Theory of Unpleasant Symptoms Essay

Comprehensive patient assessment necessitates that care providers learn about the patient’s illness, both subjectively and objectively. Assessment tools are essential for understanding and making sense of the patient’s history. The theory of unpleasant symptoms includes three concepts: symptoms, influencing factors, and performance, which allow care providers to assess patients holistically and devise appropriate assistance measures (Blakeman, 2019; Lenz, 2018).

The symptoms are described as unpleasant feelings or perceived indicators of illness in the theory, while the influencing factors are the physiologic, psychologic, and situational elements that shape how symptoms appear and their severity (Blakeman, 2019; Lenz, 2018). On the other hand, performance refers to the consequences of the symptoms, which may impact an individual’s functioning in various domains. While using the theory of unpleasant symptoms as a guide, this paper aims to describe what to look for while assessing patients.

What to look for during Patient Assessment

Various attributes can be used to describe a patient’s symptoms. The theory attributes four characteristics to patient symptoms: intensity, timing, distress, and quality (Blakeman, 2019). The intensity refers to the severity, and patients typically rate the severity of the symptom on a scale of 0 to 10, with 0 indicating “no symptom” and ten indicating “very severe.” For example, when evaluating patients with pain, there may be no pain, which is assigned a 0, or very severe pain, which is assigned a 10.

This assists healthcare providers in determining the severity of the illness and the need for immediate and aggressive interventions. The timing, on the other hand, refers to when the symptoms appear in relation to the time of day or activities (Blakeman, 2019). For example, while assessing heart failure patients, coughing may occur or be exacerbated while the patient is lying down due to lung field congestion (Malik et al., 2022). This specific timing variation may assist a clinician in differentiating one disease from another, resulting in accurate diagnoses and treatment.

Distress is also an important feature of symptoms. Distress refers to the degree to which the symptoms bother the patient (Blakeman, 2019).  A symptom may be incapacitating or simply bothersome, and patients are typically asked to indicate how much they are bothered by the symptom. This may aid in determining whether treatment or amelioration is required. Finally, as part of providing holistic care to patients, the quality of symptoms must be determined.

Frequently, the quality of symptoms is determined by asking the patient to assign one vocabulary to the state of their symptoms. When assessing pain, for example, vocabularies such as pounding, throbbing, excruciating, or flickering may be used (Dydyk & Grandhe, 2022). Although the theory advocates thoroughly assessing the four symptoms’ attributes, other features that may aid in patient symptom assessment include the onset, location, duration, aggravating, and relieving factors.


To improve patient assessment, the theory of unpleasant symptoms was developed. The theory’s most important concept is symptoms; others include influencing factors and performance. It is critical to assess the patient’s intensity, timing variation, distress, and quality of life due to a specific symptom. Such evaluation enables clinicians to make appropriate diagnoses and identify appropriate patient assistance measures. As the theory suggests, identifying and treating symptoms leads to improved performance in physical, cognitive, social, and occupational domains.

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Blakeman, J. R. (2019). An integrative review of the theory of unpleasant symptoms. Journal of Advanced Nursing75(5), 946–961.

Dydyk, A. M., & Grandhe, S. (2022). Pain Assessment. In StatPearls [Internet]. StatPearls Publishing.

Lenz, E. R. (2018). Application of the Theory of Unpleasant Symptoms in Practice: A Challenge for Nursing Investigación en Enfermería. Imagen y Desarrollo20.

Malik, A., Brito, D., Vaqar, S., & Chhabra, L. (2022). Congestive Heart Failure. In StatPearls [Internet]. StatPearls Publishing.

The Theory of Unpleasant Symptoms Example 2

The theory of unpleasant symptoms is a holistic middle-range theory that acknowledges the concept of symptoms as dimensional. It generally stipulates the complexity and the interactive nature of the symptoms experienced (Gomes et al., 2019). It comprises three major components: the symptoms being experienced by a patient, the factors that have influenced the rise of the symptoms experienced, and the consequences of the symptom experience (Moore,2021). This paper presents the theory of unpleasant symptoms, its historical background, its use in nursing research, and its use in nursing practice.

The theory can inform effective patient assessments of unpleasant symptoms. When assessing any patient, it is essential to look out for the normal conditions and the deviations (Wallstrom & Ekman, 2018). Hence, the nurse will easily know the symptoms, causes, and consequences. The entire body system is assessed for symptoms by assessing movement, texture, odors, symmetry, color size, and location. I would look for all those factors in an assessment, especially when doing an emergency assessment.

The theory of unpleasant symptoms is one of the middle-range theories that emerged in the late 20th century. It was developed in 1995 and revised in 1997. It was designed to allow nurses to understand the different symptom groups to propose non-pharmacological interventions to manage the symptoms. The theory was developed based on the assumption that groups of symptoms inherently share various characteristics, which can be explored or altered to better understand and manage symptoms (Blakeman, 2019). The theory eased nursing diagnoses and interventions by making nurses know the different groups of symptoms.

The theory of unpleasant symptoms has been used in nursing research to advance symptoms science. The theory allows researchers to use diverse perspectives in conducting symptoms research on any number of symptoms, provided the concepts and definitions of the theory are standardized (Blakeman, 2019). Therefore, researchers explore, test, and even criticize this theory’s applicability in nursing practice.

However, despite the theory having potential applications for symptom research, there is not enough evidence of literature on the design and analysis of research aiming to understand symptoms. According to Blakeman, only 64 of the 655 research studies he identified in his review have been published two decades later, focusing explicitly on symptoms and the theory of unpleasant symptoms (2019). However, the theory still has the potential to support symptoms and symptoms management research.

Over time, the use of the theory of unpleasant symptoms has progressively increased internationally. The theory has informed nursing practice through the contributions of more effective interventions. Since nurses can understand the symptom experiences, their influence, and consequences, they can develop better care interventions.

Specifically, the theory has been applied in several ways. The first one is symptoms assessment, addressing the intensity, distress, timing, and quality of the symptoms. History taking also uses the theory by addressing the possible psychological and physiological influences of the symptoms. Also, the theory is used in developing nursing interventions that are susceptible to change. Regularly assessing performance outcomes to monitor change is also another application. Also, the theory is used in developing care plans that encourage the self-monitoring and self-care of the patient (Lenz, 2018).

The theory of unpleasant symptoms helps understand the relationship between symptoms experiences, their influence, and the consequences, hence improving interventions. It has been effectively applied to nursing research and practice since it is non-linear and causal. Substantial research evidence on the further development of the theory is lacking. However, more research is ongoing.


Blakeman, J. R. (2019). An integrative review of the theory of unpleasant symptoms. Journal of Advanced Nursing75(5), 946-961.

Gomes, G. L. L., Oliveira, F. M. R. L. D., Barbosa, K. T. F., Medeiros, A. C. T. D., Fernandes, M. D. G. M., & Nóbrega, M. M. L. D. (2019). Theory of unpleasant symptoms: critical analysis. Texto & Contexto-Enfermagem28.

Lenz, E. R. (2018). Application of the theory of unpleasant symptoms in practice: A challenge for nursing. Investigación en Enfermería: Imagen y Desarrollo20(1).

Moore, A. K. (2021). The Holistic Theory of Unpleasant Symptoms. Journal of Holistic Nursing, 08980101211031706.

Wallström, S., & Ekman, I. (2018). Person-centered care in clinical assessment. European Journal of Cardiovascular Nursing17(7), 576-579.