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.
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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 are 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 may 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 intended 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 physical symptoms, and measure whether this program can be used as part of the pain management, Stacpoole et al. (2015) conducted a study. The research included patients from five care homes who had a Bedford Alzheimer’s Nursing Severity Scale score of more than sixteen (Stacpoole et al., 2015). Forty-seven patients matched the criteria, but only 37 were recruited (Stacpoole et al., 2015). Due to several deaths and other circumstances, 30 people were able to complete the study.
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After the recruitment process, the researchers collected demographic information and assessed participants’ neuropsychiatric symptoms using the Neuropsychiatric Inventory Nursing Home (NPI-NH) scale. The authors aimed to identify which symptoms were more frequent and severe (Stacpoole et al., 2015). People who could not communicate verbally were assessed using the Doloplus-2 method (Stacpoole et al., 2015). Such measurements took place three times, and interventions were applied between them.
The Namaste Program was applied as the intervention strategy, and each care worker was given the responsibility of eight patients (Stacpoole et al., 2015). Every morning after breakfast, patients were taken to a special room that featured a calm atmosphere, ambient music, 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 SMT as the basis for all symptom management interventions, family nurse practitioners should acquire more knowledge about the theory. It means that primary care institutions should require an adequate level of competency in symptom management from all prospective nurse practitioners. It would benefit not only the patients but also their families and caregivers.
Furjanic, M., Cooney, A., & McCarthy, B. (2016). Nurses’ knowledge of pain and its management in older people. Nursing older people, 28(9), 32-37.
Smith, M. J., & Liehr, P. R. (Eds.). (2018). Middle range theory for nursing. New York: NY, Springer Publishing Company.
McEwen, M., & Wills, E. M. (2017). Theoretical basis for nursing. Hong-Kong, China: Lippincott Williams & Wilkins.
Stacpoole, M., Hockley, J., Thompsell, A., 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.