An Analysis and Evaluation of the Theory of Unpleasant Symptoms

Background

Background

Understanding symptoms of patients is important because symptoms are among the most common reasons that patients seek health care.Experiencing multiple concurrent symptoms, as opposed to single symptoms, has more negative effects on patient outcomes.In addition, multiple symptoms can hinder accurate patient assessment,diagnosis and treatment,which in turn can adversely affect symptom management.The National Institute of Nursing Research has emphasized the importance of understanding multiple symptoms to improve clinical management of illness.

The Tous was developed in 19951 and updated in 19972 to support understanding of multiple symptoms that occur simultaneously.The theory has been used in nursing and other areas of research but still requires comprehensive examination to evaluate its appropriateness for use in research. Therefore, in this article we present a critique of the Tous.

Analysis of a nursing theory involves systematic scrutiny of what the author has presented about the theory.9 Theory analysis involves an objective and thorough examination of a theory’s scope, context, and content. These criteria are evaluated next. Theory scope The first step in theory analysis, classifying the scope, involves examining the concepts and propositions for abstractness and breadth.

A theory that includes more abstract and broader concepts and propositions is a grand theory, whereas a theory that consists of relatively concrete and specific concepts and propositions is a middle-range theory. Middle-range theories can be further classified in terms of the way that a phenomenon is addressed: descriptive, explanatory, and predictive theories. Lenz et al2(p14) claimed that the Tous is a middle-range theory that “was proposed as a means for integrating existing information about a variety of symptoms.” The purpose of the Tous is to understand multiple symptoms that occur at the same time to explain the symptoms as well as to guide research and nursing practice

The Tous has 3 major concepts: influencing factors, symptoms, and performance. Lenz et al described relationships among the 3 major concepts as well as associations between subconcepts of the major concepts, which indicate narrower propositions between the concepts. The Tous was developed specifically for application in nursing practice and research.

Because the Tous has relatively concrete concepts and propositions and a goal of understanding multiple unpleasant symptoms, the Tous can be characterized as a middlerange explanatory theory. In addition, the theory can be used to develop preventive interventions to adjust influencing factors for multiple symptoms,1 and the effectiveness of use of the Tous in intervention on patient outcomes has been shown in research.17 Therefore, the theory can also be viewed as a middle-range predictive theory.

Analysis on Tous

The second step in theory analysis, examining the context of a theory, includes description of 5 components:

(a) metaparadigm concepts and propositions,

(b) philosophical claims on which the theory is grounded,

(c) worldview that the theory reflects,

(d) conceptual model on which the theory is based, and

(e) previous knowledge from nursing and other disciplines from which the theory is derived.These components are applied next.

The nursing metaparadigm concepts of human beings, environment, health, and nursing and the 4 relational propositions between human beings and health; health and environment; nursing and human beings; and human beings, health, and environment9 are all addressed in the Tous. Metaparadigm concepts of human beings and health were addressed through Lenz et al’s 2(p15) definition of symptoms as “perceived indicators of change in normal functioning as experienced by patients . . . they are the red flags of threats to health.” In addition, Lenz et al2 addressed the nursing metaparadigm concepts of human beings, health, and environment by stating that an individual’s symptom experiences can be affected by social and physical environmental factors such as marital status, social support, heat, noise, and light.

On the basis of the various assertions of Lenz et al,2 the Tous addresses the nursing metaparadigm propositions of “patterning of human health experiences within the context of the environment,” “human processes of living,” and recognition “that human beings are in a continuous mutual process with their environments.”9(p312) Moreover, Lenz et al1 maintained that the Tous can be used to develop preventive interventions to alter influencing factors for multiple symptoms. Although the theorists did not explain the interventions and did not use the word “nursing” for the interventions, they described the Tous as a middle-range nursing theory that was developed for nursing practice.

Therefore, it is reasonable to assume that the interventions refer to nursing actions intended to help patients suffering from multiple symptoms, and thus addressing the nursing metaparadigm proposition that deals with nursing actions that are beneficial to human beings.

Q-1) What is the purpose of the theory?

Q-2) What is the scope of the theory?

Q-3) What were the origins of the theory?

Q-4) What are the major concepts?

Q-5) What are the theoretical propositions?

Q-6) What are the major assumptions?

Q-7) What is the context for use?

Q-8) Are the concepts theoretically and operationally defined? Why or why not?

Q-9) Are statements defined? Why or why not?

Q-10) Are linkages explicit? Explain your answer.

Q-11) Is the theory logically organized? Explain your answer.

Q-12) Is there a model/diagram? Why or why not?

Q-13) Are the concepts, statements and assumptions consistent? Why or why not?

Q-14) Are outcomes or consequence stated or predicted?

Q-15) Is the theory congruent with current nursing standards? Nursing interventions?

Q-16) Has the theory been tested? Is it supported by research? Explain your answer.

Q-17) Is there evidence that the theory has been used? Is it socially or culturally relevant? Explain your answer.

Q-18) Does the theory contribute to nursing? What are implications for nursing related to implementation of the theory?

Q-19) How would you use the theory in a research study or in practice?