Holistic symptom management: modelling the interaction phase

AIM: This article details an interaction model that links the way a nurse participates in a client's effort to describe the symptom experience and the eventual symptom management outcome. RATIONALE: Symptoms represent more than clues to an underlying disease process. Within a nursing perspective, managing symptoms requires an understanding of the person's experience and the meaning associated with each symptom. All nurses engage in symptom work with clients, but the extent of their accountability varies within their scope of practice. In the United States of America (USA) model of advanced practice nursing, the scope expands to include all aspects of symptom management such as eliciting an accurate understanding, using a symptom cluster to determine underlying causes, and involving the client in management decisions. A holistic nursing approach to symptom management is particularly well suited to the increasing numbers of people with chronic illness. METHOD: The discussion herein details the interaction phase of the evolving model of Negotiated Symptom Management in chronic illness. Analysis of the participants, process, and context governing this encounter reveal the complexities of the interaction. FINDINGS: It is argued that variables within the interaction have the potential to compromise desired nurse and client outcomes. Although symptom acknowledgement and relief is a primary goal, the emphasis for the nurse clinician remains on the person, not the symptom. Effective symptom management is dependent on hearing and attending to the lifeworld of the client. CONCLUSION: Attending to key areas of influence in the interaction process facilitates the achievement of desired outcomes in symptom management--accurate diagnosis, symptom relief, and agreement on a course of action. The dominance of chronic illness in health care, and the centrality of the symptom experience underscores the value of sensitizing nurses to these issues.