Description of the

Theory of
Unpleasant Symptoms
Presentation Outline
Theory of Unpleasant
Symptoms

The theory allows for the presence of

multiple symptoms that interact
and/or are multiplicative. It implies that
management of one symptom will contribute
to the management
of other symptoms.

Peterson and Bredow (2020).

 Introduction

• Theory of Unpleasant Symptoms is a middle

range nursing theory
• According to the theory, symptoms are
multidimensional
• The theory has helped nurses manage the
symptoms of ailments displayed by patients
– Management of one symptom contributes to the
management of another one
Source: Peterson and Bredow (2020)
 History of Theory

• Development of the theory is credited to

– The initial researches by Linda Pugh, Audrey Gift and Renee
Milligan
– Further development by Elizabeth Lenz and Frederick Suppe

• Developed in 1993
• Further development into a middle range
nursing theory through
– Clinical observations
– Empirical research
– Teamwork Source: Peterson and Bredow (2020)
Major Concepts

Source: Peterson and Bredow (2020)

 Major Parts of the Theory

• The symptoms

• Influencing
outcomes

• The
performance
outcomes Source: Nguyen, Haas, and Pugh (2017); Peterson and Bredow (2020)
 Symptoms

Symptoms have four dimensions

•Timing
– Frequency of symptoms
•Intensity
– Strength or severity of symptoms
•Quality
– Variation of symptoms based on their pathologies
•Distress
– Degree of discomfort to the patient

Source: Gomes et al. (2019)

 Influencing Factors

Influencing factors have 3 categories

•Physiological factors
– Normal or abnormal functioning of bodily systems

•Psychological factors
– Normal or abnormal state of mind

•Situational factors
– Normal or abnormal social and environmental influences
Source: Peterson and Bredow (2020)
The Performance Outcomes

The performance outcomes have 3

categories
•Physical
•Cognitive
•Social

Source: Gomes, et al. (2019); Guilkey et al. (2016)

 Application in Practice

• Assessment of symptoms
• Taking of patient history
• Clinical interventions regular
monitoring of change
• Planning of care
Source: Lenz (2018)
 Application in Practice

• Instruments of symptom assessment

• Profile of mood states (POMS)
• Virtual analog scale
• Numeric rating scale
• McGill Pain Questionnaire
• Brief fatigue inventory
• Minnesota living with heart failure questionnaire
• Short form-36
• CES-D
• Memorial symptom assessment scale
• Fox simple quality of life scale

• They have scores scales and scores used to describe the

symptoms as accurately as possible
Source: Peterson and Bredow (2020)
 Summary

• Theory of unpleasant symptoms is an

influential middle range nursing theory
• It advances nursing knowledge and
practice through
– improving the accuracy of diagnosis
– Improving effectiveness of care
– Increasing patient satisfaction
 References

• Gomes, G. L. L., Oliveira, F. M. R. L. D., Barbosa, K. T. F., Medeiros, A. C. T. D.,

Fernandes, M. D. G. M., & Nóbrega, M. M. L. D. (2019). Theory of unpleasant
symptoms: critical analysis. Texto & Contexto-Enfermagem, 28, 1-10.
doi:10.1590/1980-265X-TCE-2017-0222
• Guilkey, R. E., Von Ah, D., Carpenter, J. S., Stone, C., & Draucker, C. B. (2016).
Integrative review: postcraniotomy pain in the brain tumour patient. Journal of
Advanced Nursing, 72(6), 1221-1235. doi:10.1111/jan.12890.
• Lenz, E. R. (2018). Application of the theory of unpleasant symptoms in practice: A
challenge for nursing. Investigación en Enfermería: Imagen y Desarrollo, 20(1), 1-2.
doi:10.11144/javeriana.ie20-1.atus.
• Nguyen, J., Haas, R., & Pugh, L. (2017). The application of the theory of unpleasant
symptoms to the education and practice of nurse anesthetists. Nursing & Healthcare
International Journal, 1(4), 1-8. doi:10.23880/nhij-16000120.
• Peterson, S.J & Bredow, T.S. (2020). Middle Range Theories. Application to Nursing
Research and Practice (5th Edition). Wolters Kluwer. ISBN 9781975108311 Chapter
5, pp 77 – 86.