Application of the Theory of Unpleasant Symptoms

Application of the Theory of Unpleasant Symptoms The Application of the Theory of Unpleasant Symptoms In Pediatric Nursing Practice Krista Kelly Introduction Every human being regardless of age, ethnicity, socioeconomic status or physical ability will experience pain or unpleasant symptoms at some point in their lives. Pain can be defined as an unpleasant, subjective sensory and emotional experience associated with actual or potential tissue damage (International Association for the Study of Pain, Subcommittee on Taxonomy, 2008). This definition acknowledges not only the physical nature of the pain experience, but also recognizes the psychological aspect. Pain is a highly subjective experience and can only be accurately described by the person experiencing it. According to the Registered Nurses Association of Ontario (2013), nurses have an ethical responsibility for assessing and alleviating pain using appropriate, evidence informed pain management. It also states that nurses are also obligated to advocate for change in the care plan when pain relief is inadequate. The theory of unpleasant symptoms (TOUS) is a middle-range theory that was developed by nurses to enhance the understanding of relationships among multiple symptoms and symptom experiences to manage unpleasant symptoms through effective interventions (Lee, Vincent Finnegan, 2017). The TOUS has three major concepts that will be discussed in further detail throughout this paper. The purpose of this paper is to describe, analyze and evaluate the TOUS and its relevance to pediatric nursing practice. This paper will identify a clinical situation on a pediatric unit and will indicate how the TOUS provides direction for guiding nursing practices. Lastly, this paper will assess the utility, strengths and weaknesses of the TOUS. Description of Theory According to Smith Parker (2010), theories help guide our actions, help us reach desired results and give evidence to what has been previously achieved. Specifically, middle-range theories are abstract, yet are concrete enough that it provides a link between nursing research and practice. The middle-range theory of unpleasant symptoms was introduced in 1995 as a means for incorporating existing information about a variety of symptoms (Lenz, Pugh, Milligan, Gift, Suppe, 1997). The TOUS incorporates three major components: the symptoms that a patient is undergoing, the factors that influence symptoms and that give rise to the nature of the symptoms, and the effects of the symptom experience. Each individual symptom is considered a multidimensional experience that can be measured together with other symptoms or measured independently (Lopes- Junior, de Omena Bomfim, Nascimento, Pereira-da-Silva, Garcia de Lima, 2015). Although symptoms differ from one another, they share four common domains including: duration, intensity, quality and distress. The duration of a symptom refers to the time that the symptom occurs at, or the frequency of the symptom. Intensity indicates the severity, strength or amount of the symptom being experienced by the individual. Whereas, the quality of pain can be used to describe what the symptom feels like to the individual. For instance, pain can be described as sharp, dull, achy or throbbing. Lastly, the distress domain of the symptom experience refers to the degree to which the patient is bothered by it (Lee et al., 2017). The same symptom may be unbearable to some individuals but could be much less severe to others. Thus, it is important to ask patients how much they are bothered by the symptom to gain a better understanding of how they are interpreting the experience and the meaning they associate with it (Lenz, et al.,1997). In the TOUS, there are three factors that influence each of the previously mentioned domains: physiologic factors, psychologic factors and situational factors (Lenz, Supp e, Gift, Pugh, Milligan, 1995). Physiologic factors include the normal functioning of the body systems, the presence of any pathology and the individuals energy levels. Psychologic factors incorporate the individuals mental state and their reaction to their illness. Lastly, situational factors pertain to aspects of the individuals physical and social environment that can affect their experience and reporting of symptoms. Examples of social environment include: lifestyle behaviours, social support, employment status, and