Symptom Management Theory

Issues and Limitations

Analysis of Symptom Management Theory

• Perception vs Healthcare professional perception
• migraines
• Separation of the patients perception from the patient evaluation of symptoms
• Confused pts. presenting with anxiety or agitation instead of pain signals
• Family Involvement
• Pediatrics

Limitations

• Community or group needs
• Health-Risk Profiling
• Assessment
• Risk of Symptoms Management development
• Characterizing the Risk
• Evaluating Values & Social processes
• Analyzing Organizational Factors
• Resources for change
• Prevention
• Group Characteristics
• Ethnicity
• Diversity

Three Different Domains

Meaning of Symptoms

• Intensity
• Location
• Temporal Nature
• Affective Impact
• An individual with a long-term history with the symptom learns to catalogue various discrete and subtle sensations associated with the symptom

• Person
• Demographic
• Psychological
• Sociological
• Physiological
• Health & Illness
• Risk Factors
• Health Status
• Injuries & Disabilities
• Environmental
• Physical
• Social
• Cultural

Response to Symptoms

Physiological

Psychological

Sociocultural

Behavioral

Rating Scale

Symptom Experience

• Perception
• PET Scans "image" pain
• Rating Scales
• Meaning
• Response

Perception of Symptoms

• Can perception be modified or influenced?
• Positive/Negative thoughts
• Asthma
• Mechanical Ventilation
• Sleep

Symptom Management Theory

Overall Aims of SMT

• Develop the sub-discipline of symptom management across health science disciplines and across health care settings by elucidating and testing a Model of Symptom Management
• Improve individuals' health status, by decreasing symptom morbidity and thereby enhance their quality of life, with particular emphasis on specific cultural and ethnic groups
• Prepare scientists in Nursing and other disciplines by interdisciplinary training in the area of symptom management
• 4.Create mechanisms for synergy, cooperation, and collaboration among interdisciplinary clinical investigators working in the area of symptom management

Goals

To Avert or delay a negative outcome through biomedical, professional and self-care strategies

UCSF Model

By: Megan Wallace, Bridget Heard, Afnan Almedallah

Management Strategies

(Interventions)

UCSF School of Nursing

• Who, what, where, when, why, how much, to whom
• Assessment of Symptom Experience
• Focus for Interventions
• Change in strategies is common

Outcomes

Symptom Experience

• Patient does not seem to mind the seizures, "they make me sleepy" and "Sometimes I miss school."
• Parents express anxiety related to seizures and fear injury related to seizure
• Parents respond to symptoms appropriately
• "My heart still stops and I panic on the inside every time the school calls"

Outcomes

• Prevention of further Injury
• Maintain quality of life and growth
• Maintain emotional health

Adherence

Management Strategies

Research Question

• How does symptom management affect pediatric oncology patients? (Linder, 2010).
• How can symptom management tailor self-management in diabetes education?
• How do barriers to symptom management effect end of life care? (Jablonski, 2005).

Are there any factors that could be adjusted to increase management?

• Medication Side effects
• Delivery method of rescue meds

• Who-Mom or other health care professionals
• How-Medication Interventions
• When-When he has seizure activity
• How Much-per MD order
• Why-To prevent this
• To whom-The Patient (Billy)

Relational Proposition

Effective management of any given symptom or group of symptoms demands that all three dimensions be considered (Dodd et. al., 2001)

Non-Relational Proposition

The symptom does not have to be currently experienced to apply the model. The patient can be at risk for developing the symptom (Dodd et. al., 2001).

Symptom Management Theory

• Functional Status
• Self-Care
• Emotional Status
• Non-adherence
• Too demanding

Symptom Status

Case Study

(Childhood Epilepsy)

• Mortality
• Quality of Life
• Morbidity and Co-Morbidity
• When a symptom is successfully treated and completely resolved, the model is no longer relevant. If continued intervention is necessary to control reoccurring symptoms, then the model continues to be applicable and direct management and measurement of outcome continues

• Developed originally as the Symptom Management Model by nursing faculty at the University of California San Francisco
• The goal is to advance the knowledge in the field of symptom management and, thereby, improve health care providers' practice and individuals' symptom outcomes.

