The status and influencing factors of fatigue in kidney transplant recipients based on the theory of unpleasant symptoms: A cross-sectional study in China.

AIMS: This study describes the incidence of fatigue in kidney transplant recipients and analyses the relationship between physiological factors, psychological factors, situational factors and fatigue in kidney transplant recipients. BACKGROUND: Fatigue, as a common symptom after kidney transplantation, is affected by many factors, but the influence of some factors on the fatigue of kidney transplant recipients is still controversial. DESIGN: This cross-sectional study was designed based on the theory of unpleasant symptoms. METHODS: Our survey involved 307 participants attending the kidney transplant outpatient clinic of a tertiary Class A hospital (Changsha, Hunan, China). Data were collected between February and April 2021 using a structured questionnaire and electronic medical records. Data were analysed using IBM SPSS 25.0 (SPSS Inc.) RESULTS: It was found that the incidence of fatigue in kidney transplant recipients was 53.1%. According to the binary logistic regression analysis, sleep quality, hypokalemia, anxiety, depression and education level were independent risk factors for fatigue in kidney transplant recipients. CONCLUSION: The incidence of fatigue in kidney transplant recipients was high and was influenced by physical, psychological and situational factors. Clinical nurses should assess fatigue levels in a timely and multidimensional manner in clinical practice and provide effective and scientific guidance about fatigue self-coping and symptom management for kidney transplant recipients.

A qualitative exploration of prodromal myocardial infarction fatigue experienced by women.

AIMS AND OBJECTIVES: The purpose of this study was to explore adult women's unique and shared experiences of prodromal myocardial infarction fatigue. BACKGROUND: Fatigue is the most prevalent symptom experienced by women in the weeks and months before myocardial infarction. However, dimensions of this fatigue, such as timing, distress, intensity, quality, patterns and associated characteristics have not been established through studies of this symptom. A lack of understanding of the characteristics of myocardial infarction fatigue and the context in which it occurs makes clinical decision-making difficult. DESIGN: A qualitative, multiple case study guided by the Theory of Unpleasant Symptoms. METHODS: Women were purposively enrolled from a large hospital in the Midwestern USA. Semi-structured, audio-recorded interviews were conducted during hospitalisation and at 2-3 months postdischarge; women were also provided with a journal. A supplementary interview with family members and electronic health record review also assisted in data triangulation. Analysis was inductive and conducted within and across cases, using coding and categorisation, counting, clustering, visual displays of data and thematic development. The SRQR checklist was used in reporting the study. RESULTS: Ten women, with a median age of 60, participated. Fatigue was described primarily using the terms tiredness and lack of energy, though some women described generalised weakness and cognitive fog. This fatigue was unusual and a notable change from baseline. Many women described significant difficulties performing activities of daily living due to fatigue. CONCLUSIONS: The findings of this study will advance symptom science and an understanding of prodromal myocardial infarction fatigue. Future instrument development or selection of instruments for quantitative work will be aided by this study. RELEVANCE TO CLINICAL PRACTICE: This study provides a clearer picture of prodromal myocardial infarction fatigue experienced by women, aiding healthcare professionals in understanding and identifying this symptom.

The Predictors of Postoperative Pain Among Children Based on the Theory of Unpleasant Symptoms: A Descriptive-Correlational Study.

PURPOSE: Postoperative pain (POP) is a common outcome of surgical interventions among children. Identifying POP contributing factors can help identify children who are at risk for POP and facilitate POP management. The aim of the study was to determine the predictors of POP based on the Theory of Unpleasant Symptoms. DESIGN AND METHODS: This descriptive-correlational study was conducted in 2018-2019 on 153 children purposively recruited. Data were collected using a personal characteristics questionnaire, the Coping Strategies Questionnaire, the Child Pain Anxiety Symptoms Scale, and a Visual Analogue Scale for Pain. The SPSS software (v. 21.0) was used for data analysis. RESULTS: Twelve participants were excluded and final data analysis was done on the data obtained from 141 participants. Most of participants were male (65.2%), underwent abdominal surgery (53.2%), and experienced POP (86.5%). Their age mean was 8.58±2.23. Linear regression analysis revealed that the physiological factors of heart rate, preoperative pain, and surgery duration as well as the psychological factors of anxiety and coping strategies were significant predictors of POP among children. All these factors collectively explained 34% of the total variance of POP. Situational factors (such as age, gender, and ethnicity) had no significant effects on POP. CONCLUSIONS: Heart rate, preoperative pain, surgery duration, anxiety and coping as predictive factors of POP can be considered when designing effective POP management strategies. PRACTICE IMPLICATIONS: The findings provide a better understanding about the predictors of POP and can be used to develop pain management among children.

An integrative review of the theory of unpleasant symptoms.

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.

Symptom management in Behcets disease.