access to health care services. On the contrary, physical environments can include but are not limited to variables such as noise, light, temperature and polluted air/water; all of which can influence symptoms (Lenz Pugh, 2014). According to Lenz Pugh (2014), the outcome concept in the TOUS is performance. Performance refers to the outcome or effect of the symptom experience and how it impacts the individuals functional status, cognitive functioning and physical performance. For example, certain symptoms may affect an individuals ability to perform the activities of daily living or may alter their memory, concentration or problem solving skills (Lee et al., 2017). Application to Clinical Practice The assessment and management of pain or unpleasant symptoms are essential skills while dealing with the pediatric population. With children, especially infants and toddlers who are unable to communicate, it can be extremely challenging to identify the presence of pain, which in turn makes it difficult to treat. Therefore, it is important to assess pain by receiving input from the child and their parents or care givers. In the case when a child is unable to communicate, their family and caregivers should be able to advocate for suitable interventions to manage pain based on what they know about their child and the current situation (RNAO, 2013). The TOUS exemplifies a perspective that not only includes the physical domain of the human experience, but also recognizes the importance influence of psychological and situational factors, as well as their interaction on the symptom experience (Lenz Pugh, 2014). The writer was able to apply this theory in the pediatric setting while caring for an eight year-old female patient who was experiencing painful urination and abdominal pain related to a urinary tract infection. Looking at the physiological factors, this patient had a history of a fever for the past month, lower abdominal pain and a decreased appetite; otherwise her diet was classified as tolerated. Regarding the psychological factors, the patient expressed she was happy, as she was being discharged that afternoon. While the writer was taking vital signs, the patient was alert, oriented, compliant and aware of why she was in the hospital. As the writer was providing care for this patient, it was evident that there was suppo rt from her father, mother and little brother, all who provided positive words of encouragement to get well soon. The updated version of the TOUS states that symptoms can occur alone or simultaneously, thus this paper will focus on multiple symptoms experienced by the patient; painful urination and abdominal pain. The patient expressed that she experienced a burning and painful sensation while urinating and that it had been occurring for the previous four days. When asked to rate her pain on a severity scale from 0-10, she rated her pain as a 4. In regards to the distress of her symptom, she mentioned it really bothered her during the night, as she was frequently waking up with the urge to urinate. In regards to the patients performance, she was unable to fulfill her social role as a grade four student, piano student and dance student as she stayed in the hospital for five days. She was also unable to assist her mother and father in playing/ taking care of her younger brother as she was experiencing abdominal pain that restricted her from doing so. The TOUS is valuable tool for nurses as it helps collect the previously mentioned data, which in turn helps nurses individualize interventions that fit the patients needs and unique pattern of symptoms (Lenz, et al.,1997). In order to manage symptoms effectively, these nursing interventions should include the evaluation of the symptoms individually and as a whole in order to comprehend their interactions (Lopes-Junior et al., 2015). Understanding symptoms of patients is important because experiencing multiple simultaneously occurring symptoms, as opposed to one symptom can have more negative effects on patient outcomes. Ultimately, understanding these multiple symptoms can help improve clinical management of an illness or disease (Lee et al., 2017). Assessment of Overall Utility There are both strengths and weaknesses in the utility of the TOUS. The TOUS can be used to improve the understanding of the symptom experience of individuals in various scenarios and provides information that is useful for nursing interventions that can