Symptom management theory applied to nursing care: scoping review

to identify publications about the applicability of the Symptom Management Theory in nursing care to pediatric, adolescent, adult and elderly patients.

Methods:

scoping review following the steps: definition of the objective, research question and inclusion criteria; search, selection and analysis of publications; synthesis of results. The search occurred in the VHL, SciELO, CAPES and PubMed Journals Portal bases, contemplating publications between 1994 and July 2020.

Results:

out of 3,286 studies, ten were selected, published between 2008 and 2019. They described the relationships between the participants and the domains (person, environment, health and disease), components (symptom experience, management strategies, results) and presented strategies for symptom management.

Conclusions:

the Symptom Management Theory was considered applicable to the participants of the studies and to nursing care. It was concluded that understanding the interaction of these elements is essential to plan actions aimed at controlling symptoms effectively.

Descriptors:
Nursing Care; Signs and Symptoms; Assessment of Symptoms; Nursing Theory; Review

Keywords / DeCs/MeSH Descriptors	Virtual libraries / Information sources
Symptom management theory OR Nursing theory AND Symptom management model AND Signs and symptoms OR Symptom evaluation AND Nursing care AND Pediatric nursing AND Adult	Virtual Health Library Scientific Electronic Library Online CAPES Journal Portal*
Symptoms management theory OR Nursing theory AND Conceptual model of symptom management AND Signs and symptoms OR Symptom assessment AND nursing care AND Pediatric nursing AND Adult	PubMed*

