Transcript Theory of Unpleasant symptoms in Congestive heart failure

By Beatrice Leavel Nelson
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Congestive Heart Failure (CHF) “affects 5
million people in the United States” (Crowder,
2006, p.27)
CHF is expected to double in prevalence by the
year 2030 (Horowitz et al. 2004)
Hammer and Ellion (2005) state that CHF
patients “represent the highest readmission
rate of all diagnostic groups” (p.231)
Esposito et al.(2009) estimated the cost for 2008
for CHF to be $34.8 billion dollars (p.437)
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Annema, Luttic and Jaarsma (2009) estimated
that in CHF patients that 23-31% of
readmissions were perceived as preventable
According to Lowery, Massaro, and Yancy
(2004) readmission rates are high for CHF
patients at “2%, 20%, and 50% within 2 days, 1
month and 6 months respectively.” (p.5)
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Patients with CHF are frequently readmitted to
the acute care facility (Hamner and Ellison,
2005)
Patients with CHF need education on
medications, a low sodium diet, daily weights,
and monitoring for changes.
A person with CHF needs to be able to
recognize a change, decide on an appropriate
intervention then evaluate the effectiveness of
that intervention (Riegel, et al, 2009)
Through identification of early
symptoms in patients with CHF, patients
can seek treatment for an exacerbation of
CHF before they require hospitalization.
Teaching patients early symptom
management will hopefully decrease
decompensation and improve overall
well-being in the CHF patient
population.
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The theory of unpleasant symptoms (TOUS) is
a middle range theory based on the idea that
common experiences are found among people
experiencing different symptoms in different
populations in varied experiences (McEwen
and Wills, 2007)
Lenz and Pugh (2003) describe symptoms as
“the perceived indicators of change in normal
functioning as experienced by patients.” (p.74)
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The theory has three major components
(McEwen and Wills (2007m p.258)
- The symptom the individual is
experiencing
- Influencing factors that produce or
affect the symptom experience
- The consequences of the symptom
experience
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TOUS uses the terms of duration, intensity,
distress and quality to describe unpleasant
symptoms
TOUS uses factors that are physiological,
psychological or situational
TOUS notes that symptoms can occur
singularly, but more often they occur in
combination
The authors of TOUS note one purpose of
TOUS is help nurses remove or relive
unpleasant symptoms
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Driscoll, Davidson, Clark, Huang and Aho
(2009) stated that patients must be supported in
their conditions to reduce hospitalizations and
improve symptoms.
Driscoll et all (2009) state that CHF patients
often experience shortness of breath, decrease
exercise tolerance, and lethargy. These are
symptoms that CHF patients can be taught to
monitor.
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Jurgens et al. (2009) recommends the
identification of symptom clusters to identify
exacerbations or worsening of the disease
Jurgens et al (2009) used the TOUS to
demonstrate that when multiple symptoms
were present that often it was difficult for
patients to differentiate the quality of each
individual symptom. Thus they recommended
the identification of clusters of symptoms.
CHF is a common reason for hospital
readmission. The TOUS describe the
interplay often seen when multiple
symptoms are occurring at the same
time. By identification of symptoms
early, perhaps interventions can be
provided to decrease symptoms. By
decreasing symptoms in the home, acute
care admissions should also decrease.
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Annema, C., Littik, M.-L., & Jaarsma, T. (2009). Reasons for readmission in heart
failure: Perspectives of patients, caregivers, cardiologist, and heart failure nurses.
Heart & Lung 38 (5), 427-434.
Crowder, B. F. (2006). Improved symptom mangement through enrollment in an
outpatient congestive heart failure clinic. MEDSURG Nursing , 15 (1), 27-35.
Dickson, V. V., & Riegel, B. (2009). Are we teaching what patients need to know?
Building skills in heart failure self care. Heart & Lung , 38 (3), 253-261.
Driscoll, A., Davidson, P., Clark, R., Huang, N., & Aho, Z. (2009). Tailoring
consumer resources to enhance self-care in chronic heart failure. Australian Critical
Care , 133-140.
Esposito, D., Bagchi, A. D., Verdier, J. M., Bencio, D. S., & Kim, M. S. (2009).
Medicaid beneficiaries with congestive heart failure: Association of medication
adherence with healthcare use and costs. American Journal of Managed Care , 15 (7),
437-445.
Hallerbach, M., Francoeur, A., Pomerantz, S. C., Morris, D. L., Eiger, G., Cohn, J., et
al. (2008). Patterns and predictors of early hospital readmission in patients with
congestive heart failure. American Journal of Medical Quality , 18-23.
Hamner, J. B., & Ellison, K. J. (2005). Predictors of hospital readmission after
discharge in patients with congestive heart failure. Heart & Lung , 34 (4), 231-239.
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Holzapfel, N., Zugck, C., Muller-Tasch, T., Lowe, B., Wild, B., Schellberg, D., et al.
(2007). Routine screening for depression and quality of life in outpatients with
congestive heart failure. Psychosomatics , 48 (2), 112-116.
Horowitz, C. R., Rein, S. B., & Leventhal, H. (2004). A story of maladies,
misconceptions and mishaps: Effective managment of heart failure. Social Science &
Medicine , 58, 631-643.
Jurgens, C. Y., Moser, D. K., Armola, R., Carlson, B., Sethares, K., & Reigel, B.
(2009). Symptom clusters of heart failure. Research in Nursing and Health , 551-560.
Lenz, E. R., & Pugh, L. C. (2003). The Theory of Unpleasant Symptoms. In M. J.
Smith, & P. R. Lehr, Middle Range Theory for Nursing (pp. 69-90). New York:
Springer Publishing Company.
Lowery, S. L., Massaro, R., & Yancy, C. W. (2004). Advances in the management of
acute and chronic decompensated heart failure. Lippincott's Case Management , 4-18.
McEwen, M., & Wills, E. M. (2007). Theoretical basis for nursing (2nd Edition ed.).
Philadelphia: Lippincott Williams & Wilkins.
Riegel, B., Moser, D. K., Anker, S. D., Appel, L. J., Dunbar, S. B., Grady, K. L., et al.
(2009, September 22). Promoting self-care in persons with heart failure a scientific
statement from the American heart association. Circulation:Journal of the American
heart association , 1141-1163.