Symptom distress: Future perspectives for practice, education, and research

Abstract

In this issue we have attempted to clarify the meaning of symptom distress and review the state of knowledge regarding generalized symptom distress and the distress response to the occurrence of specific symptoms. Although the concept is basic to nursing, psychology, and medicine, its meaning is confused in the literature. In particular, authors fail to differentiate the occurrence of a symptom from symptom distress. The use of a consistent conceptual framework would add clarity to future research efforts in symptom occurrence and symptom distress. At present, the framework that seems most practical is Leventhal and Johnson's Self-Regulation Theory.7 Further, work on the relationship of this theory to specific nursing theories, such as Orem's Self-Care Deficit Theory of Nursing, would further clarify the appropriate role of the nurse and give direction for the use of symptom occurrence and symptom distress in developing nursing diagnoses. Among the numerous questions that still need to be answered are the following: (1) How is quality of life improved or reduced over time by changes in symptom distress? (2) What nursing interventions are useful to reduce symptom distress rather than symptom occurrence? (3) Is symptom distress paired to the occurrence of single symptoms or is it a generalized response to the occurrence of multiple symptoms? (4) What nonpharmacologic nursing interventions are effective in reducing insomnia in cancer patients? (5) Are anxiety, depression, worry, and fear symptoms or are they expressions of distress associated with symptoms and psychologic concerns? and (6) How should information about symptom occurrence and symptom distress be used in the formulation of nursing diagnoses? Symptom occurrence and distress have been discussed since medieval times, yet, inadequate attention has been given to why and how they are important to individual patients and specific health care providers. Nurses have assumed that knowledge of symptoms and symptom distress was essential to practice but have failed to focus on how to use this knowledge and how to reduce symptom distress. Both the occurrence of symptoms and the related distress can be found in published lists of appropriate nursing diagnoses.14,15 Both concepts are important to the practice of nursing. Symptom distress, however, is a complex concept that requires further, in-depth understanding.