decrease, prevent or manage negative symptoms and their unpleasant effects (Lenz Pugh, 2014). However, the TOUS lacks detail that may be useful in working with a specific symptom or illness in a given clinical population, such as pediatrics. Specifically, the TOUS has focused only on subjectively perceived symptoms rather than objective observable data. Neonates, infants and toddlers or children who are cognitively impaired, are incapable of verbalizing their pain. Therefore, pain or unpleasant symptom assessment should also be based on behavioural and physiological cues rather than just subjective information. For example, an infant may display pain by frowning or clenching their jaw and crying uncontrollably. They may moan, whimpe r or have a difficult time being consoled by a parent or caregiver. Being agitated, squirmy or rigid can also be indicative of pain or unpleasant feelings in infants and should be noted (Merkel, Voepel-Lewis, Shayevitz Malviya, 1997). The TOUS does an excellent job at looking at the individual in a holistic manner, such that it considers the interactions between individuals and their environment, the multidimensionality of symptom experiences of the individual and uses a biopsychosocial approach (Lee et al., 2017). While constructing an individualistic health care plan for patients, the TOUS does not include an intervention component within the model. This may indicate that the theory is more useful for observing concepts, examining their relationships, and developing tools to measure the concepts/relationships than for developing specific interventions for particular symptoms (Lenz, et al.,1997). In the future, the theory should include suggestions for interventions on specific symptoms for health care providers to use in practice. Conclusion The purpose of this paper was to describe, analyze and evaluate the TOUS in a clinical pediatric setting and its connection to nursing practice. The uses, strengths and weaknesses of the theory were also presented. The TOUS is a middle-range theory that emphasizes the importance for nurses to understand that physiological, psychological and situational factors can influence multiple symptoms, which in turn can affect the individuals performance. It is also critical to realize that the performance outcomes can loop back to impact the symptom experience itself, as well as to alter the influencing factors (Lee et al., 2017). Overall, this theory can be applied in different settings to understand symptoms of individuals, however specific nursing interventions are currently lacking in this theory. With continued research and studies, this theory can only increase in its practicality to health care professionals and caregivers. References International Association for the Study of Pain, Subcommittee on Taxonomy. (2008). Pain terms: A list of definitions and notes on usage. Pain, 6, 249. Lee, S.E., Vincent, C., Finnegan, L. (2017). An analysis and evaluation of the theory of unpleasant symptoms. Advances in Nursing Science, 40 (1), E16-E39. Lenz, E.R., Suppe, F., Gift, A.G., Pugh, L.C., Milligan, R.A. (1995). Collaborative development of middle-range nursing theories: Toward a theory of unpleasant symptoms. Advances in Nursing Science, 17 (3), 1-13. Lenz, E.R., Pugh, L.C., Milligan, R.A., Gift, A.G., Suppe, F. (1997). The middle-range theory of unpleasant symptoms: An update. Advances in Nursing Science, 19 (3), 14-27. Lenz, E.R., Pugh, L.C. (2014). The theory of unpleasant symptoms. In M. J. Smith (Ed.), Middle range theory for nursing (3rd ed.), (165-195). New York: Springer Publishing Company. Lopes- Junior, L.C., de Omena Bomfim, E., Nascimento, L.C., Pereira-da-Silva, G., Garcia de Lima, R.A. (2015). Theory of unpleasant symptoms: Support for the management of symptoms in children and adolescents with cancer. Revista gaucha Enfermagem, 36 (3), 109-112. Merkel, S.I., Voepel-Lewis, T., Shayevitz, J.R., Malviya, S. (1997). The FLACC: A behavioural scale for scoring postoperative pain in young children. Pediatric Nursing, 23 (3), 293-297. Registered Nurses Association of Ontario [RNAO]. (2013). Assessment and management of pain, third edition. Retrieved from http://rnao.ca/sites/rnao-ca/files/AssessAndManagementOfPain2014.pdf Smith, M.C., Parker, M.E. (2010). Nursing theory and the discipline or nursing. In M.E. Parker M.C. Smith (Eds.), Nursing Theories and Nursing Practice (3rd ed.), (pp.3-15). Philadelphia, PA: Davies.

