Theory of Symptom Management

Purpose of Theory

Purpose

• The original model created in 1994 by the University of California, San Francisco provided a framework to allow faculty involved in symptom research and clinical practice
• The revised model from 2001, the concept labels were slightly altered and the influence of person, environment, and health and illness were made explicit by situating the entire model within these spheres

Symptom Experience

• Subjective and based on perceptions
• Based on frequency, severity, and level of distress symptoms cause
• Symptom experience can be more bothersome at different times (ex: work vs while trying to sleep)

3 Domains in Nursing Science

3 Domains

• Person
• Individual Characteristics
• ex: older adults, children, women, ethnic groups
• Environment
• Physical, social, and cultural characteristics
• Health/Illness
• Health Status, risk factors, disease, and injury

Symptom Management Strategies

Symptom Management Strategies

• Strategies used to avoid or minimize symptoms
• Effective by reducing frequency of symptoms
• Effective by decreasing severity of symptoms
• Effective by relieving distress associated with symptoms

*Goal is symptom reduction seen in outcomes

(Smith & Leihr, 2018).

Outcomes

• Focuses on
• self-care
• functional status
• costs
• quality of life
• mortality
• emotional status
• morbidity and co-morbidity

Defined by change in symptom status in frequency, severity, or distress (Smith & Liehr, 2018).

Miscellaneous

Misc

• Not connected to a nursing grand theory
• Based on other nursing models such as Orem's Self-Care Model and Sorofman, Tripp-Reimer, Lauer, & Martin's Model of Symptoms of Self-Care
• Related to models from anthropology, sociology, and psychology

(Smith & Liehr, 2018)

Using Symptom Management Theory to Explain how Nurse Practitioners Care for Children with Asthma

Use in Practice #1

• This article analyzed the use of STM in practice with children with asthma
• STM explains the symptom experience, symptom management strategies, and status symptom outcomes
• NP's rely on information from both the child and the child's caregiver
• This article implies that if a child is not able to communicate effectively or the caregiver has a lack of understanding about the underlying disease, STM's primary concepts may not work
• The article proposed new concepts that include communication between dimensions of symptom experience and symptom management

Newcomb, P. (2010). Using Symptom Management Theory to Explain how Nurse Practitioners Care for Children with Asthma. Journal of Theory Construction & Testing, 14(2), 40-44. https://www.proquest.com/scholarly-journals/using-symptom-management-theory-explain-how-nurse/docview/868177911/se-2?accountid=12259

Ways STM could be useful in practice:

Use in Practice #2

• The numeric pain scale when assessing patient's on their pain level
• Using the pain scale will give nurses the guidance on how much medication to administer or think of non-pharmacological interventions to decrease their pain symptom
• PHQ-9 scale used for depression screening
• Able to determine the severity of depression in patients
• Edmonton Symptom Assessment System (ESAS)
• Used to rate intensity of nine most common symptoms experienced by cancer patients

• Linder (2010) used the SMT design to study symptom management in children with cancer
• Many SMT studies with children have been qualitative in nature
• Determined younger children identified more physical issues and are present-oriented
• Older children grapple with depression and other mental-health symptoms in addition to physical symptoms

Linder (2010)

Linder, L. (2010). Analysis of the UCSF Symptom Management Theory: Implications for Pediatric Oncology Nursing. Journal of Pediatric Oncology Nursing, 27(6), 316–324.

https://doi.org/10.1177/1043454210368532

• Chronic pain affects anywhere from 14.6% to 64% of adults.
• Rural pain management is a particular challenge due to the potential of an aging population, lower socioeconomic status, and limited access to care.
• The study aimed to determine if Telehealth was an effective chronic pain management intervention to decrease the severity of pain among patients.
• The trial found that Telehealth specifically designed for pain management was a need among those with chronic noncancer pain and reached more patients.

Eaton et. al. (2014)

Eaton, L., Gordon, D., Wyant, S., Theodore, B., Meins, A., & Rue, T. et al. (2014). Development and implementation of a telehealth-enhanced intervention for pain and symptom management. Contemporary Clinical Trials, 38(2), 213-220. https://doi.org/10.1016/j.cct.2014.05.005

• The PHQ-9 is an assessment tool to screen for depression
• In 2009, depression had an estimated prevalence of 10-15% in the UK
• The aim of this study was to determine the usefulness of the PHQ-9 Questionnaire patients were given by their GPs
• The GPs looked at the severity of the scores and based treatment on those scores of 604 patients
• ~ 7-8 weeks after the intervention the PHQ-9 was readministered to patients and again in another four weeks
• Patients who either had a high score or did not have an adequate change in their symptoms as determined by the PHQ-9 were five times more likely to have their treatment plan changed.

Moore et al. (2012)

Moore, M., Ali, S., Stuart, B., Leydon, G., Ovens, J., Goodall, C., & Kendrick, T. (2012). Depression

management in primary care: an observational study of management changes related to

PHQ-9 score for depression monitoring. British Journal Of General Practice, 62(599), e451-

e457. https://doi.org/10.3399/bjgp12x649151