OBJECTIVE: To determine the symptoms experienced by patients diagnosed with Behcet's Disease and how they cope with them. METHODS: The qualitative study was conducted from September 2013 to March 2014 at Ege University Medical Faculty Hospital, Turkey, comprising patients having all symptoms of Behcet's Disease. Data was collected through semi-structured focus-group interview form. The findings were assessed using Theory of Unpleasant Symptoms and Symptom Management Theory. SPSS 20 and Nvivo 10 were used for data analysis. RESULTS: Of the 35 patients, 16(45.8%) were female and 19(54.2%) were male. The symptoms affected patients' lives, and the patients used either positive or negative symptom management strategies, leading to either positive or negative results during symptom management. CONCLUSIONS: Behcet's Disease patients needed effective symptom management.

Towards a symptom cluster model in chronic kidney disease: A structural equation approach.

AIMS: The aim of this study was to test a symptom cluster model in chronic kidney disease patients based on the Theory of Unpleasant Symptoms, accounting for the relationships between influencing factors, symptom experience and consequences for quality of life. BACKGROUND: The evaluation of symptom clusters is a new field of scientific inquiry directed towards more focused symptom management. Yet, little is known about relationships between symptom clusters, predictors and the synergistic effect of multiple symptoms on outcomes. DESIGN: Cross-sectional. METHODS: Data were collected from 436 patients with advanced stages of chronic kidney disease during July 2013-February 2014 using validated measures of symptom burden and quality of life. Analysis involved structural equation modelling. RESULTS: The final model demonstrated good fit with the data and provided strong evidence for the predicted relationships. Psychological distress, stage of chronic kidney disease and age explained most of the variance in symptom experience. Symptom clusters had a strong negative effect on quality of life, with fatigue, sexual symptoms and restless legs being the strongest predictors. Overall, the model explained more than half of the deterioration in quality of life. However, a reciprocal path between quality of life and symptom experience was not found. CONCLUSIONS: Interventions targeting symptom clusters could greatly improve quality of life in patients with chronic kidney disease. The symptom cluster model presented has important clinical and heuristic implications, serving as a framework to encourage and guide new lines of intervention research to reduce symptom burden in chronic kidney disease.

Integrative review: postcraniotomy pain in the brain tumour patient.

AIM: To conduct an integrative review to examine evidence of pain and associated symptoms in adult (≥21 years of age), postcraniotomy, brain tumour patients hospitalized on intensive care units. BACKGROUND: Healthcare providers believe craniotomies are less painful than other surgical procedures. Understanding how postcraniotomy pain unfolds over time will help inform patient care and aid in future research and policy development. DESIGN: Systematic literature search to identify relevant literature. Information abstracted using the Theory of Unpleasant Symptoms' concepts of influencing factors, symptom clusters and patient performance. Inclusion criteria were indexed, peer-reviewed, full-length, English-language articles. Keywords were 'traumatic brain injury', 'pain, post-operative', 'brain injuries', 'postoperative pain', 'craniotomy', 'decompressive craniectomy' and 'trephining'. DATA SOURCES: Medline, OVID, PubMed and CINAHL databases from 2000-2014. REVIEW METHOD: Cooper's five-stage integrative review method was used to assess and synthesize literature. RESULTS: The search yielded 115 manuscripts, with 26 meeting inclusion criteria. Most studies were randomized, controlled trials conducted outside of the United States. All tested pharmacological pain interventions. Postcraniotomy brain tumour pain was well-documented and associated with nausea, vomiting and changes in blood pressure, and it impacted the patient's length of hospital stay, but there was no consensus for how best to treat such pain. CONCLUSION: The Theory of Unpleasant Symptoms provided structure to the search. Postcraniotomy pain is experienced by patients, but associated symptoms and impact on patient performance remain poorly understood. Further research is needed to improve understanding and management of postcraniotomy pain in this population.

Frailty and predictive factors in Chinese hospitalized patients with heart failure: a structural equation model analysis.

AIMS: Frailty is closely related to the prognosis and quality of life of patients with heart failure (HF). However, the predictors of it are still unclear. Our study aimed to describe the frailty status of Chinese hospitalized patients with HF and explore predictive factors guided by Theory of Unpleasant Symptoms. METHODS AND RESULTS: In this cross-sectional descriptive study, questionnaire-based survey was conducted among 323 patients hospitalized with HF in three tertiary hospitals in Wuhan, China. Frailty was measured by the Tilburg Frailty Indicator (TFI) in this study. The model based on Theory of Unpleasant Symptoms fits the sample well (root mean square error of approximation = 0.063, goodness of fit index = 0.977, normed fit index = 0.901, and comparative fit index = 0.940). Frailty among Chinese patients hospitalized with HF was at high level (TFI = 6.57 ± 3.05). General demographic characteristics (older age, female gender, lower education level, and medical payment method), physical factors (higher New York Heart Association cardiac function class), psychological factors (more severe depression), and social factors (poorer social support) were significant predictors of more severe frailty (P < 0.05). Depression played an important mediating role in this study. CONCLUSION: Theory of Unpleasant Symptoms can be used to guide the research on the frailty of HF patients. It is suggested to strengthen emotional support and health education for HF patients in China. In addition, more attention should be paid to the less educated population by providing more personalized health guidance.

