performance indicators concurrent with the subjective symptom reports. Additionally, the influence of family, essential in pediatric oncology, is absent in the majority of studies guided by the TOUS. The TOUS is a structurally complicated framework that would be a conceptual fit for pediatric oncology if family influence and perceived function were included. Studies across this population and guided by the TOUS are needed, although testing all the theorized linkages in the TOUS would likely require a large sample size of patients and, thereby, multisite approaches given that cancer is a rare disease in childhood.

THEORY OF UNPLEASANT SYMPTOMS: CRITICAL ANALYSIS

ABSTRACT Objective: to analyze the Theory of Unpleasant Symptoms according to the model proposed by Walker and Avant. Method: a descriptive-reflexive study developed in the first half of 2016. He used the first five phases proposed by the Walker and Avant model: identification of the origins of the theory; examination of the meaning of the theory; logical adequacy; utility; degree of generalization and parsimony of theory. Results: the study allowed the reflection on the Theory of Unpleasant Symptoms, considering the multidimensionality of the symptoms and the potential stimulation between them. It was identified the relations between the main concepts used to construct the theory: physiological, psychological and situational factors, followed by performance, suffering, duration, quality, intensity and unpleasant symptoms. Conclusion: the Theory of Unpleasant Symptoms presents a structured theoretical framework, presenting logical meaning, through well-defined concepts and relations, which make possible its use in practice, teaching and nursing research.