Title, country, year of publication, journal and virtual library/information source	Objective	Method (Type of study, Participants)	Main results
Conceptual Model of Symptom- Focused Diabetes Care for African Americans(9) United States of America 2008 Journal of Nursing Scholarship PubMed*	Describe a conceptual model focused on symptoms and strategies to improve self-care practices and quality of life perceptions of African-American women with type II diabetes.	Type of study: descriptive research Population/sample: African- American women with type II diabetes.	Conceptual model focused on symptoms with innovative approach for the care of a distinct population, involving the participants in the self-care, relevant result in relation to the population studied, since diabetes is one of the main causes of morbidity and mortality in African-Americans and the self-management of diabetes is the basis of care.
Analysis of the UCSF Symptom Management Theory: Implications for Pediatric Oncology Nursing(4) United States of America 2010 Journal of Pediatric Oncology Nursing PubMed*	Analyze the applicability of the Symptom Management Theory in studies with children with cancer.	Type of study: critical reflection Population/sample: children with cancer	The application of theory to studies involving children has been limited to descriptive studies that test parts of the theory. Its strengths include attention to the context in which the symptoms are occurring and its possibility of clinical practice. It has demonstrated applicability in studies involving children with cancer, but further research is needed to investigate and clarify the role of indirect reporting of children's symptoms by parents or other caregivers and health professionals.
Investigación que prueba teoría: una aproximación desde enfermería cardiovascular(10) Colombia 2012 Aquichan SciELO/ CAPES JOURNALS PORTAL*	Verify the assumptions of the first dimension of the Conceptual Model of Symptom Management.	Type of study: methodological research Population/sample: 380 women hospitalized with confirmed diagnosis of acute coronary syndrome	Three observable components of the conceptual model of symptom management were confirmed: perception, evaluation and response. The presence of the non-observable variable "symptom experience", which is directly influenced by the observable component "Assessment", was confirmed.
Disability Intervention Model for Older Adults with Arthritis: An Integration of Theory of Symptom Management and Disablement Process Model(11) South Korea 2014 Asian Nursing Research PubMed*	To present and carry out critical reflection of two models such as a conceptual basis for building the Disability Intervention Model for Older Adults with Arthritis.	Type of study: review article Population/sample: elderly with arthritis	The Disability Intervention Model for Older Adults with Arthritis was developed based on two theories, one being the Symptom Management Theory including the three components of the theory: experience, management strategies and symptom outcomes. It also considered the domains "person", "environment", "health and disease" in the relationships between the factors that influence the care of elderly patients with rheumatoid arthritis, understanding the impact of disease on physical, cognitive, emotional and socioeconomic health. Therefore, it can be used as a theoretical model aimed at care and research to improve the functional status of elderly patients with rheumatoid arthritis.
Respuestas de la mujer frente a los síntomas de Síndrome Coronario Agudo basados en el Modelo Conceptual del Manejo de los Síntomas(12) Colombia 2014 Avances em enfermeira PubMed*	Describe the response actions of the woman and the time it takes to seek help with the symptoms that arise with Acute Coronary Syndrome.	Type of study: quantitativedescriptive cross-section Population/sample: 80 women hospitalized with diagnosis of acute coronary syndrome	This study promoted the understanding of the phenomenon of response of women to the symptoms of Acute Coronary Syndrome and pointed out the contribution of the conceptual model of symptom management associated with the identification of the various responses of women and how they contribute to the understanding of the time delay in seeking care and the actions and factors that influence the severity of the syndrome.
Perioperative site: an analysis from the perspective of the Symptom Management Theory(13) Brazil 2015 USP Nursing School Journal VHL/SciELO/PubMed *	To analyze, within the perspective of the Symptom Management Theory, what exists in the literature about the symptom "perioperative headquarters" plus the experience of the Study and Research Group of the Perioperative Headquarters.	Type of study: theoretical reflection Population/sample: none	The symptom of the perioperative site analyzed from the perspective of the Symptom Management Theory was considered in its multifactorial aspects, highlighting the interrelation of the domains "person", "environment", "health state/disease" and in the dimensions "symptom experience", "symptom management strategies" and "symptom repercussions", with the purpose of highlighting it. It was observed that it has been insufficiently valued, registered and treated in clinical practice.
I'm thirsty! Experience of the surgical patient in the perioperative period(14) Brazil 2016 Journal of the Brazilian Association of Surgical Center Nurses, Anesthesia Recovery and Sterilization Material Center VHL*	To reveal the experience of the surgical patient in the immediate postoperative period in relation to the headquarters, in the perspective of the Symptom Management Theory.	Type of study: qualitative Population/sample: 14 postoperative patients (orthopedic, gynecological, neurological and digestive tract surgery) admitted to the infirmary	From the perspective of the Symptom Management Theory, the thirst for the multivariousness of the symptom is perceived and experienced through physical repercussions such as dry mouth, dry and cracked lips, salivary alteration and in the texture of the tongue and sensation of suffocation and weakness; the emotional repercussions reflect feelings such as anguish, fear and impotence before the symptom.
Symptom management in Behcet's disease(15) Turkey 2018 Journal of Pakistan Medical Association PubMed*	Identify the symptoms experienced by patients diagnosed with Behcet's disease and how patients deal with them.	Type of study: qualitative Population/sample: 35 patients with Behcet's disease	The Unpleasant Symptoms Theory and the Symptom Management Theory were used to identify patients' symptoms and coping methods. The symptoms reported by the participants were: lesions in the oral and genital mucosa, blurred vision, intense pain, neurological and joint involvement, boredom, depression, stress and fear. The symptoms reported were perceived by the participants as negative, and it was concluded that they affected their lives and needed effective management.
Bowel symptoms and self-care strategies of survivors in the process of restoration after low anterior resection of rectal cancer(16) China 2018 Biomedical Central Surgery PubMed*	Identify intestinal symptoms and self-care strategies for rectal cancer survivors during the recovery process after resection surgery.	Type of study: qualitative Population/sample: 100 adult patients	The participants' intestinal symptoms and post-surgery self-care strategies were investigated through a structured interview tool based on the dimensions of the "Symptom Management Theory", including the experiences and symptom management strategies. Among the results, it was observed that more than 90% of the patients presented changes in intestinal habits (perianal and abdominal pain, excessive flates, perianal itching, fecal incontinence, decreased sensitivity and perception of elimination, incomplete fecal elimination and dirt) and the self-care strategies adopted by the participants included diet, medications for the intestine, management of practices and exercises.
Exploring our understanding of fatigue among adolescents living with HIV: Highlighting the unknown(17) United Kingdom 2019 Journal of Health Psychology PubMed	Apply the symptom management model to conceptualize fatigue among adolescents with HIV*.	Type of study: critical reflection Population/sample: adolescents with HIV*	The symptom management model can be a useful theoretical framework for linking research results to symptom and outcome management. Correcting individual fatigue through self-management strategies, particularly in early adolescence, can improve outcomes by increasing quality of life, decreasing school absenteeism and low achievement, and improving future prospects of adolescents with HIV.

