Looking at Symptoms with a Middle-range Theory Lens*

One of the most challenging expectations for nurses—in research or clinical settings—is the translation of nursing theory for use in practice and research. The Ladder of Abstraction is a construct depicting 3 different levels of ideas regarding a health issue, such as pain. The Ladder of Abstraction has 3 rungs: the philosophical, theoretical, and empirical rungs—3 different ways to think about and approach a health issue. The higher the level on the ladder, the more abstract the ideas. Middle-range theory exists on the middle rung and it is described as theory occurring at the intersection of practice and research. For this discussion, we consider chronic pain through a middle-range lens using middle-range theories from differing levels of abstraction. None of these theories are more “correct” than the other, but each theory provides a different lens for seeing everyday nursing practice. It is up to the practicing nurse to choose a theory that fits her own personal values and to let the theory guide action, enabling evaluation from the view with the middle-range theory lens. (Adv Stud Nurs. 2005;3(5):152-157) O ne of the most challenging expectations for nurses today—in research or practice settings—is the translation of nursing theory and science for use in practice and research. There are many ways to think about practice issues, such as symptom experience, and nurse researchers and practitioners are looking at frameworks to guide study and intervention with people experiencing symptoms. Symptoms are a subjective experience, appraised by the patient. Examples of symptoms are pain, nausea, or fatigue. By contrast, signs are observable indicators of a change in health status. A nurse identifies a sign through careful observation and evaluation. Pain, nausea, and fatigue may be evaluated as signs when measured as the amount of pain medication used, the frequency of vomiting, and the number of hours spent recumbent, respectively. Chronic pain has recently been a common topic in the lay press, in part because of the withdrawal of cyclooxygenase-2 inhibitors. Chronic pain affects approximately 1 in 6 Americans and costs the United States approximately $100 billion annually. Most people seek pain relief solely from medication (ie, “pharmaceutical salvation”), but pain is affected by many factors (physiologic and nonphysiologic), which may demand pain management approaches other than medication. Generally, pain is undertreated because patients and physicians underestimate its effects on functioning. Nonpharmacologic treatments for pain have expanded to include interventions, such as lifestyle changes, mindfulness therapy, or alternative therapies (eg, vitamins and herbs). All of these interventions are within the realm of nursing practice and could be considered in addition to traditional pharmacologic interventions. The effect of pain on psychosocial factors and the effect of psychosocial factors on PROCEEDINGS