Nursing Theory Analysis Paper: The Theory of Unpleasant Symptoms Introduction

The middle-range theory of unpleasant symptoms was developed by Lenz, Suppe, Gift, Pugh and Milligan (1995) in an article entitled “Collaborative Development of Middle-Range Nursing Theories: Toward a Theory of Unpleasant Symptoms” and updated in a follow-up article entitled “Middle-Range Theory of Unpleasant Symptoms: An Update” (Lenz, Pugh, Milligan, Gift & Suppe, 1997). The theory holds that three categories of variables are responsible for affecting the occurrence, intensity, timing, level of distress, and quality of symptoms: 1) physiological factors, 2) psychological factors, and 3) situational factors. In doing so, the theory of unpleasant symptoms addresses the four concepts of nursing metaparadigm: person, environment, health, and nursing. This theory is especially useful in the emergency department (ER), which is the current field in which I work.

Background

The background of the theory of unpleasant symptoms is situated in the need identified by Lenz et al. (1995) for a mid-range approach to nursing theory-research and theory-based practice to help provide a more substantive underpinning for nurses in the real-world. As Lee, Vincent and Finnegan (2017) state, “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). By identifying the complex array of symptoms that patients often present with in today’s health care environment—as the Institute of Medicine (IOM, 2012) has pointed out—nurses can be better prepared to address patients’ needs and provide the type of quality care that the patients seek. The theory of unpleasant symptoms was developed as a way to help nurses apply the nursing metaparadigm to the complexity of patients’ presentations.

The theorists behind the theory of unpleasant symptoms—Lenz, Suppe, Gift, Pugh and Milligan—all have backgrounds in nursing scholarship, each being the author of a variety of works and publications on nursing. For example, Lenz is currently the Dean and Professor at the College of Nursing at Ohio State University, and Pugh is a professor at Johns Hopkins University School of Nursing. Thus, the backgrounds of the theorists are situated in the academic field of nursing education (“E. Lenz & L. Pugh,” 2010). Their experiences in interacting with students as well as other health care professionals convinced them of the need to develop a new approach to nursing that would them “to place greater emphasis on developing and using theories of the middle range to underpin nursing research and practice” (Lenz et al., 1995).

The theory has been assessed by both the originators of the theory (Lenz et al., 1997) and other researchers who have assessed its utility (Lee et al., 2017). According to Lee et al. (2017), the theory of unpleasant symptoms “demonstrates good social and theoretical significance, testability, and empirical and pragmatic adequacy” (p. 16). In other words, the theory has substantial use in the field of nursing, has been proven to be effective in providing greater quality care to patients through empirical analysis, and is supported by solid results. Lee et al. (2017) note that the theory was designed in order to help nurses understand how various symptoms relate to one another and how symptom experiences can be better understood by viewing them as a whole instead of compartmentalizing them or viewing them individually as though they were not connected to one another. The researchers also pointed out, however, that while the theory has been utilized as a...

Thus, Lee et al. (2017) saw fit to update the literature on the theory of unpleasant symptoms by applying the framework of Fawcett and DeSanto-Madeya to it. What the researchers concluded was that while the theory in and of itself, as expressed by Lenz et al. does pose some clarity and language structure issues, the ideas and concepts in the theory itself are significant, provable via testing, and do have utility in nursing. The positive approach to nursing that the theory yields is the concept that nurses should focus not just on individual symptoms when tending to a patient but rather on multiple symptoms and what that multitude can mean. Lenz et al. (1997) likewise discuss the “interactive nature of the symptom experience” in their review of their own theory, two years after first publishing it in 1995, to show that the symptoms presented by patients are not to be understood in isolated contexts but rather as part of a total phenomenon of the patient’s health state.
Theory Description

The theory uses reductive reasoning, which includes a mixture of inductive and deductive reasoning. Inductive reasoning is applied when a researcher observes a phenomenon and intuits the answer based on prior knowledge and understanding of the elements involved in the phenomenon. The researchers then test the answer to see if it is the correct one for addressing the problems or issues identified in the phenomenon. In this sense, the theorists involved in the development of the theory of unpleasant symptoms used inductive reasoning to gauge the issue, identify the solution, and test the solution to establish its merit. They did this by applying their background knowledge and experience of nursing and the nursing environment in their professional and educational careers and utilizing their research skills to test the validity of their theoretical approach to the problem of understanding the complexity of patients’ symptoms. Their tests led them to revise their original thesis and modify it so as to account for the new evidence that was obtained—and in this sense their research was deductive as well. As Lenz et al. (1997) reported, “revisions have resulted in a more accurate representation of the complexity and interactive nature of the symptom experience” (p. 14). So while their initial theory was based on inductive reasoning, their revisions utilized deductive reasoning.

The researchers utilized deductive reasoning by approaching the phenomenon separately as well—i.e., from a different angle, following their initial inductive approach to the phenomenon in question. That is, they used evidence available on why nurses were not responding adequately to patients’ symptom complexity and used that evidence to develop a solution based on empirical data. Then they confirmed their theoretical approach.

Reductive reasoning was also evident in the sense that the theorists could argue that for nurses to ignore the complexity of symptoms or to view each symptom as though it were isolated from the others would be like dissecting the patient in the waiting room and then taking each part of the patient back for assessment one piece at a time (Lenz et al., 1997). This approach is not holistic or corresponding with the treatment of the patient as a whole person. In order to appropriately treat the whole person, the nurse must come to grips with the whole, complex, interacting aspects of the patients’s symptoms and more deeply understand that interaction. In doing so, the nurse can apply the nursing metaparadigm more effectively. Lenz et al. (1997) supplied numerous examples in their revised approach to the theory…