From a practitioner's point of view, symptoms rarely present individually. The challenge is how do you manage more than one symptom at a time. This presentation will give examples of common symptom clusters observed clinically and raise questions. As an example, if a client is experiencing pain, insomnia and fatigue, the decision may be made to manage pain pharmacologically. The rationale being, if the individual's pain is under control, he will be able to sleep and as a consequence fatigue will lessen. However, the drug administered, may also be sedative and contribute to the experience of fatigue. This example illustrates a linear and causal relationship between symptoms that may not be true. Another example, an individual presents with loss of energy, insomnia, psychomotor retardation and decreased appetite. Is this individual fatigued, depressed or both? If, he is both fatigued and depressed which came first and is one symptom causing the other? In both examples questions arise like, how do you assess and manage two or more symptoms at once? Is there a priority in which symptoms should be managed first? Can one symptom predictably affect another? Are there contextual issues that bear on the management of symptoms presenting together? Do certain symptoms always present together and if so are they causally related? There are many research questions, the answers to which the practitioner eagerly awaits. A major component of nursing practice deals with symptom management and this practice depends on the evidence nursing research produces. We need to develop a paradigm of symptom clusters to guide both research and practice. Since people are holistic beings, an understanding of his symptom experience requires that symptom clusters be addressed. Only when we understand the relationship and interaction of presenting symptoms can we hope to design effective interventions for their management.
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