According to the textbook, nurses in various settings are adopting a research-based (or evidence-based) practice that incorporates research findings into their decisions and interactions with patients. Analyze the role nurses play in improving health care quality and safety through the use of evidence-based practice (EBP). How do you see this role being applied in your workplace? What internal stakeholder perspectives would you need to consider, including stakeholder support, in order to successfully implement an EBP project in your workplace?

Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to “RN-BSN Discussion Question Rubric” and “RN-BSN Participation Rubric,” located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.

Using the theory of unpleasant symptoms as a guide, what would you look for in an assessment tool for patient symptoms?

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Case Study: A 45-year-old white man presents to your office complaining of left knee pain that started last night. He says that the pain started suddenly after dinner and was severe within a span of 3 hours. He denies any trauma, fever, systemic symptoms, or prior similar episodes. He has a history of hypertension for which he takes hydrochlorothiazide (HCTZ). He admits to consuming a great amount of wine last night with dinner .On examination, his temperature is 98°F, his pulse is 90 beats/min, his respirations are 22 breaths/min, and his blood pressure is 129/88 mm Hg. Heart and lung examinations are unremarkable. The patient is reluctant to flex the left knee, wincing in pain at touch, and has passive range of motion. The knee is edematous, hot to touch, and has erythema of the overlying skin. No crepitation or deformity is apparent. No other joints are involved. Inguinal lymph nodes are not enlarged. Complete blood count (CBC) reveals a white blood cell count of 10,900 cells/mm³ and is otherwise normal.

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The theory of unpleasant symptoms (TOUS) describes various aspects of the clients presenting a set of symptoms since they are complex. This theory posits that symptoms are not expressed in isolation of physiological, psychological, or situational factors, which affect the levels of productivity (Lenz & Pugh, 2020). According to the TOUS, the evaluation of symptoms experienced by patients should be done by an instrument that measures at least the intensity, annoyance or distress, temporal dimensions, and functional impairment of a symptom. Clinicians are therefore in a position to recognize the cause(s) of multiple symptoms rather than focusing on treating individual symptoms, which are signs of dysfunction in Living Conditions.

Tools to Evaluate TOUS

One of the fundamental points of a good symptom and symptom dimensions assessment tool is to measure academic achievement validly. Studies carried out in the recent past have pointed out that symptom assessment should not only be a severity questionnaire, but also duration, frequency, and distress level of the symptoms should be considered to increase the understanding of the symptoms from the patient’s perspective (Smith et al., 2023). For instance, while pain of different intensity is often associated with the postpartum period after childbirth, the assessment of the condition of a woman is not complete if only the pain in her body is considered because after childbirth, a woman also feels emotionally distressed and tired. Therefore, a tool developed based on the TOUS should include reliable scales for pain, fatigue, mood, and any changes in cognition, with all aspects of the symptoms addressed.

Another question relates to the impact of antecedent factors on symptoms as provided by the TOUS. Biological factors, for example, infection, psychological factors, stress and anxiety, social factors, stress and support, or environmental factors, stress or post-traumatic stress, can all alter symptoms perception (Lenz & Pugh, 2020). Thus, the assessment tool must contain those sections that may be used to assess the patient’s history, his/her emotional state, and influence. Measures such as the Edinburgh Postnatal Depression Scale or the Multidimensional Fatigue Inventory are connected to the TOUS model as they consider symptom clusters instead of single complaints (Brown et al., 2022).

Lastly, a valid and reliable assessment tool should also be clinically useful and applicable in various patients’ clinical conditions. Since the signs vary because of demography and culture, it is crucial to validate the instruments in various groups for reliability (Smith et al., 2023). Mobile applications that can be adopted to track patient symptoms have been commonly prescribed as they help in real-time follow-up and interaction between the patient and healthcare provider.

Conclusion

By summarizing the main points of the TOUS framework, it is possible to note the importance of the multidimensional and patient-centered approach to symptom assessment. Clinically optimal decision support tools are those that combine the aspects of symptom severity, distress, influencing factors, and performance. Coordinated care for patients is the current goal that can help in moving from disease management to disease prevention, thus improving the quality of services in relation to patient care.