Information Systems In Business Organizations Essay

The website of PC Magazine, upon looking at its physical makeup, and design, was designed to entice and provoke consumers all over the world, some of them, I assume, are hooked on online shopping, to purchase products featured on their website. The home page of the website appears to be patches of commercial billboards as it is occupied by advertising ads publicizing their line of products. Some of the wide variety of products presented in the website includes printers, digital cameras, laptops, mobile phones, software and hardware products for computers, mp3 players, to flash drives, speakers, projectors, subscriptions for PC magazine as well, and many more. There is also a broad range of links that you can visit that depends on your fields of interest. For online window shoppers, there is a link for product guides and reviews. Products available in the market, including all brand names, companies and corporations who pay Pcmag.com for advertisements, and product partners, are reviewed and rated. The reviews are useful enough, containing the positive and negative feedbacks of each product. The ratings on the other hand are based on the features, compatibility to other gadgets, design, and the price of the product. There are also software products, for shareware, demo trial, and freeware that the online client can sample and access. As tagline of the Pcmag.com goes, their website is intended for an independent individual. To prove their claim, they have provided links for how-to’s, do-it-yourself’s, tips and guides, and video blogs. For the online information-seeker, there are links for news updates and columns about products in the market, whether these are upgrades, new product launches, additional reviews, comments, etc. Aside from the advertisements plaguing the website, there is also a separate link for online shoppers, which constitute numerous merchandises that are available for purchasing, shopping options, and technology solutions. Moreover, there are discussion boards for online clients who wish to communicate with other online clients about gadget finds, current trends, and other issues about technology and its advances.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Overall, the website of PC Magazine spells out the words â€Å"to sell.† There isn’t any link in the website which does not feature an advertisement or stimulating signs such as low prices, sales, and discounts for products. For each mouse click, there is always a provocation to purchase gadget items. The website accommodates online shoppers, online window shoppers, and consumers deciding on what products to purchase for their particular needs and why. However, pcmag.com primarily caters to businesses or corporations that are planning advertising strategies for the promotion of their products. In as much as the website would want to display themselves as a consumer-centered community, it is likely that business corporations are more benefited by them than their consumers. People who are knowledgeable about management and marketing issues or even rational consumers who are not easily swayed by advertising would know this. Advertising is a very powerful and persuasive tool in stimulating consumers to believe what they are trying to sell. It does not even contribute much to information technology because it is only concerned with the promotions of software and hardware products. Although there are links provided for how-to’s and such, it still lacks depth and beneficial information to sustain the demands of learning information technology. The extensive amount of information provided in each link would be a subject of interest to you if you are a techie and gadget-dependent or if you want to learn how to operate gadgets that are widely used nowadays. If these are your objectives in visiting the sites, then it would be an advantageous and helpful thing for you to do. The product guides and reviews would prove to be the most interesting and valuable links for consumers, as it has the most consumer-centered feel to it. In general, the usefulness and value of the website depends upon your needs and concerns.

Freakanomics Book Critique - 1036 Words

Freakanomics Book Critique What do the Klu Klux Klan, real estate agents, Chicago gangs, and sumo wrestlers all have in common? Surprisingly, economics. Steven D. Levitt, an award-winning University of Chicago economist with an unconventional view of the world, and his co-author Stephen J. Dubner, an intrepid author and reporter, set out to find the bizarre correlations between world events using economics in their 2005 New York Times Bestseller Freakanomics: Exploring the Hidden Side of Everything. Freakanomics is at times controversial and some of the information could be outdated yet it is still highly entertaining and intriguing, based on verified and factual information yet communicated in a fashion that is understandable to even the most math-phobic or economics-impaired individual. Freakanomics is a new kind of microeconomic research coined by Levitt and Dubner and does not have anything to do with stock market predictions or a company’s production of goods. Instead, Freakanomics uses economic principles and research to answer curious questions such as â€Å"If drug dealers make so much money, why do they still live with their mothers?† and â€Å"What do cheating teachers and sumo wrestlers have in common?† Each chapter endeavors to answer a bizarre question about how the world, and people, really work. Economics is often thought to be a cold and calculating science of graphs and dollar signs. Freakanomics however is a unique blend of economics’ emotionless logic, curiosity,

Common Reader and Complex Reader Free Essay Example, 1250 words

The common reader according to the author is a layman who, in relation to what was mentioned earlier, simply wants to experience and satisfy his needs. Since the Grand Canyon is greatly advertised as a nice place to visit, being there with other tourists, experiencing and enjoying the view would already be enough for the common reader. The complex reader, on the other hand, will not be satisfied by simply being there. He is an expert so he will be able to see with observant eyes other things which may not be even noticed by other people. There is something that he wants to experience further, something uncommon and different. Therefore, he does not get satisfied by visiting the Grand Canyon unless he finds out something he did not read about in books or magazines. Perhaps he would find another venue from where he could see the renowned tourist spot with a new perspective. The complex reader is a planner so that knowing what to expect at the Grand Canyon, he will make detailed notes about alternative activities or venues for his visit. The common reader is also simple in his ways. We will write a custom essay sample on Common Reader and Complex Reader or any topic specifically for you Only $17.96 $11.86/page What a wonderful sunset . On the contrary, the complex reader will plan to camp and have a barbecue party because he interprets the red sky as a sign of a good night for outdoor activity. The analysis was mentioned earlier. This is absent among common readers while it is a defining characteristic of the complex reader.