This paper applies the middle-range Theory of Unpleasant Symptoms, developed by Lenz et al. (1995), to the clinical practice problem of nursing burnout. The paper begins by summarizing nursing burnout as a global phenomenon with multifaceted causes, then introduces the theory's core framework — situational, physiological, and psychological factors — as a suitable lens for understanding burnout. It traces the theory's origins and prior applications in bariatric nursing and Alzheimer's disease care, before proposing how the framework could guide individualized interventions and peer-review monitoring systems to identify and reduce burnout risk in nursing practice.
Nursing burnout is a global phenomenon among nurses — a problem that leads to negative effects for other nurses, health care facilities, and patients seeking quality care. The factors that lead to burnout among nurses have been studied in a variety of ways, and researchers have identified personality type (Cañadas-De la Fuente, Vargas, San Luis, García, Cañadas & Emilia, 2015) as well as external environmental issues as causes of burnout (Sadati, Rahnavard, Heydari, Hemmati, Ebrahimzadeh & Lankarani, 2017), yet there is still no clear understanding of how to address this issue.
The middle-range Theory of Unpleasant Symptoms, developed by Lenz, Suppe, Gift, Pugh, and Milligan (1995), proposes that physiological factors, psychological factors, and situational factors all play a part in determining the occurrence, intensity, timing, and level of distress of a person's health status. As burnout among nurses can be considered a health issue related to situational, psychological, and physiological factors, the theory of unpleasant symptoms provides a suitable approach to this problem — just as it does for nurses attempting to diagnose and treat patients. In the case of nursing burnout, the nurses themselves become the patients.
Lee, Vincent, and Finnegan (2017) state that "understanding multiple patient symptoms is essential, and the theory [of unpleasant symptoms] demonstrates that nurses should focus on multiple rather than individual symptoms" (p. 16). This approach applies appropriately to the problem of nursing burnout, as research has shown the issue stems from a multitude of variables that may interact, interlock, and work together to effect the breakdown of a nurse's ability to carry on.
Lenz et al. (1995) identified a need for a more substantive theory that could be used to better understand patients and the complexity of illnesses and health-related issues. Instead of viewing morbidities as isolated and unrelated problems, the theory of unpleasant symptoms gave health care providers the opportunity to view patients more holistically — with a sense of how one set of issues could impact another set, even if medically speaking the two conditions were unrelated. In other words, the theory allowed for the total experience of the patient to be understood more clearly, which could then allow health care providers to see new ways to treat the patient more effectively and completely.
Lee et al. (2017) assessed the theory of unpleasant symptoms and found that it "demonstrates good social and theoretical significance, testability, and empirical and pragmatic adequacy" (p. 16). As the purpose of the theory was to help nurses better understand how different symptoms may be related, and how taking a whole picture of a patient's health — rather than a compartmentalized one — could give the nurse a better foundation for providing quality care, the theory's applicability was demonstrated via empirical analysis. Lenz et al. (1997) likewise corroborated this when they evaluated the "interactive nature of the symptom experience" that leads to health problems (p. 20).
"Theory used in bariatric and Alzheimer's nursing contexts"
"Individualized interventions and peer-review monitoring proposed"
My nursing practice would change by incorporating this theory in the sense that it would provide a better framework for monitoring the health levels of nurses. Bergum et al. (2017) have shown that the nursing peer review tool can assist nurses in identifying risk factors before they become problematic in the health care workplace. Uniting the nursing peer review tool with the theory of unpleasant symptoms framework, nurses could evaluate their peers in a meaningful way — enabling them to monitor their own situational, physiological, and psychological experiences in order to understand symptoms more clearly and address any issues that arise before they worsen. Early intervention could prevent nurses from having to leave the profession due to burnout or from taking extensive time off, which leaves staff short-handed and places other nurses at greater risk for burnout themselves.
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