An integrative review of the theory of unpleasant symptoms

Abstract

Aims The aim of this study was to explore how the theory of unpleasant symptoms (TOUS) has been used in the methodological design and analysis of symptom research. Design An integrative review, using Whittemore and Knafl's approach. Data Sources Searches were conducted between 26 January–10 February 2018. Databases included CINAHL Complete, PubMed, Proquest Nursing and Allied Health Source, Health Source: Nursing/Academic Edition, Academic Search Complete and Google Scholar. Review Methods A systematic approach to searching, screening and analysing the literature was applied. The matrix method, content analysis, constant comparison, counting and clustering were used. Results Sixty‐four records were included. Most studies were quantitative, cross‐sectional, instrument‐based and conducted in the USA. Various symptoms and patient populations were represented and each of the TOUS concepts were explored. Conclusion Although the theory has a role to play in furthering symptom science, attention should be paid to the areas of the model and of symptom research that have received less attention. More complex statistical approaches and big data will help to illuminate symptom experiences. Additional focus on intervention studies and all symptom dimensions will help to advance symptom science research. Impact This review is the first to provide a comprehensive, systematic summary of the uses of the TOUS across the research literature to date. This theory is a diverse, holistic middle‐range theory capable of being applied to multiple symptoms and populations. Researchers should consider using the theory as a conceptual framework for studies to advance symptom science and explore symptoms holistically.

Synergistic Impact of Symptom Clusters on Health-related Quality of Life in Patients With Chronic Obstructive Pulmonary Disease: a Secondary Data Analysis

“…It is noteworthy this study identi ed three symptom clusters in patients with COPD, two symptom clusters in patients with severe-stage COPD. From the 'Theory of Unpleasant Symptoms' [29], Lenz and colleagues stated that physiological factors in uence the symptom clusters, this study empirically con rmed that an association between stage of the disease and symptom clusters.…”

“…Clinical experiences and middle range 'Theory of Unpleasant Symptoms' indicate that the existence of symptom clusters can signi cantly increase symptom burden and synergistically affect patients' HRQoL compared with the single symptom [29,30]. To our knowledge, no studies have speci cally evaluated the synergistic impacts of symptom clusters on HRQoL in the COPD population.…”

A qualitative exploration of prodromal myocardial infarction fatigue experienced by women

“…The middle-range Theory of Unpleasant Symptoms (TOUS), developed by Lenz, Pugh, Milligan, Gift, and Suppe (1997), served as the theoretical framework for this study. A full exploration of the ways this theory has been used in symptom research (Blakeman, 2019) and a critical evaluation of this theory (Lee, Vincent, & Finnegan, 2017) are available elsewhere. Briefly, the TOUS is a flexible, middle-range theory that allows for a comprehensive exploration of the symptom experience, including factors affecting the symptom experience and consequences of symptoms (Blakeman, 2019;Lee et al, 2017;Lenz & Pugh, 2014).…”

“…Finally, symptoms affect a person's performance, such as functional status, activities of daily living (ADL) and cognitive functioning (Lenz et al, 1997). Researchers have often explored the negative effect of the symptom experience on ADL and quality of life in terms of performance outcomes (Blakeman, 2019). However, positive aspects of performance, such as care-seeking behaviours, are also a potential outcome of the symptom experience (Blakeman, 2019).…”

“…Researchers have often explored the negative effect of the symptom experience on ADL and quality of life in terms of performance outcomes (Blakeman, 2019). However, positive aspects of performance, such as care-seeking behaviours, are also a potential outcome of the symptom experience (Blakeman, 2019).…”