A Cancer-Specific Middle-Range Theory of Symptom Self-Care Management: A Theory Synthesis

The middle-range theory of symptom article describes the self-care management for adults with cancer.  Middle-range theories are usually general, simple, and straightforward (McEwen & Wills, 2019, p. 210).  Due to their limited number of concepts, the propositions are clearly stated, and the hypotheses are testable.  The peer-reviewed study indicated that cancer patients could benefit from self-care management behaviors to relieve their discomfort (Baydoun et al., 2018).  The two symptom management theories and self-care management synthesize to create a theory of symptom self-care. “The newly synthesized theory conceptualizes cancer as a chronic illness with related symptoms that persist beyond the acute phase of treatment.” (Baydoun et al., 2018, p. 1).  The study sheds light on the empowerment that cancer patients have when they can take their symptom management into their own hands.  I recall a patient I had in the CTICU once under an enormous amount of discomfort.  She wanted to be discharged, so she refused narcotics in the attempt to be released earlier.  I taught her a little trick I used on my pediatric patients in the ED.  I brought in an energy beauty bar for her to try. It’s a small handheld vibrating facial device for lymphatic drainage removal.  I taught her how to give herself a facial lymphatic massage.  Using the power of overriding the gateway theory, she self-soothe for comfort and relieve her pain.  There is something about allowing a patient to control at least one aspect of their care when so many factors play against them. 

Application of Theoretical Frameworks and Models

Applying theoretical frameworks and models can strengthen nursing research and promote theory-based practice within the nursing profession.  Theoretical frameworks provide a guide to study the design and intervention development for future research (Chinn & Kramer, 2018).  Without theoretical frameworks, the foundation for research could be compromised.  The whole purpose of evidence-based research (EBR) is to ask the question, see the need for change, study and implement the change and evaluate the change outcomes.  It is vital to see all those who came before you.  We have much to learn and grow from researching past articles. The ability to zero in on specific and relevant data is essential.  This foundation helps to focus specific variables and viewpoints so that the researcher can interpret all data gathered(McEwen & Wills, 2019).  For example, it would be challenging to analyze every single study ever done for pain management in cancer patients. That’s where theoretical frameworks and models can be of use and aid in promoting theory-based practice within the nursing profession.  Utilizing the framework of previous studies provides nurses with a way to organize all the clinical data to be interpreted and analyzed more efficiently.

When I worked in the emergency department, I wanted to find Munchausen By Proxy studies.  I was suspicious of a mother who brought her daughter to the ER with gastrointestinal symptoms.  I was able to find multiple articles, one by Sorrentino, who spoke of the book Playing Sick.  I read the book, used the information I was suspicious of, and reported the patient’s mother to our Attending Physician.   My suspicions were correct, and this mother was making her child ill.  After six months in and out of the courtroom, the little girl was finally free from a tortuous life. I was able to apply the theoretical frameworks from other studies, and I’m almost sure I saved a life.