Holistic Theory of Unpleasant Symptoms

Contributor: Amy Kenefick Moore
August 23, 2018

Author – Amy Kenefick Moore, PhD, RN, APRN, CNM, FNP-BC, APHN-BC, HWNC-BC

Year First Published – 2018
Major Concepts of the Theory

Wellbeing, Symptoms, Human energy field, Integrative nursing, and Holism. The Holistic Theory of Unpleasant Symptoms describes manifestations of the human energy field that encompass wellness and unpleasant symptoms. It suggests the nature of transformative nursing interventions, their mechanisms of effect, and their outcomes.


Holistic theory, theoretical model of health and wellbeing.

Brief Description

The Holistic Theory of Unpleasant Symptoms (HTOUS), a new theoretical model of health and wellbeing, is grounded in the philosophy of complex holism and inspired by the Theory of Unpleasant Symptoms (TOUS) and Martha Rogers’ “Science of Unitary Human Beings”. TOUS described antecedents, attributes, and performance-related consequences of symptoms and suggested linear relationships. HTOUS is a refinement of both structure and content, viewing humans as complex irreducible energy fields and symptoms as manifestations of the human energy field. These are perceived, experienced, and expressed by humans.

Symptoms are considered manifestations of patterns associated with open energy fields called ‘nurse’, ‘patient’, and ‘environment’. Because field manifestations are perceived, experienced, and expressed by people, they are responsive to nursing input. If healing is considered a change in the energy field in a manner that we label as wellness, then nursing interventions can be characterized as energy patterning.

Emphasis is placed on the extent to which the human energy field perceives self as well. The model describes manifestations of field patterning called Symptom Experience, Wellbeing, and Spirituality. These were not present in TOUS. Nursing interventions are used to help people experience a personalized wellbeing in the context of unpleasant symptoms.

Spirituality is a powerful addition to the model, explaining phenomena such as improved sense of wellbeing in the setting of spiritual transcendence despite the presence of otherwise distressful symptoms such as pain. The holistic transformation of TOUS, including spirituality and wellbeing better reflects the reality of human experience. The model is suitable for practice and research, suggesting opportunities for effective planning, implementation and evaluation of theory-guided nursing practice.

Primary Sources for the Theory

Moore, A. K. (2021). The Holistic Theory of Unpleasant Symptoms. Journal of Holistic Nursing. https://doi.org/10.1177/08980101211031706

Lenz, Elizabeth, PhD, RN, Suppe, Frederick, Gift, Audrey, PhD, RN, Pugh, Linda, et al. (1995). Collaborative development of middle-range nursing theories: Toward a theory of unpleasant symptoms. Advances in Nursing Science, 17(3), 1-13.

Lenz, E., Pugh, L., Milligan, R., Gift, A., & Suppe, F. (1997). The Middle-Range Theory of Unpleasant Symptoms: An Update. Advances in Nursing Science, 19(3), 14-27.

Butcher, H. (2018). Martha E. Rogers’ Nursing Science. Retrieved September 12, 2018 from https://pressbooks.uiowa.edu/rogeriannursingscience/.


Based on a unitary perspective, the Holistic Theory of Unpleasant Symptoms views humans as complex, dynamic, irreducible energy fields. Field manifestations are perceived, experienced, and expressed by people and responsive to nursing input. Symptoms, as manifestations of field, form recognizable patterns. Patterns include contextual phenomena including behaviors, actions and experiences such as wellbeing. Because the fields are continuously open, they are subject to transformative nursing intervention at any time.

Enhancement of wellbeing is possible despite the presence of otherwise distressful symptoms. Practice implications are suggested and explained, including how transformative nursing actions help people experience wellbeing in the context of unpleasant symptoms, even in the context of serious illness or at the end of life.

Amy Kenefick Moore (1953 – )

Amy Kenefick Moore is a certified Advanced Practice Holistic Nurse who received a PhD in Nursing from the University of Massachusetts and did a postdoctoral fellowship at Yale University. She is also certified as a Health and Wellness Nurse Coach, a Family Nurse Practitioner, and a Certified Nurse Midwife. She has been on the faculty of the School of Nursing at the University of Connecticut since 1999, teaching nursing theory for advanced practice and quantitative analysis of health sciences data. Her nurse coaching training included a focus on the end of life. She has a private practice in integrative nurse coaching, specializing in caregivers, both personal and professional. Throughout her long career, she has focused on quality of life throughout the lifespan, believing that it’s never too late to make things better than they might have been. A resident of Bloomfield, CT, she is the mother of 4 children and grandmother of 2.