Theory of Unpleasant symptoms in Congestive heart failure

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Theory of Unpleasant symptoms in Congestive heart
failure

• By Beatrice Leavel Nelson

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Congestive Heart FailureSignificance

• 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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Congestive Heart FailureBackground

• 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)

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Specific Aims

• 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

• 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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TOUS

• 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

• 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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Application of TOUS to CHF

• 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.

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Summary

• 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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References

• 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.
  CirculationJournal of the American heart
  association , 1141-1163.
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