Theory of Unpleasant Symptoms: Nursing Guide
Nurses are experts at managing symptoms. The Theory of Unpleasant Symptoms (TOUS) attempts to define the intensity and outcomes of negative symptoms, from a mild headache to chronic fibromyalgia pain. This middle-range theory can help nurses assess symptoms and understand their impacts on patients.
While it was initially published in 1995 by Audrey Gift, Linda Pugh, Renee Milligan, and Elizabeth Lenz, Theory of Unpleasant Symptoms has undergone revisions since its initial publication date. For example, one updated paper incorporated spirituality, energy fields, and visualizations. Theory is constantly shifting to reflect new ideas and philosophies of modern nursing.
Breaking Down Unpleasant Symptom Theory
The TOUS attempts to define the complexity of illness symptoms in terms of causes and effects. The theory has three components:
- Symptoms: Subjective experiences that vary in quality, intensity, timing, duration, and the distress they cause.
- Influencing factors: Situational, physiological, and psychological factors such as age, gender, mood, and cognition.
- Performance outcomes: The symptoms’ impacts on the patient’s ability to perform physical, cognitive, and social roles.
Note that patients can, and often do, have more than one symptom at a time, and the experience of one symptom can become an influencing factor for another.
Theory of Unpleasant Symptoms in Practice: 3 Examples
Example 1:
Ormand is a 68-year-old man with chronic obstructive pulmonary disease (COPD). He was admitted to the emergency department (ED) after experiencing worsening shortness of breath over the past week.
Symptoms: Ormand reports persistent dyspnea (shortness of breath). He says, “I feel like I can’t catch my breath.” He also experiences fatigue, anxiety, and sleep problems.
Contributing factors:
- Physiological: Advanced COPD, recent respiratory infection, and poor oxygenation.
- Psychological: Ormand’s dyspnea makes him feel anxious and fearful, which increases his respiratory rate and makes it more difficult to catch his breath.
- Situational: Ormand lives alone, in a second-floor apartment without an elevator. This makes him feel isolated and makes daily activities physically demanding.
Performance outcomes: Because of his symptoms, Ormand struggles with basic self-care activities like dressing, preparing meals, and leaving his apartment. His anxiety keeps him from doing pulmonary rehabilitation exercises, which worsens his deconditioning and shortness of breath.
Potential nursing interventions: The care plan includes administering prescribed bronchodilators, teaching pursed-lip breathing to reduce anxiety and improve ventilation, and coordinating with social services to explore home health support. The nurse also introduces guided relaxation exercises to manage the psychological component of his dyspnea.
Example 2:
Maria is a 45-year-old woman undergoing her third cycle of chemotherapy for stage II breast cancer. She presents to the oncology clinic and says she is “feeling exhausted all the time,” despite sleeping 10 hours a night.
Symptoms: Maria experiences profound fatigue, nausea, decreased appetite, and difficulty concentrating. She rates her fatigue as 8/10, stating that it prevents her from caring for her children and working part-time from home.
Contributing Factors:
- Physiological: Cytotoxic effects of chemotherapy, anemia, dehydration, and inadequate nutrition.
- Psychological: Stress related to her diagnosis, loss of control, and fear of disease progression.
- Situational: Maria has limited social support. Her partner works long hours, and her family lives hours away.
Performance outcomes: Maria’s fatigue and cognitive fog make it difficult to complete daily activities, leading to frustration and sadness. Her reduced physical activity further worsens her fatigue, creating a negative feedback loop.
Potential nursing interventions: The care plan includes nutrition counseling, hydration support, and education on pacing and prioritizing daily activities. The nurse suggests light exercise, such as short walks, to improve stamina, and recommends that Maria join oncology support groups. She also refers Maria to a state childcare network.
Example 3:
Sofia is a 12-year-old girl recently diagnosed with type 1 Diabetes. She presents to the pediatrician’s office with fatigue, frequent urination, and frustration as she adjusts to her new diagnosis and insulin regimen.
Symptoms: Fatigue, dizziness, irritability, frequent urination, and occasional headaches.
Contributing factors:
- Physiological: Blood glucose fluctuations and dehydration from polyuria.
- Psychological: Anxiety about injections, fear of hypoglycemia, and stress from adjusting to a new diagnosis.
- Situational: Changes in school routine, self-consciousness about monitoring blood sugar in front of peers, and disrupted sleep from nighttime blood glucose checks.
Performance outcomes: Sofia struggles with concentration in school, decreased participation in physical activities, and embarrassment among her peers. These performance issues have caused her grades to drop, and she’s become more isolated from her friends.
Potential nursing interventions: The nurse briefly reviews Sofia’s diabetes treatment plan and explains why her symptoms are occurring. The nurse also educates Sofia’s parents to encourage regular social participation and sports activity, as these are key to Sofia’s feelings of normalcy. Lastly, the nurse recommends a pediatric diabetes support group and suggests that Sofia follow diabetic influencers on social media to encourage further education and adjustment.
Unpleasant Symptoms Theory FAQ
Has the TOUS been tested?
Yes, this theory has been used and applied in various studies and research papers. Experts say that, while the theory isn’t perfect, it still has significance, and urges nurses to understand symptoms within a holistic context rather than as isolated parts.
How does the TOUS affect daily nursing practice?
Nursing is all about caring for the whole person, not just individual symptoms. Even if nurses don’t think about the theory by name, they naturally consider how a patient’s symptoms affect their daily life, well-being, and ability to function. This perspective helps nurses plan care that addresses the bigger picture, not just one isolated problem.
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