Symptom Management: What We Know and What We Do

Abstract

Nursing has considered symptoms as perceptions, experiences which are often distressing, as opposed to the medical perspective which views symptoms as keys to diagnosis. Diminishing distressing symptoms has been at the essence of nursing since its inception. In her book Notes on Nursing: What It Is and What It Is Not, Florence Nightingale highlights the relief of pain and discomfort as central to nursing (Nightingale, 1946). Much knowledge has been acquired about certain distressing symptoms, particularly pain, but less about others. The mechanisms of pain, factors that exacerbate it, pharmacological agents that decrease it, and comfort measures that soothe it have all been studied by different disciplines, including nursing. There are even textbooks on the nursing management of pain where this information is detailed (Donovan & Watt-Watson, 1992). However, there are still data suggesting that nurses do not utilize the knowledge they have regarding pain management (Abbott et al., 1992; Donovan, Dillon, & McGuire, 1987), particularly in children (Johnston, Abbott, Gray-Donald, & Jeans, 1992; Schecter, Allen, & Hanson, 1986). This is due, in part, to inconsistent knowledge and inconsistent beliefs about the value of changing practice among nurses. Howell, Foster, Hester, Void, and Miller (1996) describe the implementation of a pain management program for nurses in a pédiatrie setting. They clearly describe the process of the acquisition of knowledge by staff. From this description, the comprehensiveness involved in changing staff attitudes towards pain management is evident and can partly explain why less comprehensive and less rigorously implemented programs have failed. These authors followed through with their program and found that ultimately nurses truly "owned" components of the program's pain assessment and management strategies, as shown by their personal modifications which maintained the principles of the program.