Scope & Focus

• Person
• 9 year old male, well adjusted, married parents, older sister
• Health & Illness
• Car accident resulting in head trauma
• No previous Illness
• Medication managed epilepsy with intermittent break through seizures
• Environment
• School Age
• Many friends
• On School soccer team

• Affects anyone with a symptom that may need management
• Recipient of this model can be a client, family, or community
• Helps identify barriers and factors influencing effective symptom management

Metaparadigm

• Person
• Health
• Environment
• Nursing

Scope/Comprehensiveness/Significance of Theory

• The scope of this theory is to delay a negative outcome through biomedical, professional and self care strategies. It is useful because of its applicable to nurses
• Symptom Management is a dynamic process, often requiring changes in strategies over time or in response to acceptance or lack of acceptance of the strategies devised.
• It is a very broad theory which is applicable to any patient who needs to manage their symptoms to what he/she feels
• The ramifications of acute vs chronic symptom management needs to be further explored if the model is to be comprehensive and optimally useful.

Explication

Explication: Is it understandable and are the concepts clearly defined? (Fawcett, 2005)

• Yes, this theory is clearly defined

Parsimony

Parsimony: Is the theory stated clearly and concisely? (Fawsett, 2005)

• The theory is clear and easy to understand. The examples provided are concise and demonstrate the theory in simple form.

Social Utility and Significance

Has the theory been applied in the real world of nursing practice? If not, is it feasible to do so? Do the theory-based actions lead to positive outcomes? (Fawsett, 2005)

• The duration of symptom evaluation depends upon its persistence and need for continued intervention and response to treatment (Marylin Dodd et al., 2000)
• The Symptom Management Theory has been applied to real life situation (Will discuss when presenting research articles)

Testability

Logical Development: Clarity

• Yes, it is testable. A more generic intervention that utilizes an approach of providing patients with education, self-care skills and support is currently being tested (Miaskowski et al., 1995-1999).
• Since its publication, the model has demonstrated its ability to generate research questions and hypotheses across a range of illness states
• These attributes add to the overall validity and strength of the model

Research Articles

References

• "Using Symptom Management Theory to Explain how Nurse Practitioners Care for Children with Asthma"
• "A Program of Symptom Management for improving quality of life and drug adherence in AIDS/HIV patients"

• Dodd, M., Janson, S., Facione, N., Faucett, J., Froelicher, E. S., Humpherys, J., . . . Taylor, D. (2001). Advancing the science of symptom management. Journal of Advanced Nursing, 33(5), 668-676.
• Jablonski, A., & Wyatt, G. K. (2005). A model for identifying barriers to effective symptom management at the end of life. Journal of Hospice and Palliative Nursing, 7(1), 23-36.
• Linder, L. (2010). Analysis of the UCSF symptom management model theory: Implications for pediatric oncology nursing. Journal of Pediatric Oncology Nursing, 27(6), 316-324. http://dx.doi.org/10.1177/1043454210368532
• Skelly, A. H., Leeman, J., Carlson, J., Soward, A. C., & Burns, D. (2008). Conceptual model of symptom-focused diabetes care for African Americans. Journal of Nursing Scholarship, 40(3), 261-267
• Newcomc, P. (2010). Using Symptom Management Theory to Explain How Nurse Practitioners care for Children with asthma. The Journal of Theory Construction & Testing. 14(2), 40-44
• Fawcett, J. (2005). Criteria for evaluation of theory. Nursing Science Quarterly,18(2), 131-135.
• Chiou, P., Kuo, B., Lee, M., Chen, Y., Chuang, P., Lin, L. (2006). A program of symtom management for improving quality of life and drug adherence in AIDS?HIV Patients. Journal Compilation. pgs 169-179

Credibility/Usefulness

• Despite its strengths in agreement and making sense, several logical fallacies are present in the SMT.
• Time
• Symptom Assumptions
• Lacking Multiple symptoms
• Acute vs. Chronic

• As a middle range theory, the SMT is proposed to be relevant across populations experiencing illness-related symptoms
• To date, the model has been established as a useful framework for research among adults with a variety of health and illness states (Bay & Bergman, 2006).
• The model has been used to explore differences in symptoms based on race and ethnicity (Humphreys et al., 2008)
• It has also been used as a framework for synthesizing current research related to family caregiver symptoms (Fletcher, Dodd, Schumacher, & Miaskowski, 2008).

(Dodd et al., 2001; Henly et al., 2003)