symptom management nursing school of ahmu 赵江. symptoms

Symptom Manageme

ntNursing School of Nursing School of

AhmuAhmu赵江赵江

Symptoms

Symptoms play an important role in the health-illness experience.They signal a change in functioning and represent the reason for seeking health care.

Experienced by clients with various acute and chronic conditions, symptoms are the primary concern of patients and health care providers.

Effective symptom management, which is viewed as an essential component of nursing practice,has taken precedence in the care of patients with chronic illness.

Diane Doran, Joan Almost.Nursing-sensitive outcomes: state of the science.2003

SymptomsSymptoms refer to refer to

(a) sensations or experiences reflecting changes in a person’s biopsychosocial functions;

(b) a patient’s perception of an abnormal physical,emotional, or cognitive state;

(c) the perceived indicators of change in normal functioning as experienced by patients.

In a recent article, Dodd and colleagues(2001) defined a symptom as a “subjective experience reflecting changes in the biopsychosocial functioning, sensations, or cognition of an individual.”

DEFINITION


Symptoms are characterized by their subjective nature.They are difficult to measure objectively and cannot be detected by another person,such as a healthcare professional.

In contrast, signs refer to objective abnormality, evidence, or manifestation indicative of illness or disease. Signs are “more or less definitive, obvious, and apart from the patient’s impressions”. They can be detected by the patients themselves or by the health care providers.

DEFINITION


Effective symptom management or symptom control is considered an outcome of nursing practice.

It begins with a comprehensive and accurate assessment of the client’s symptom experience.

Assessment is followed by selecting appropriate strategies to prevent or relieve the symptoms,implementing the strategies,and evaluating their effectiveness in controlling the symptoms.symptom assessment, therefore, forms the foudation for effective management.


ASSESSMENT

Connie Henke Yarbro, Margaret Hansen Frogge, Michelle Goodm. Cancer Symptom Management(3rd edition).2004:5

Management

Management involves

(a) identifying and recognizing symptoms, (b) appropriately interpreting symptoms, (c) monitoring and evaluating symptoms, (d) selecting strategies to relieve the symptoms experienced and enhance functioning and well-being, (e) evaluating the effectiveness of these strategies.


Self-care or self-management of symptoms should aim at controlling or relieving symptoms.

Effective management of symptoms begins with a comprehensive and accurate assessment.However,measuring symptoms presents some challenges,due to their subjective nature.


Symptom Manageme

nt

Providing comfort, relieving symptoms, and easing distress caused from cancer and its treatment is known as symptom management.

This type of care is important during all stages of cancer treatment and is aimed at controlling symptoms and improving quality of life. It also addresses the family's needs throughout the course of the illness. Participating in symptom management is of key importance because it enables patients to focus their time on feeling better.

http://www.cccoutreach.com/symptom_management/

OVERVIEW

In recent years, there has been an increased focus on symptom management in cancer patients. Because of more frequent early detection and better treatments, cancer patients are living longer than they were years ago. There is also an increased focus on symptom management and quality of life. It is very important to begin symptom management early in the treatment process. If left untreated, these symptoms can significantly impair a patient's quality-of-life and cause them to function at a lower level in their daily activities.

symptom management symptom management

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of symptom management is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, palliative care, and supportive care.

http://www.nci.nih.gov/Templates/db_alpha.aspx?CdrID=269453

DEFINITION

ItemItem AllAll ReviewReview

Four terms 39774 8191

Symptom management

1343 442

Palliative care

33612 5953

Supportive care

5639 2115

Comfort care

200 27

All patients with medical illness should be made as comfortable as possible by relieving pain and other distressing symptoms. This is a fundamental goal of palliative care.

http://www.stoppain.org/palliative_care/content/symptom/default.asp

Palliative care

Palliative care is:Patient-centred rather disease-focusedDeath accepting but also life-enhancingA partnership between the patient and the carersConcerned with healing rather than curing

Robert G. Twycross. Introducing palliative care(4th edition).2003

“Together Everyone Achieves More”

Palliative care is best administered by a group of people working as a team.In practice,some or all of the following will be involved:

Doctor(s) and nurses(the essential core clinical team)Physiotherapist,occupational therapist,other specific therapistsSocial worker,chaplain/priest/rabbi,other advisersVolunteers.


TEAMWORK

In essence,there is good quality of life when the aspirations of an individual are matched and fulfilled by present experience.

There is poor quality of life when there is a wide divergence between aspirations and present experience.

