A common reason why peopleseek health care is due to pain which is defined as unpleasant feeling becauseof disease, injury, or actual and potential tissue damage. It is highlypersonal experience and can be accurately described only by the individualexperiencing it. According to International Association (2008) pain can becaused by physical, psychological, or combination of both because pain is notonly cause by physical injury or tissue damage but also psychological effect toperson such as emotional, spiritual, culture, and situational factors (Potter et al., 2014).
Every culture has their own perception and responses about pain becauseit consists of different factors and connective parts that influencing thepain. The first factor influencing the pain is physiological such as Age,fatigue, heredity and neurological function. Age is can be due to thedevelopmental differences among the age groups how they perceive and react tothe pain. fatigue can also influence the pain because it will increase the painperception, increase the severity of pain, and affect the coping abilities. Aboutheredity, recent research that the increasing or decreasing sensitivity to painis can be due to genetic information passed on by parents.
For neurologicfunctions, it can be due to the fact that it will interrupt or influence thenormal perceptions of pain. The 2nd factors that influencing pain is Socialfactors such as attention, previous experience, family and social support. There’sbeen research that if the attention to pain increased will lead to aggravationof pain and whereas distraction can alleviate the pain.
The previous experienceof pain will affect the patient how to responds and cope with painful events.For example, “if patient experience the same type of pain and the pain wassuccessfully relived, it will become easier to interpret the pain sensation, asa result, the patient is better prepared to take actions to relieve pain” (Potteret al., 2014, p. 1024). Family and social support also affects the pain becausethe individual experiencing it may need support, assistance and protection tominimize the loneliness and fear which can help in coping and alleviating thepain, if they felt abandoned or lack of support to love ones will aggravate thepain due to stress that affecting the coping abilities and the perception ofpain.
The third factor influencing pain is spiritual factor. Prayer andspiritual support is beneficial to patient experiencing pain because it candecrease the suffering by providing hope and connections to god. However, insome traditions, they viewed pain as a punishment from god or the time todemonstrate the strength of character how they handle or cope with the pain.The fourth factor that influences pain is psychological factors which isanxiety and how they define the pain.
Pain can cause anxiety and when it wasunnoticed it can lead to ineffective pain management or difficulty managing thepain and the person on how they define the pain can also affect the perceptionof pain. For example, in some cultures will perceive pain as a threat, losspunishment or challenge (Potter et al., 2014).
I had decided to talk about the perception of pain in African Americans(AAs) culture which is according to Springshare Association (2016) AAs is alsoknown as Black culture that primarily rooted in Africa and culturalcontributions of Americans Africans descent to the culture of united states. Researchby Booker (2016) in describing their relationship with pain, AAs culturedescribed the quality and intensity of pain is differ among the other cultures.it has been reported that they have greater severity/intensity of pain and therelated symptoms in compared to other races. however, their objectivemanifestations don’t match on their subjective symptoms of pain. For example,”AAs are more likely to underestimate the seriousness of and less likely toreport chest pain and often delay emergency care as a result of the cliniciansmay be inclined to underestimate or misinterpret the presence and intensity ofpain in AAs” (Booker,2016). In discussing their pain responses and copingstyle, their endurance of pain without displaying the feelings and withoutcomplaint is AAs common response and coping style, it can be due to their variouscultural belief such as talking and complaining about pain does no good and it willjust aggravate the pain and they believed that pain is something that one justmust be live with and bear. The other possible reasons are they wanted tominimize the family concern, maintain a sense of privacy and they are concernedthat their signs and symptoms and pain reactions would affect their looks andtherefore they tried to avoid or deny the pain. AAs also had a spiritual beliefthat commonly use in response and cope with the pain which is praying, hoping,belief in god, and positive self-talk/coping self-statements other non-pharmaceutical responses that includes music, guarding, catastrophizing, divertingattention, and minimizing of pain versus controlling the pain (Booker, 2016).
As a caregiver, it is important to be aware what variations be inassessment of pain when caring for different ethnic groups, knowing theircommon verbal and non-verbal cues will help the caregiver choose whatappropriate assessment tool can be use so that it will provide a positive datathat can help in providing proper intervention and effective pain relief. Aboutthe culture that I had chosen, AAscommon verbal description of pain includes aching, tiring, exhausting, sharp,stabbing, tender, throbbing, and nagging and the nonverbal cues are dependingon the severity and intensity of pain that affecting their normal functioningand their productivity because according to my research their pain experiencehas a high impact on their level of functional activities which includesdifficulty of walking, difficulty in performing activities of daily living,disturbed sleep, psychosocial impairments, worrying, depression, feeling stressed,interference with performing work/occupational duties, decrease socialinteraction, and impaired sex life (Booker, 2016).Therefore, it isessential to use the proper assessment tool to provide pain managementeffectively. However, choosing the right assessment tool has a factor neededfor consideration which includes their age, developmental stage, patientcondition, type of pain, cognitive ability, preferences and the culture.
