Theory of unpleasant symptoms as a guide

Full Answer Section

   

• Duration: How long has the patient been experiencing the symptom?
• Timing: When does the symptom occur?
• Quality: What does the symptom feel like?
• Distress: How much distress does the symptom cause the patient?

In addition to these dimensions, it is also important to assess the impact of the symptom on the patient's quality of life. This includes assessing the symptom's impact on the patient's ability to perform activities of daily living, participate in social activities, and sleep well. An assessment tool for patient symptoms that is informed by TOUS would be one that:

• Is comprehensive and assesses all of the dimensions of symptoms listed above
• Is easy to use for both patients and clinicians
• Is valid and reliable
• Is sensitive to change

Here are some specific examples of items that might be included in an assessment tool for patient symptoms that is informed by TOUS:

• Type: What type of symptom are you experiencing? (e.g., pain, shortness of breath, nausea, fatigue)
• Intensity: How severe is the symptom? (e.g., mild, moderate, severe, debilitating)
• Duration: How long have you been experiencing the symptom? (e.g., less than a week, 1-2 weeks, more than 2 weeks)
• Timing: When does the symptom occur? (e.g., all the time, only at certain times of day, only when I do certain activities)
• Quality: What does the symptom feel like? (e.g., sharp, dull, aching, burning)
• Distress: How much distress does the symptom cause you? (e.g., none, mild, moderate, severe)
• Quality of life: How much does the symptom impact your ability to do the things you want to do? (e.g., not at all, a little bit, a lot)

In addition to these items, the assessment tool might also include items to assess the patient's coping mechanisms and support system. An example of a valid and reliable assessment tool for patient symptoms that is informed by TOUS is the Memorial Symptom Assessment Scale (MSAS). The MSAS is a 32-item questionnaire that assesses the intensity, frequency, and distress of 32 common symptoms experienced by cancer patients. It is easy to use for both patients and clinicians and is sensitive to change. Other assessment tools that are informed by TOUS include:

• Edmonton Symptom Assessment System (ESAS)
• Functional Assessment of Cancer Therapy-Symptom Index (FACT-S)
• Symptom Distress Scale (SDS)
• Symptom Management Scale (SMS)

These tools can be used to assess symptoms in a variety of patient populations, including cancer patients, patients with chronic diseases, and patients in the acute care setting. By using an assessment tool that is informed by TOUS, clinicians can gain a comprehensive understanding of the patient's symptom experience and develop a more effective treatment plan.  

Sample Answer

   

The theory of unpleasant symptoms (TOUS) is a middle-range theory of nursing that describes the nature, antecedents, and consequences of unpleasant symptoms. It views symptoms as holistic experiences that are influenced by a variety of factors, including physiological, psychological, and situational factors.

According to TOUS, the assessment of unpleasant symptoms should be comprehensive and include the following dimensions:

• Type: What type of symptom is the patient experiencing?
• Intensity: How severe is the symptom?