Psychological and somatic symptoms among breast cancer patients in four European countries: A cross-lagged panel model.

Psychological and physical health among women with breast cancer are linked. However, more research is needed to test the interrelations between psychological and somatic symptoms, over time and throughout the different phases of breast cancer treatment, to determine when and which interventions should be prioritized. Six hundred and eighty nine women from four countries (Finland, Israel, Italy and Portugal) completed questionnaires during their first clinical consultation following diagnosis with breast cancer, and again after 3 and 6 months. The questionnaires included self-reported measures of psychological symptoms (Hospital Anxiety and Depression Scale; the Positive and Negative Affect Schedule Short Form) and somatic symptoms [selected items from the International European Organization for Research and Treatment of Cancer (EORTC) questionnaires]. Psychological and somatic symptoms were relatively stable across the three time-points. Cross-lagged paths leading from somatic to psychological symptoms (beta coefficients of 0.08-0.10), as well as vice-versa (beta 0.11-0.12), were found to be significant. No evidence was found for cross-cultural differences in mutual effects of psychological and somatic symptoms. The findings of this study call for tailoring personal interventions for breast cancer patients-either from a somatic perspective or a psychological perspective-and adjust them to the specific experiences of the individual patient.

The Theory of Unpleasant Symptoms in Pediatric Oncology Nursing: A Conceptual and Empirical Fit?

Symptom management knowledge is a priority for pediatric oncology nursing research. Theories and models can frame the studies of symptoms experienced during childhood cancer. This article describes and analyzes the middle-range theory, theory of unpleasant symptoms (TOUS), for its conceptual and empirical fit with pediatric oncology nursing based on its current use in adult oncology research and its limited use to date in pediatric oncology. Searches in PubMed and CINAHL databases using the keywords theory of unpleasant symptoms and cancer and covering the time period 2000 to 2017 yielded 103 abstracts for review. Twenty published reports met eligibility criteria for review; only one included pediatric oncology patients. No study to date has tested all the components of the TOUS in pediatrics. The TOUS component of performance appears to be underaddressed across completed studies that instead include a focus on patient-reported quality of life rather than on perceived behavioral or performance indicators concurrent with the subjective symptom reports. Additionally, the influence of family, essential in pediatric oncology, is absent in the majority of studies guided by the TOUS. The TOUS is a structurally complicated framework that would be a conceptual fit for pediatric oncology if family influence and perceived function were included. Studies across this population and guided by the TOUS are needed, although testing all the theorized linkages in the TOUS would likely require a large sample size of patients and, thereby, multisite approaches given that cancer is a rare disease in childhood.

Development and testing of a novel symptom assessment scale for Behçet's disease

Background/aim: This study was designed to develop a Behçet's disease (BD) symptom assessment scale based on the theory of unpleasant symptoms, which deals with understanding symptom experiences in a disease. Materials and methods: The BD Symptom Assessment Scale has two sections: the factors influencing symptoms and the situations influenced by symptoms. Both of these sections were developed through an initial item pool, and expert opinions were consulted during a pilot test performed with 30 patients with BD. We then tested the validity and reliability of this scale on 218 different patients with BD fulfilling the ISG criteria. Finally, we scored this scale. Results: The validity and reliability study of the first section found that the scale had favorable fit indices (X²= 525.86, X²/ SD = 3.15, GFI = 0.90, CFI = 0.89, IFI = 0.89), constituting three dimensions and 20 items. The validity and reliability study of the second section found that the scale had favorable fit indices (X² = 579.14, X² / SD = 3.48, GFI = 0.91, CFI = 0.89, IFI = 0.89) and constituted three dimensions and 20 items. Conclusion: This novel symptom assessment scale for BD is a valid and reliable tool for evaluating patients with BD.

Change in Psychological, Physiological, and Situational Factors in Adults After Treatment of Chronic Cough.

