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Symptom Management Theory

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megan wallace

on 26 November 2013

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Transcript of Symptom Management Theory

Symptom Management Theory

UCSF School of Nursing
Analysis of Symptom Management Theory
Symptom Management Theory
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.
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
Three Different Domains
Person
Demographic
Psychological
Sociological
Physiological
Health & Illness
Risk Factors
Health Status
Injuries & Disabilities
Environmental
Physical
Social
Cultural
Symptom Experience
Perception
PET Scans "image" pain
Rating Scales
Meaning
Response
Issues and Limitations
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
Management Strategies
(Interventions)
Who, what, where, when, why, how much, to whom
Assessment of Symptom Experience
Focus for Interventions
Change in strategies is common
By: Megan Wallace, Bridget Heard, Afnan Almedallah
UCSF Model
Perception of Symptoms
Can perception be modified or influenced?
Positive/Negative thoughts
Asthma
Mechanical Ventilation
Sleep
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
Rating Scale
Physiological
Psychological
Sociocultural
Behavioral
Response to Symptoms
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
To Avert or delay a negative outcome through biomedical, professional and self-care strategies
Goals
Outcomes
Functional Status
Self-Care
Emotional Status
Non-adherence
Too demanding
Symptom Status
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
Scope & Focus
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
Case Study

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
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"
(Childhood Epilepsy)
Outcomes
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)
Management Strategies
Prevention of further Injury
Maintain quality of life and growth
Maintain emotional health
Adherence
Are there any factors that could be adjusted to increase management?
Medication Side effects
Delivery method of rescue meds
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).
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).
Explication
Explication
: Is it understandable and are the concepts clearly defined? (Fawcett, 2005)
Yes, this theory is clearly defined
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.
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)
Logical Development: Clarity
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
Credibility/Usefulness
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).
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.
(Dodd et al., 2001; Henly et al., 2003)
Testability
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
"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"
References
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
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