Forexample, a tool that would be appropriate to patient who is unable to communicatedue to various conditions is behavioral observation pain assessment tool and simpleassessment approach tool that involves close observation of behavioral changesis for cognitively impaired patients (Potter et al., 2014). Culture affectsbehavioral responses to pain and treatment. So, it is essential to assess whatis their cultural preferences and able to apply the positive information thathad been gathered (Potter et al.
, 2014). For the culture that I had chosen, the assessmenttool that I will use is a behavioral observation tool such as the ABBEY painassessment scale because in my understanding about AAs culture, their objectivemanifestations don’t match on their subjective symptoms of pain and theirendurance of pain without displaying the feelings and without complaint is AAscommon response and coping style. However, their pain experience has a greaterlevel of functional disabilities such as difficulty walking, difficultyperforming ADLs and decrease psychosocial interaction (Booker, 2016). Abbey et al. (2002) argued that ABBEY pain assessment scale is designedto assist and assess the patients in pain who are unable to clearly articulatetheir needs and used as a movement based assessment such as while moving,showering, and during pressure area care. Also, ABBEY scale will measure orassess six behaviors of the patients which includes verbalization, facialexpression, change in body language, behavioral changes, physiological changes,and physical changes. a score of 14 plus for severe pain, 8 to 13 is themoderate pain, 3 to 7 is mild pain and 0 to 2 is the no pain.
Therefore, theassessment tool that I would use based on my understanding about AAs culture isbehavioral assessment tool such as the ABBEY scale (Abbey et al., 2002). AAs culture uses a various strategy to manage pain such as medication,complementary and, alternative such as prayer, faith, religion, herbalremedies, folk medicine and physical therapy. however, they are unwilling orhesitant to use an analgesic medication because they believed that takinganalgesic medication viewed as want to versus have to and pain medication will justhide the underlying problems.
They are also fearful of possible complicationsor consequences such as addiction, dependence, and side effects and due to fearof surgery and perception that they may experience the possible complicationsinstead of benefits their surgery to alleviate pain is often declined ordelayed (Booker,2016). In my understanding, The variation ofnursing interventions be in management of pain would be Depends on theinformation that had gathered from the patients, because according to book the effective routine approach to painassessment and management is using the ABCDE pneumonic which is “A is Ask aboutthe pain regularly, Assess pain systematically, B is believe the patient andfamily in their report of pain and what relieves it, C is choose pain controloptions appropriate for the patient, family, and setting, D is Deliverinterventions in a timely, logical, and safe manner, and E is Empower patientsand their families. Enable them to control their treatment to the greatestextent possible” (Potter et al., 2014, p. 1027).
Therefore, I will use thispneumonic when managing the pain to various patients. for the culture that Ihad chosen and based on my research information that I had gathered, I willchoose a complimentary, traditional and alternative therapies in performingpain management for them because it was their strategies and management stylesfor pain due to their belief, traditions or cultural preferences in other wordsI will incorporate their cultural and religious practices as my interventionfor them. As a caregiver, it is important to be aware of cultural or ethnicdifferences and acknowledge that the knowledge, attitudes, belief, andpreferences may influence the pain judgment and management to patients.
Forexample, if the patient reported a mild to intense pain and the nurseunderestimate it or uses an opinion about the patient report of pain it canaffect in determining the proper doses of pain medication. Being bias or notaware on patient culture can cause nurses to consistently overestimate orunderestimate the patient’s pain which can lead to a source of error inassessing and managing their pain (Potter et al., 2014). It is important to beculturally competent by integrating the knowledge, skill, desire, encounters, andawareness when providing care and according to Leininger and McFarlanddefinition of culturally competent care it is a “use of culturally based careand health knowledge in sensitive, creative, and meaningful ways to fit thegeneral lifeways and needs of individuals or groups for beneficial andmeaningful health and wellbeing or help them face illness, disabilities, ordeath” (Potter et al., 2014, p.