To improve quality of life,it is necessary to narrow the gap between aspirations and what is possible.Palliative care aims to do this.


Symptom Manageme

ntModel

The symptom management model has been developed by nurse researchers at the University of California San Francisco.

This model can be used by clinicians in assessing and/or selecting interventions for single or multiple symptoms or by researchers in framing studies.


A model for symptom management. The University of California, San Francisco School of Nursing Symptom Management Faculty Group. Image J Nurs Sch.1994.26(4):272-6

http://nurseweb.ucsf.edu/www/rcsm.htm

Marylin Dodd, RN, PhD, FAAN, Director, Research CenterKathryn Lee,RN, PHD, FAAN, Director, Research Training Program Virginia Carrieri, RN, DNS, FAAN, Co-Director, Research Training Program

The goal of the Research Center for Symptom Management (RCSM) is to advance the knowledge in the field of symptom management and, thereby, improve health care providers' practice and individuals' symptom outcomes.

At the same time, health care providers have difficulty developing symptom management strategies that can be applied in the acute care, ambulatory care, and home care settings because there are few tested models of symptom management.

The model assumes six things:

1.Self-report is the only true way to know if an individual is experiencing a symptom;

2.Persons who are “high risk” for a symptom can have the symptom prevented or improved by interventions prior to symptom occurrence;


3.Persons who cannot communicate verbally may still experience symptoms;

4.Symptom management may be directed at individuals,groups,families,or the environment;

5.Outcomes and contextual influences can modify the symptom experience and that the symptom management process is dynamic,changing with these modification.


The figure shows the symptom management model.

The key elements in the model are symptom experience ,symptom status and outcomes,and symptom management strategies (who,what,when,where,how,to whom,why).

All elements are impacted by patient variables,such as developmental stage and gender, health and illness variables, such as comorbidities or disabilities,the environment,and the physical,cultural,and social milieu of the patient and situation.


The symptom experience incorporates the individual’s common sense representation of the symptom,including cognitive and emotional beliefs about the symptom,its causes,and ways to cope.

Symptoms can lead to perceptions of changes in usual feelings or behaviors.These perceptions are part of the experience.


The seven attributes of the symptom

may be evaluated by the person experiencing it or they may need to be brought out by the nurse during an evaluation of a patient’s symptom status.


associated manifestations

Robert G.Twycross,Andrew Wilcock.Symptom management in advanced cancer.2001:6

The scientific approach to Symptom Management can be encapsulated in the acronym “EEMMA”

diagnosis of each symptom before treatment

explanation to the patient before treatment

individualized treatment

continuing review of the impact of treatment

no unwarranted assumptions

Derek Doyle, Geoffrey Hanks, Nathan I. Cherny, Kenneth Calman.Oxford textbook of palliative medicine.2005

Professional

health care

provider distress

Family distress

Patient distress

The interrelationship between the distress of the patient,their family, and the health care providers.

Derek Doyle, Geoffrey Hanks, Nathan I. Cherny, Kenneth Calman.Oxford textbook of palliative medicine.2005

The book is written for doctors, specialist palliative medicine physicians, oncologists, geriatricians, surgeons, family physicians, neurologists and chest physicians. We know, however, that it is much used by nurses and researchers in other disciplines, though not written primarily for them.

Derek Doyle, Geoffrey Hanks, Nathan I. Cherny, Kenneth CalmanEdition: 3, illustratedPublished by Oxford University Press,2005ISBN 0198566980, 97801985669841244 pages

This text is an invaluable resource for nurse researchers, scholars, and health care professionals committed to effective, quality nursing care as evidenced by nursing-sensitive outcomes measurement

By Diane Doran, Joan AlmostEdition: illustratedPublished by Jones & Bartlett Publishers, 2003ISBN 0763722871, 9780763722876363 pages

Introducing palliative careBy Robert G. TwycrossEdition: 4, illustratedPublished by Radcliffe Publishing, 2003ISBN 185775915X, 9781857759150190 pages

Designed to assist clinical oncology nurses in skillfully relieving and diminishing the cancer patient's symptoms, Cancer Symptom Management, Third Edition, provides essential information and the tools neccesary to provide quality care to cancer patients.

By Connie Henke Yarbro, Margaret Hansen Frogge, Michelle GoodmanEdition: 3, illustratedPublished by Jones & Bartlett Publishers, 2004ISBN 0763721425, 9780763721428765 pages

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