Symptom Management Theory and Interventions
Among the most critical middle range models is the symptom management theory (SMT). Its importance is based on the fact that the majority of people visit health providers because of symptoms. Initially introduced in 1994, the SMT passed through several updates (Smith & Liehr, 2018). It describes the multidimensional nature of symptoms and can be used to develop effective intervention strategies to facilitate such related activities as pain management (Smith & Liehr, 2018). This paper describes this model and provides an overview of some examples of the use of this theory in nursing practice. It also includes information on potential implications of related research in regard to the delivery of primary care.
The SMT is based on six assumptions that describe the essence of symptoms and the goals behind various symptom management methods. The first and most critical assumption says that individual perceptions would be the primary source of information that is needed to study symptoms (Smith & Liehr, 2018). The other five assumptions can be summarized as that the model is applicable even when an individual does not experience symptoms (Smith & Liehr, 2018). Also, caregivers might interpret the nonverbal patient’s experience and assume the interpretation is accurate. Finally, interventions can be applied to both individuals and groups.
The model can be conceptually divided into three parts – the symptom experience component, symptom management strategies, and the outcomes component. Currently, only the former two elements are comprehensively described by the model, and the third needs more attention and academic research. The first component is used to describe patients’ symptoms using an individual’s perception, how this discernment can be evaluated, and possible responses (McEwen & Wills, 2017).
The second component is supposed to guide clinicians through the intervention choosing process (Smith & Liehr, 2018). The outcome component holds all possible consequences that may result from both symptoms and attempts to manage them (Smith & Liehr, 2018). Some of the examples are quality of life, costs, and self-care. These components exist within the broader context of the person, environment, and health and illness.
Lack of knowledge on this theory and the development of symptom management interventions may lead to unfavorable consequences in terms of adverse patient outcomes and negative experiences. There is evidence that the majority of nurses face a knowledge deficit in pain management, and this shortcoming adversely impacts the well-being of older patients (Furjanic, Cooney, & McCarthy, 2016). Therefore, the importance of this model in contemporary nursing is sound.
The SMT and Behavioral Symptoms
People diagnosed with dementia and Alzheimer’s disease may be subject to symptom management because the majority of such patients often experience physical distress in terms of pain. Namaste Care program was proposed as the manifestation of the SMT – the approach is based on the manipulation of the three context variables. The program attempts to enhance the experiences of patients by taking a person-oriented approach, providing an appropriate environment, and targeting risk factors (Stacpoole et al., 2015).
To evaluate the impacts of Namaste Care on various behavioral and bodily symptoms, and gauge whether this system can be utilized included in the pain administration, Stacpoole et ing. (2015) conducted the study. The study incorporated patients from 5 care homes that had a Bedford Alzheimer’s Nursing Intensity Scale score greater than sixteen (Stacpoole ainsi que al., 2015). Forty-seven patients matched conditions, but only thirty seven were recruited (Stacpoole et al., 2015). Due to a number of deaths and some other circumstances, 30 individuals were able in order to complete the research.
After the particular recruitment process, the particular researchers collected massive information and evaluated participants’ neuropsychiatric signs and symptoms using the Neuropsychiatric Inventory Nursing House (NPI-NH) scale. The particular authors aimed in order to identify which signs and symptoms were more regular and severe (Stacpoole et al., 2015). People that could not really communicate verbally had been assessed utilizing the Doloplus-2 method (Stacpoole ainsi que al., 2015). Like measurements happened 3 times, and surgery were applied together.
The Namaste Program was used as the treatment strategy, and every care worker has been given the obligation of eight individuals (Stacpoole et ing., 2015). Every early morning after breakfast, individuals were taken in order to a special space that featured a relaxed atmosphere, ambient songs, dimmed lights, and a relaxing scent (Stacpoole et al., 2015). The worker individually welcomed each participant by name and continued with the program, which included pain management, engaging activities, and storytelling (Stacpoole et al., 2015). Family members were welcome to participate in the process and were actively encouraged. There were two sessions per day, each lasting for one hour.
The impacts of the Namaste Care program can be considered significant. Patients from four care homes experienced a decrease in the severity of neuropsychiatric symptoms (Stacpoole et al., 2015). Therefore , it can be concluded that Namaste Care positively affects patients’ experience in terms of pain reduction. The study is comprehensive because it measures numerous behavioral symptoms, but the generalizability may be limited due to the small number of participants. The study results also serve as evidence that the SMT may facilitate the creation of effective intervention strategies that are targeted against unfavorable patient experiences.
Intervention to Decrease Symptom Burden
Traeger et al. (2015) conducted a study in which they assessed the symptom management intervention rendered by nurse practitioners. The patients were all diagnosed with nonmetastatic cancer and were starting chemotherapy (Traeger et al., 2015). The primary goal of the authors was to reduce patient symptoms by encouraging preventative strategies and collaboration between nurses and patients (Traeger et al., 2015). One hundred and two participants were randomly divided into two groups – one received only standard care, and the other was also subject to intervention.
The intervention was limited to telephone calls after each chemotherapy session. The data was analyzed using the Memorial Symptom Assessment Scale-Short Form and Family Caregiver Satisfaction-patient scale. The efficacy of this intervention was not proved because there were no significant differences between the groups (Traeger et al., 2015). The possible reason is that the intervention strategy was not developed according to the SMT – an appropriate environment was not provided, and the intervention was not person-oriented. Despite its failure to facilitate favorable patient outcomes, this research shows that without utilizing the SMT, it is challenging to develop an adequate intervention strategy.
According to studies covered in this paper, SMT is a powerful model for enhancing the experiences of patients and reducing the symptom burden. Because it is recommended to use the particular SMT since the foundation for all sign management interventions, family members nurse practitioners ought to acquire more understanding about the idea. This means that main care institutions ought to require an sufficient degree of competency within symptom management through all prospective health professional practitioners. It might advantage not only the particular patients but furthermore their own families and caregivers.
Furjanic, M., Cooney, The., & McCarthy, W. (2016). Nurses’ understanding of pain plus its management within older people. Nursing older people, 28(9), 32-37.
Smith, M. J., & Liehr, P. L. (Eds. ). (2018). Middle range concept for nursing. Brand new York: NY, Springer Publishing Company.
McEwen, M., & Wills, E. Meters. (2017). Theoretical foundation for nursing. Hong-Kong, China: Lippincott Williams & Wilkins.
Stacpoole, M., Hockley, J., Thompsell, The., Simard, J., & Volicer, L. (2015). The Namaste Care programme can reduce behavioural symptoms in care home residents with advanced dementia. International Journal of Geriatric Psychiatry, 30(7), 702-709.
Traeger, L., McDonnell, T. M., McCarty, C. E., Greer, J. A., El‐Jawahri, A., & Temel, J. S. (2015). Nursing intervention to enhance outpatient chemotherapy symptom management: Patient‐reported outcomes of a randomized controlled trial. Cancer, 121(21), 3905-3913.