Within the field of nursing there are many theories that receive a great deal of attention for the manner in which they assist nurses in treating patients. The middle range theory of unpleasant symptoms was developed many years ago and has proved to be beneficial to nurses treating patients with various ailments. The purpose of this discussion is to investigate the middle range theory of unpleasant symptoms as it relates to cancer patients. This subject was chosen because of the substantial number of patients that are affected by cancer. As a result of the presence of so many cancer patients, Nurses must understand how to effectively treat people with this disease. The middle range theory of unpleasant symptoms is one of the tools that can assist in the treatment of cancer patients.
Overview of theory
According to Smith & Liehr (2008) Middle range theory is defined as "a set of related ideas that are focused on a limited dimension of the reality of nursing. These theories are composed of concepts and suggested relationships among the concepts that can be depicted in a model. Middle range theories are developed and grow at the intersection of practice and research to provide guidance for everyday practice and scholarly research rooted in the discipline of nursing (Smith & Liehr,2008)." The theory was created combine existing knowledge concerning many different symptoms. In addition Smith & Liehr report that the purpose of the theory is to "improve understanding of the symptom experience in various contexts and to provide information useful for designing effective means to prevent, ameliorate, or manage unpleasant symptoms and their negative effects (Smith & Liehr,2008)." In other words the purpose of the theory is to provide nurses and other healthcare professionals with the tools needed o prevent or relieve the unpleasant symptoms associated with various diseases and ailments experienced by patients. The theory is also designed to ensure that the nurse of medical professional takes into consideration all of the factors that contribute to unpleasant symptoms. The components of this theory will be addressed more thoroughly in the section to follow.
Description of components of the theory
The origin of the middle range theory began with theory of unpleasant symptoms developed by Lenz et al., (1995). The theory focused on "a model for the experience of, and relationships between, concurrent symptoms. The theory evolved from collaboration among three individual investigators who began work on two concepts that represent unpleasant symptoms, dyspnea and fatigue, simultaneously. The investigators noted commonalities between the two concepts and subsequently realized that a more general theoretical formulation would be appropriate for describing multiple symptoms, such as pain and other unpleasant symptoms, across different clinical populations (Myers, 2009)." This theory of unpleasant symptoms can be seen in the depiction above (taken from Myers, 2009). The model is divided into three sections which acknowledge factors associated with unpleasant symptoms: physiological, psychological, and situational. The authors also note that all of the symptoms may vary in their duration, distress, quality and intensity. In addition the unpleasant symptoms typically have an impact on the manner in which the patient performs as it relates to the following three levels: functional status, cognitive functioning, and physical performance.
Concepts: The theorists asserts that there are three factors associated with the unpleasant symptoms: physiological, psychological, and situational. Physiological factors are related to the normal systems of the body including the cardiovascular system. The physiological factor is also inclusive of pathological problems such as infection. The second factor is psychological and encompasses the mental state of the patient and can include such ailments are depression. Psychological factors are also inclusive of how a patient reacts to being ill; this reaction can have a great deal to do with the patient's support system. The final factor involves the situation that the patient is in and entails their lifestyle. Lifestyle factors encompass characteristics such as employment. In addition the situational factor is also inclusive of personal experiences. The theory then focuses on the distress, duration, intensity and quality of the unpleasant symptoms in relation to the aforementioned factors.
Analysis and evaluation of theory:
Is the theory stated clearly and concisely?
The theory is extremely clear and concise. The theorist involved in the development of the theory understood the importance of creating a platform upon which nurses would have the ability to find solutions to the unpleasant symptoms facing patients. In addition the concepts presented by the theory can be explained and understood without a lengthy explanation. For instance, The research has demonstrated the simple way in which the three factors taken into consideration can be utilized in the context of patient care and treatment. Any nurse that reads a description of the theory will not have difficulty grasping the concepts that the theory presents and applying these concepts into the practice of nursing. For instance, a nurse treating a patient with stage 2 breast cancer will be able to evaluate the unpleasant symptoms the patient might be experiencing by taking into consideration the physiological, psychological and situational factors associated with the exact symptoms that are experienced.
How many concepts/variables are involved as key components of the theory and their adequacy?
The theory espouses five concepts variables. The initial or main variables are associated with the physiological, psychological, and situational. The authors also explain that all of the symptoms may vary in their duration, distress, quality and intensity. In total there are seven concepts associated with the middle range theory of unpleasant symptoms. I think that the number of concepts presented by the theory are adequate and take into consideration both the cause (physiological, psychological, and situational) and the characteristics of the unpleasant symptoms (duration, distress, quality and intensity). This thorough handling of the theory translates into a nursing tool that is simple to utilize but also provides nurses with complex information concerning the condition of a patient as it pertains to unpleasant symptoms.
Is the theorists' description of their theory consistent with the definitions of the key concepts
The description of the theory provide by the theorist is consistent with the definitions of key concepts. The theory us straightforward and although the concepts presented in the theory are not complex they do assist the nurse in understanding the complex nature of the unpleasant symptoms that a patient might experience. The theory is consistent because it takes into consideration concepts and aspects of the human mind, body and souls that are often overlooked with other theories. This thorough treatment of the patient assists the theory in being consistent and reliable as a nursing theory.
Has the theorist identified any inadequacies in the theory?
There have been some inadequacies recognized by the theorists who developed middle range theory. For this reason the theory was updated in 1997. The theory updates were associated with both clinical practice and research measures. The update takes into consideration a more complex approach related to the correlations between the three factors and the features of the unpleasant symptoms.
What inadequacies in the theory have you identified?
The only inadequacies that I can identify have to do with the scope of the theory. I believe that the scope of the theory could be made broader so that issues such as the impact of spousal and familial support will also be explored. In the case of cancer patients such issues can help to lessen or increase unpleasant symptoms and their negative effects. As a result these issues should be explored more thoroughly.
To what clinical situations or managerial systems can the theory be applied
This theory can be applied to clinical situations involving cancer patients and others with chronic and/or terminal illnesses. This theory can be utilized by nurses to develop a plan of treatment that is tailored to meet the specific needs of patients based on the underlying causes of their unpleasant symptoms. There have been several studies that have demonstrated the use of this theory in clinical situations. These studies will be reviewed in further detail in the evaluation section below.
How could this theory guide your clinical or managerial practice?
This theory would be vitally important in an oncology setting. The theory will provide a mechanism through which the patient can be evaluated holistically and the unpleasant symptoms that are being experienced can be managed utilizing the proper tools. Those tools might be medication (physiolocal), behavior modification/meditation/counseling (psychological) or a support group (situtational). All of these solutions to the problems that cancer patients are likely to face are essential to assisting the patient and treating the whole person. This particular theory can also be used as a preventative measure within the context of clinical practice. Nurses should consider the factors presented by the theory early on in the treatment process and develop strategies that will prevent unpleasant symptoms from ever occurring.
Evaluating the theory as used in research:
How have the authors proposed that the theory will guide the research?