Theory of Unpleasant Symptoms in Multiple Sclerosis

Theory of Unpleasant Symptoms

A theory is derived through knowledge and provides a way of explaining phenomena.nNursing as a profession, must follow the specific metaparadigm when caring for patient. This involves the person, environment, health and caring. Beneath the metaparadigm we have grand theories in which concepts are more abstract. Middle range theories are constructed by grand theories but generated to a lower level of abstraction to therefore be applied in guiding patient specific populations. In this paper, we will be looking at a middle range theory known as the theory of unpleasant symptoms. The purpose of this theory will be explained in addition to the key concepts and assumptions. The theory will then be applied to a specific nursing case experienced by the writers. The theory of unpleasant symptoms, will be evaluated on terms of how this theory in particular can guide every day nursing practice in more than one specific patient population.

Case Description

The clinical example I will be using in order to prove the theory of unpleasant symptoms fits it best is a client that was in my care who suffered from multiple sclerosis. He had to deal with going from a healthy man working a physically demanding job he loved, to losing function of both legs and partial function of his arms. He is now bed ridden and in a constant flexed position unable to get up unless done so by a lift into a wheelchair. Accompanying his immobility are multiple wounds on various locations throughout his body, which make even the slightest movement extremely uncomfortable. He is also living with a permanent urinary catheter to lessen the opportunity of any further skin breakdown his immobility has caused. This is along with many other symptoms such as constipation, incontinence, stiffness, muscle spasms, and chronic pain. Not only has this had a drastic impact on him physically, but also mentally as he now lives in constant extreme fear of the future. It is very difficult for him as he is completely fine cognitively, while having to undergo the debilitating physical and mental health symptoms that accompany multiple sclerosis at the same time. My client also suffers from anxiety and depression because of this, with his biggest concern being whether he will ever be able to work again, if he will lose his ability to speak or write, how his family will cope and whether or not he will eventually lose his life to this disease.

Theory Description

The theory of Unpleasant Symptoms, was developed in 1995 and revised in 1997, by four nurse researchers who shared interest in the nature and experience of different symptoms and the process of concept and theory development. This theory provides insight into different groups of unpleasant symptoms and their relationships amongst each other. This theory encompasses three major concepts; the symptoms, influencing factors of the symptoms and the performance consequences. Among these concepts are influencing factors which include: physiological, psychological and situational factors that affect the patient. These concepts are influenced by the “occurrence, intensity, timing, distress level and quality of the presented symptoms”.  Middle range theories must be generalizable and useful across multiple patient populations. This theory is observed in every clinical setting and provides guidance in nursing practice. Patient symptoms and influencing factors are present in all patient populations impacting a patient’s recovery. When treating a patient, the goal is treating the illness, however an important step in recovery is also treating the patients mental state and the patients support systems.

As per Hegyvary, symptoms are “perceived indicatory of change in normal functioning as experienced by patients... they are the red flags of threats to health.” P#. The physiological, psychological and situational factors will consequently affect an individual’s functional status, cognitive functioning and physical performance. Therefore, nurses must understand these factors and recognize the use of this theory in order to provide effective patient care.

Theory in Practice

The theory of unpleasant symptoms can be used to explain how our client suffering from multiple sclerosis may interpret his symptoms, factors that contribute to this interpretation and possible ways of reducing or making the symptoms more bearable for him. Those living with MS experience many physically exhausting symptoms such as spasticity, fatigue, sexual dysfunction, bladder and bowel dysfunction, pain, cognitive dysfunction, and depression – most of which have been experienced by my patient. We will examine the physiological, psychological and situational factors that may influence his perception of these symptoms and the relationship between them. My client is a perfect candidate to test the relationship between this theory as the symptoms associated with multiple sclerosis does not only affect my client physically, but also affects his mental health and social life as well. The theory of unpleasant symptoms is a middle range theory, which makes it a great candidate to help aid in nursing practice by guiding our future research in symptom management.

Physiologic factors that could contribute to my client’s perception of his unpleasant symptoms include his disease process, nutritional status and mobility. Unfortunately, these physical symptoms as a cluster could have a potentially larger impact on other factors. An example of this is an increase in my clients pain affecting his desire to eat, which then impacts his mobility due to increasing fatigue leading to decreased range of motion. A study by Motl & Mcauley proved that ensuring management of multiple symptoms can have an overall impact on the physical activity behavior of those suffering from MS, therefore leading to greater overall satisfaction.

Psychological factors that could contribute to my clients reported symptoms include perceived management of symptoms, current mood, and disease knowledge. According to Siegert the lifetime rate of depression among those suffering from MS is 50%, which is not only caused by the disease process itself but can also be caused by side effects of potential treatment options. Those suffering from depression are less likely to adhere to long term disease modifying therapy, causing a potential for disease progression or symptom exacerbation. Maintaining your clients psychological symptoms are as important as the physical as they are interrelated and affect one another. Ensuring your client is knowledgeable in regards to their disease process and treatment options can also improve overall health. A study by Rosiak & Zagożdżon showed accurate information from medical personnel about the illness as well as the ability to cope with the limited physical resources are of utmost importance.

Situational factors that would influence my client’s perception include lack of social support, loss of employment and hospital stay duration. My client not only has to deal with the physical and mental despair that comes with this disease, but also the situational. My client has had to deal with a lack of social support as he is not married, has no children and does not have much support other than immediate family. According to a study by Rosiak & Zagożdżon patients with MS were shown to function considerably better in physical and mental spheres whenever they received various forms of social support. Aside from this he has been unable to maintain employment due to his progression of disease and has spent over a month in hospital during only one admission of many. It is well known that MS is associated with a heavy economic burden coupled with a decreased ability to remain in the work force. The loss of employment brings detrimental consequences to patients and families with respect to short-term and long-term economic, psychosocial and healthcare utilization domains. 

In conclusion, the theory of unpleasant symptoms proves that patients perceive illness as clusters of unpleasant symptoms that both individually and jointly impact their experience, emotional distress and functional abilities. It is both the physical symptoms along with the perception of the lived experience that affect’s their overall satisfaction. As a healthcare provider it is up to us to come up with interventions to lessen the burder these symptoms may cause. Multiple things can be done such as pain management, physical exercise, providing patient with information regarding their disease and treatment, providing therapeutic support, etc.