Study	Clinical diagnosis and symptom or group of symptoms	Domains addressed	Components addressed	Strategies reported by participants or suggested by authors for symptom management
Conceptual Model of Symptom-Focused Diabetes Care for African Americans ⁽⁹⁾	Diabetes mellitus: - Symptoms of hyperglycemia; - Symptoms of hypoglycemia; - Numbness, tingling or pain in the feet.	- Person; - Environment; - Health and disease.	- Experience of symptoms; - Strategies of symptom management; - Results of symptoms.	Strategies suggested by the authors: - Health education practices; - Active listening and welcome; - Physiological (clinical management); - Behavioral (self-care practices); - Socio-psychological (confrontation, stress, community resources).
Analysis of the UCSF Symptom Management Theory: Implications for Pediatric Oncology Nursing ⁽⁴⁾	Child and youth cancer: - General symptoms of oncopediatric patients.	- Person; - Environment; - Health and disease.	- Experience of symptoms; - Strategies of symptom management; - Results of symptoms.	Did not present.
Investigación que prueba teoría: una aproximación desde enfermería cardiovascular(10)	Acute coronary syndrome: - Did not present.	- Person; - Environment; - Health and disease.	- Experience of symptoms; - Strategies of symptom management; - Results of symptoms.	Did not present.
Disability Intervention Model for Older Adults with Arthritis: An Integration of Theory of Symptom Management and Disablement Process Model(11)	Rheumatoid arthritis: - Pain; - Rigidity and edema in the joints; - Fatigue.	- Person; - Environment; - Health and disease.	- Experience of symptoms; - Strategies of symptom management; - Results of symptoms.	Strategies suggested by the authors: - Administer drugs; - Stimulating self-care practices and facing the disease.
Respuestas de la mujer frente a los síntomas de Síndrome Coronario Agudo basados en el Modelo Conceptual del Manejo de los Síntomas(12)	Acute coronary syndrome: - Did not present.	- Person; - Environment; - Health and disease.	- Experience of symptoms; - Strategies of symptom management; - Results of symptoms.	Strategies reported by participants: - Use of home medicines; - Oral hydration; - Control of respiratory pattern; - Waiting for the symptoms to pass; - Calling the ambulance. Strategies suggested by the authors: - Develop interventions for the care of women with acute coronary syndrome; - To evaluate interventions and impact on responses of women with acute coronary syndrome; - Implement effective screening systems in emergency services that allow nursing professionals to quickly identify the event and initiate care; - Develop surveys to evaluate responses to symptoms of acute coronary syndrome.
Perioperative site: an analysis from the perspective of the Symptom Management Theory(13)	atient in immediate postoperative period: - Perioperative site.	- Person; - Environment; - Health and disease.	- Experience of symptoms; - Strategies of symptom management; - Results of symptoms.	Strategies suggested by the authors: - Offer ice and menthol; - Stimulate gargle with cold water; - Apply moist gauze with water or saline solution on oral mucosa; - Offer water and ice up to 50 ml (limit the volume of liquid to be safely administered and reduce the risk of bronchoaspiration).
I'm thirsty! Experience of the surgical patient in the perioperative period(14)	Patient in immediate postoperative period: - Perioperative site.	- Person; - Environment; - Health and disease.	- Experience of symptoms; - Strategies of symptom management; - Results of symptoms.	Strategies reported by participants: - Offer ice popsicle; - Moisten oral mucosa with cotton soaked in water at room temperature.
Symptom management in Behcet's disease(15)	Behcet's disease: - Lesions in the oral mucosa and genitals; - Blurred vision; - Intense pain; - Neurological and joint impairment; - Boredom; - Depression and stress; - Fear.	- Pessoa; - Ambiente; - Saúde e doença.	- Experience of symptoms; - Strategies of symptom management; - Results of symptoms.	Strategies suggested by the authors: - Use of analgesic drugs; - Complementary therapies; - Stimulation to positive thoughts and facing the disease.
Bowel symptoms and self-care strategies of survivors in the process of restoration after low anterior resection of rectal cancer(16)	Patient in the postoperative period of colorectal surgery: - Perianal and abdominal pain; - excessive flatos; - Perianal itching; - Fecal incontinence; - Decreased sensitivity and perception of eliminations; - Incomplete fecal elimination; - Dirt.	- Person; - Environment; - Health and disease.	- Experience of symptoms; - Strategies of symptom management; - Results of symptoms.	Strategies reported by participants: - Use of medication; - Dietary intake with fiber and low fat content; - Seat bath with water and saline solution in cases of perianal pain.
Exploring our understanding of fatigue among adolescents living with HIV: Highlighting the unknown(17)*	Human Immunodeficiency Virus: - Fatigue	- Person; - Environment; - Health and disease.	- Experience of symptoms; - Strategies of symptom management; - Results of symptoms.	Strategies suggested by the authors: - Planning cognitive behavioral interventions; - Stimulate physical activities; - Plan actions to improve sleep pattern, mood and reduce anxiety.

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[1] Corresponding author: Lara Adrianne Garcia Paiano da Silva E-mail: laraagps@gmail.com