Unpleasant Symptoms Middle Range Theory Introduction
The middle range theory of unpleasant symptoms was developed to apply to a broad range of diseases whenever unpleasant symptoms require nursing attention. This theory was first published nearly a decade ago (Lenz, Suppe, Gift, Pugh, & Milligan, 1995) through a collaborative effort among faculty and graduates from the University of Maryland School of Nursing’s doctoral program. Each contributor had focused on an unpleasant symptom for their dissertation research—Gift on dyspnea and Milligan and Pugh on fatigue (Lenz & Pugh, 2003). The theory was designed to integrate their shared insights and provide a framework for understanding and addressing various unpleasant symptoms in nursing practice.
Scholarly Work
Frederick Suppe, a philosopher of science who taught in the University of Maryland’s doctoral program, co-authored the manuscript that introduced the middle range theory of unpleasant symptoms. Two years after its initial publication, a refined version of the theory was introduced, emphasizing the reciprocity between the concepts of the theory (Lenz, Pugh, Milligan, Gift, & Suppe, 1997).
Concepts in the Theory
The middle range theory of unpleasant symptoms centers around three major concepts: symptoms, influencing factors, and performance outcomes (Lenz & Pugh, 2003).
- Symptoms: A symptom is defined as an individually perceived indicator of deviation from normal function, which may occur alone or in combination with other symptoms. Symptoms are characterized by intensity, distress, duration/frequency, and quality, which refers to the nature of the symptom or how it manifests (Lenz & Pugh, 2003).
- Influencing Factors: These include physiological (e.g., anatomical or structural issues, genetic predispositions, bodily processes), psychological (affective and cognitive states), and situational (social and physical environments) factors that can influence and be influenced by the symptom experience. The theory suggests that when multiple symptoms are present, they can exacerbate each other, creating a reciprocal relationship. For example, nipple pain and fatigue in nursing mothers can exacerbate each other, potentially leading to premature termination of breastfeeding, an undesirable performance outcome (Lenz & Pugh, 2003).
- Performance Outcomes: These refer to the consequences of the symptom experience, encompassing the individual’s ability to function. This includes motor skills, social behaviors, and cognitive functions, which may be impacted by the presence of symptoms (Lenz & Pugh, 2003).
Lenz and Pugh Outcomes
Lenz and Pugh (2003) reported that research related to the middle-range theory of unpleasant symptoms is beginning to be reported in the literature. Much of this research has been conducted by the developers of the theory themselves. Some studies have focused on interventions to diminish symptoms and improve performance outcomes, while others have examined the relationships between influencing factors that impact symptom experiences.
Research conducted by other scholars has explored unpleasant symptoms in various patient populations, including cancer patients undergoing chemotherapy, heart-lung transplant recipients, patients with end-stage renal disease, and individuals with Alzheimer’s disease (Lenz & Pugh, 2003). The use of the theory in research has led to critiques that were considered and applied when the theory was refined (Lenz et al., 1997).
Limited Area of Theory Implementation
Lenz and Pugh (2003) noted that there are surprisingly few published reports of the theory being used in practice, despite the fact that unpleasant symptoms are common among patients encountered by nurses. Unlike lower-level theories that focus on a single symptom, such as pain, the more generic theory of unpleasant symptoms provides a framework for understanding and managing complex combinations of symptoms that frequently occur in real-world clinical settings.
For example, the theory emphasizes the importance of an in-depth assessment of symptoms that considers the contribution of influencing factors. It suggests that multiple management strategies may need to be applied simultaneously, given the multivariate nature of the factors influencing symptoms.
Versatility and Dynamicity of the Theory
The middle range theory of unpleasant symptoms is both versatile and dynamic. It encourages healthcare providers to consider the effects of multiple symptoms occurring together on a patient’s functioning and to assess functional patient outcomes. The theory highlights the importance of using a variety of management strategies tailored to the specific influencing factors affecting the patient’s symptoms (Lenz & Pugh, pp. 85-86).
The theory’s dynamic nature allows it to adapt to different clinical situations, guiding the assessment and management of symptoms in various patient populations. Its versatility lies in its applicability across a range of conditions and settings, making it a valuable tool for nursing practice, education, and research.
Final Results
Research guided by the middle range theory of unpleasant symptoms has so far focused on symptoms such as pain, dyspnea, nausea, vomiting, and fatigue (Lenz & Pugh, 2003). However, there are many more symptoms that remain to be explored. Further research is needed to elaborate on the relationships between influencing factors and how these factors interact with the symptom experience.
Lenz and Pugh also suggest that there is potential for further development of the performance component of the model, including the consideration of primary and secondary outcomes, as well as temporally proximal and distal outcomes. The middle range theory of unpleasant symptoms remains a work in progress, with the potential to benefit practicing nurses, students, and researchers as a guiding framework.
The theory could also benefit from increased application in practice and research, allowing for continued empirically based development that would enhance its usefulness.
Conclusion
The middle range theory of unpleasant symptoms provides a comprehensive framework for understanding and addressing a wide range of symptoms in nursing practice. By considering the dynamic interplay between symptoms, influencing factors, and performance outcomes, the theory offers a versatile approach to managing complex symptom combinations that often occur in real-world settings. Although the theory has been primarily applied in research, there is significant potential for its further development and implementation in clinical practice.
To fully realize the benefits of the theory, more research is needed to explore additional symptoms, examine the relationships between influencing factors, and refine the performance component. By using the theory as a guiding framework, nurses, students, and researchers can better understand the complexities of symptom management and improve patient care outcomes.