Theory of unpleasant symptoms

The theory of unpleasant symptoms (TOUS) was developed purely to get an insight into the relationship between symptom experiences and multiple symptoms. In every nursing care, symptoms are at heart, and most of what nurses do with patients is usually based on symptoms. The measuring of signs is done, assessing factors that may cause changes, developing strategies to prevent and manage the symptom, and assisting patients through self-management and monitoring (Gomes et al., 2019). The TOUS possesses three parts: the symptoms, influencing factors, and performance outcomes.

Symptoms have variations in distress, timing, duration, and intensity. Symptoms can occur concurrently, whereby multiple symptoms may have different or exact causes and possess multiplicative or cumulative effects. Functional factors are usually categorized as situational, physiological, and psychological to allow physical thinking realm of care. Physiological factors comprise gender, age, and the variables related to treatments and illness (Samantarath et al., 2018). According to Blakeman (2019), psychological factors comprise cognition and mood and powerful influence on symptoms. Situational factors emphasize the social and physical impacts on the patient. Performance determines the outcome of the particular symptoms, which comprise cognitive, physical, and social performance roles.

The TOUS highlight complication on symptoms as well as implying management and preventive strategies. According to Lenz (2018), the related categories of influencing factors influence symptom occurrence and their experience. These particular symptoms affect individual performance, which can also feedback to cause an impact on influencing factors and symptom experience. This paper will focus on the theory of unpleasant symptoms in a patient with depression symptoms.


It is crucial to determine a patient’s symptoms because they are the critical determinants for patients to seek healthcare (Riegel et al., 2019). The experience of several symptoms influences the patient outcomes and provokes more negative consequences. Experiencing similar symptoms might prompt similar interventions. The TOUS assumes that depression shares some common characteristics which can be explored and altered to manage and understand the symptoms more effectively. Through this, it is possible to research to determine better intervention for the sign. Multiple effects are experienced when symptoms occur together. Symptoms are measured by quality, level of distress, timing, and intensity.

Nurses may question the patient when the condition started to determine the severity level. It is usually hard to decide when depression starts because the symptoms typically manifest slowly and in phases. How the disease is affecting the patient is also noted, and depression affects the individual’s normal function, hence developing the feeling of guilt, despair, fatigue, lack of sleep or excessive sleeping, memory loss, and so forth. These symptoms may also be found in other conditions; therefore, nurses must be keen on examination to develop the symptoms of the specific disease.

The degree of strength of the condition, severity, and amount of the symptom is determined to develop the best intervention measures, such as to what extend depression has influenced the individual’s functioning. The quality of the symptom, which entails the feeling of having the symptom, is provided by this theory and the symptom’s location. The nurses should receive clear information on how the person feels deep inside due to the illness, which indicates the specific symptoms associated with the disease.

Influencing factors

Depression can be influenced either collectively or individually by factors that include; situational physiological, and psychological. This condition can be caused by psychological factors which interfere with the mood or the brain’s cognitive states. High-stress levels can lead to depression due to the release of chemicals that interfere with the brain. Additionally, imbalances in the brain may cause depression due to mood interference caused by miscommunication of neurotransmitters. These conditions influence an individual’s normal brain function, which results in tiredness and extreme sadness and happen during, before, or in response to the experience. Cognitive factors may result in depression due to the uncertainty of the symptom and influence the knowledge of the symptom.

Physiological factors resulting from depression affect the normal functioning of the body system, energy levels and are usually interrelated with treatment and genetic variables. According to Mullins & Lewis (2017), a family that has a history of depression is at the most significant risk of occurrence of the condition; therefore, physicians need to assess the patient’s family history to determine if any family member has an experience of the situation before. Women are more likely to be diagnosed with depression; therefore, if the condition presented by a female patient possesses similarities in the symptoms of depression, a significant percentage is that she is suffering from the disease. Vulnerability to conflicts may also raise an alarm that an individual is suffering from the condition. It is crucial to interview the patients on their past experiences to get a clear picture of the symptoms presented by the patient. Diseases may show similar symptoms arising from physiological factors; therefore, it is crucial to separate these symptoms to develop the exact symptoms of the illness under treatment.

Situational factors that cause depression are described by the theory of unpleasant symptoms comprised of environmental and social factors that influence the symptom’s experience and meaning. Environmental factors that subject an individual to symptoms of depression include disasters, for example, drought, floods, and so forth (Majeed & Lee,2017). Air, water, and food pollution also lead to depressive disorders. Furthermore, environmental stress arising from catastrophic environmental events, noise pollution electrical pollution need to be highly considered in assessing patients exhibiting symptoms of depression. Additionally, employment, lifestyle, cultural, social support, and financial resources are situational factors that may cause depression. Social factors that trigger depression include being isolated by loved ones, trauma such as rape, being in an abusive relationship, friendship failures, family feuds, job loss, and the demise of a loved one. It is crucial to do a thorough investigation on the patient to know the root of depression to avoid misinterpretation of this condition with other illnesses.


Depression also has effects on individual performance, as described by TOUS. A person suffering from depression does not exploit their full potential due to their feeling of weakness. The activities carried out by this individual daily are minimal. Depression deprives an individual of the energy to keep going; hence can spend a whole day without performing any meaningful function. Physicians ought to assess the performance of the individual based on the symptoms presented to compare and evaluate if they are due to depression. Depression is usually a disability, and it impairs an individual’s function. Individuals suffering from depression spend most of their time thinking, and this causes fatigue which hinders them from performing physical tasks effectively. When they decide to complete a job, the work output is usually meager, and it is hard for an individual suffering from this condition to be assigned work that requires quick and quality performance. Absenteeism in places of work is experienced a lot, leading to low performance in any organization with an individual suffering from this condition. Focus and sound decision-making are lost, and this individual experiences little or no communication. This adversely affects the overall performance in the job sector, and conflicts are experienced from time to time. This condition can affect functional performance, for example, role performance, physical activity, and social activities. Individuals with depression do not like associating with other individuals, which is a crucial symptom indicator that the individual has a high possibility of depression.

It is hard to understand if a person is suffering from depression unless the person opens up; therefore, they will keep on being assigned tasks no matter the condition and output are required. Furthermore, the disease can affect cognitive, for example, problem-solving thinking. Individuals with depression have a lot of thoughts running in their minds; therefore, it is hard for them to stick to one idea and make a sound decision based on the particular study. Problem-solving is not an easy task for them, and they will always end up making the wrong choices and solutions in the end.  The individual’s mental stability is interfered with, and it becomes so difficult to make any sound decisions; therefore, nurses form their intervention plans considering the way the person talks, responds to questions, time taken to respond to question, and how the person responds to the questions. When an individual has depression, nothing seems to work out hence being rendered functionless, lowering the particular individual’s performance.

In conclusion, the theory of unpleasant systems guides nurses in research and practice on symptoms of the particular condition by assessing severity, management, and preventive strategies. Understanding a specific symptom is aided by this theory because most signs of disease occur together. The theory possesses three parts which include situational factors, psychological and physiological factors. Depression is influenced by these factors, which correlate with each other. The symptoms of depression should be well assessed to develop the specific symptoms that indicate an individual suffers from depression. Situational factors influence the immediate environment and social factors that lead to symptoms of depression. Psychological factors focus on the mental well-being of an individual that indicates whether an individual suffers from depression or not. Physiological factors influence the normal functioning of the body that leads to depressive disorder. Depression has consequences that negatively impact the well-being of an individual. The typical performance of an individual is interfered with, and little work is done daily.


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