BACKGROUND: We hypothesized that addressing anxiety and depressive mood disorders will improve chronic cough severity and cough quality of life (CQOL). METHODS: Major tenets of the theory of unpleasant symptoms were examined in a longitudinal observational study of consecutive adults with cough of > 8 weeks' duration treated in our cough clinic. At baseline and 3 and 6 months, subjects completed 3 Punum Ladders rating cough severity, the CQOL Questionnaire, the Depression, Anxiety, and Stress Scales-21, and the Duke Functional Social Support Questionnaire. Cross-sectional baseline and longitudinal regression analyses were conducted. RESULTS: Eighty subjects (55 women) with a mean age of 58.5 ± 11.1 years and a cough duration of 86.0 ± 123.7 months were enrolled. At baseline, worse cough severity was significantly associated with less education and worse ability to speak bothered by cough and the urge to cough. Worse CQOL was significantly associated with worse depression symptoms, urinary incontinence, and ability to speak; use of self-prescribed remedies; and younger age. Significant improvements in depression and stress symptoms occurred at 3 and 6 months. Anxiety symptoms improved, particularly in the first 3 months. Improvement in cough severity was significantly associated with less education, male sex, and improvement in ability to speak and urge to cough. Improvement in CQOL was significantly associated with improvement in urinary incontinence, urge to cough, anxiety symptoms, and use of self-prescribed remedies. CONCLUSIONS: Using the theory of unpleasant symptoms, we have come to appreciate that managing psychological, physiological, and situational factors in addition to focusing on identifying the cause of cough is important to maximize improvement in CQOL.

Diseño, validación facial y de contenido de un instrumento de valoración de los síntomas en la mujer con enfermedad coronaria, enmarcada en la teoría de los síntomas desagradables / Design, facial and content validation of an instrument for assessing symptoms in women with coronary heart disease, framed in the theory of unpleasant symptoms

OBJETIVO: Diseñar y validar un instrumento para la valoración de los síntomas en la mujer con enfermedad coronaria, enmarcada en la Teoría de los Síntomas Desagradables. METODOLOGIA: Estudio metodológico psicométrico, orientado por: "Los Síntomas" primer Concepto de la Teoría de los Síntomas Desagradables de Lenz y colaboradores. Se realizó Crítica Teórica del constructo elegido demostrando su utilidad en la investigación y práctica disciplinar. Desde lo empírico, se ponderaron 260 evidencias por medio de Crítica Metodológica y Empírica, aplicando el sistema de Revisión Integrativa articulada al Modelo Conceptual Empírico de Fawcett & Garity, obteniéndose tan solo 30 "Piezas Investigativas" utilizadas para la construcción de los ítems; a los síntomas de Lenz, se suman los síntomas psicosociales reportados en mujeres con enfermedad coronaria, generándose un primer diseño compuesto por 87 ítems. RESULTADOS: Al diseño se realiza Validación de Contenido por expertos: Modelo Escobar y Cuervo 2008 (análisis SPSS 20), Coeficiente Correlación de Kendall= 0,682 (p< 0.05), "buena concordancia entre jueces". Modelo de Lawshe Normalizado por Tristán 2008 con Content Validity Ratio= 0.57 e Index Validity Content= 0.797 demostrando que los "Ítems son unidades de análisis esenciales". Finalmente para la Validación Facial, se realizó Prueba Piloto con 21 mujeres que cumplieron los criterios de inclusión, posterior a esto se realizó discriminación semiótica de los ítems obteniéndose un instrumento tipo Autoinforme, heteroaplicado, compuesto por 67 ítems, un remanente investigativo que requiere nuevas validaciones para elevar su capacidad psicométrica. PALABRAS CLAVES: Validez Facial, Validez de Contenido, Instrumento, Valoración, Síntomas en la Mujer, Enfermedad Coronaria, Teoría de los Síntomas Desagradables.

OBJECTIVE: To design and validate an instrument for assessing the symptoms in women with coronary disease framed in the Theory of the Unpleasant Symptoms. METHODOLOGY: Methodological study psychometric oriented by "The Symptoms," first concept of the Theory of Unpleasant Symptoms by Lenz et al. Theoretical Critique of the construct chosen was performed proving usefulness in research and practice discipline. From the empirical 260 evidences were weighted through Methodological and Empirical Critique, applying the Integrative Review System articulated to the empirical Conceptual Model by Fawcett & Garity, obtaining only 30 "Investigative Pieces" used for the construction of the items; to the Lenz symptoms were added the reported psychosocial symptoms in women with coronary disease, generating a first design composed of 87 items. RESULTS: The design was done by Expert Content Validation: Model Escobar and Cuervo 2008 (analysis Statistical Package for the Social Sciences IMB SPSS 20) Kendall Correlation Coefficient, K= 0.682 (p< 0.05): "Good agreement between judges". Model Normalized by Tristan 2008 Lawshe: Content Validity Ratio= 0.57 and Content Validity Index= 0.797, showing: "Items: are units of essential analysis". Finally Validation Facial was the Pilot Test conducted on 21 women who met the inclusion criteria after this, the discrimination semiotics was performed obtaining an instrument type: Self-Report, heteroapplied consisting of 67 items, a remnant of research that requires further validation to increase its psychometric capacity.