A neurological function. Age is can be due

A common reason why people
seek health care is due to pain which is defined as unpleasant feeling because
of disease, injury, or actual and potential tissue damage. It is highly
personal experience and can be accurately described only by the individual
experiencing it. According to International Association (2008) pain can be
caused by physical, psychological, or combination of both because pain is not
only cause by physical injury or tissue damage but also psychological effect to
person such as emotional, spiritual, culture, and situational factors (Potter et al., 2014).

Every culture has their own perception and responses about pain because
it consists of different factors and connective parts that influencing the
pain. The first factor influencing the pain is physiological such as Age,
fatigue, heredity and neurological function. Age is can be due to the
developmental differences among the age groups how they perceive and react to
the pain. fatigue can also influence the pain because it will increase the pain
perception, increase the severity of pain, and affect the coping abilities. About
heredity, recent research that the increasing or decreasing sensitivity to pain
is can be due to genetic information passed on by parents. For neurologic
functions, it can be due to the fact that it will interrupt or influence the
normal perceptions of pain. The 2nd factors that influencing pain is Social
factors such as attention, previous experience, family and social support. There’s
been research that if the attention to pain increased will lead to aggravation
of pain and whereas distraction can alleviate the pain. The previous experience
of 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 was
successfully relived, it will become easier to interpret the pain sensation, as
a result, the patient is better prepared to take actions to relieve pain” (Potter
et al., 2014, p. 1024). Family and social support also affects the pain because
the individual experiencing it may need support, assistance and protection to
minimize the loneliness and fear which can help in coping and alleviating the
pain, if they felt abandoned or lack of support to love ones will aggravate the
pain due to stress that affecting the coping abilities and the perception of
pain. The third factor influencing pain is spiritual factor. Prayer and
spiritual support is beneficial to patient experiencing pain because it can
decrease the suffering by providing hope and connections to god. However, in
some traditions, they viewed pain as a punishment from god or the time to
demonstrate the strength of character how they handle or cope with the pain.
The fourth factor that influences pain is psychological factors which is
anxiety and how they define the pain. Pain can cause anxiety and when it was
unnoticed it can lead to ineffective pain management or difficulty managing the
pain and the person on how they define the pain can also affect the perception
of pain. For example, in some cultures will perceive pain as a threat, loss
punishment or challenge (Potter et al., 2014).

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I had decided to talk about the perception of pain in African Americans
(AAs) culture which is according to Springshare Association (2016) AAs is also
known as Black culture that primarily rooted in Africa and cultural
contributions of Americans Africans descent to the culture of united states. Research
by Booker (2016) in describing their relationship with pain, AAs culture
described 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 the
related symptoms in compared to other races. however, their objective
manifestations don’t match on their subjective symptoms of pain. For example,
“AAs are more likely to underestimate the seriousness of and less likely to
report chest pain and often delay emergency care as a result of the clinicians
may be inclined to underestimate or misinterpret the presence and intensity of
pain in AAs” (Booker,
2016). In discussing their pain responses and coping
style, their endurance of pain without displaying the feelings and without
complaint is AAs common response and coping style, it can be due to their various
cultural belief such as talking and complaining about pain does no good and it will
just aggravate the pain and they believed that pain is something that one just
must be live with and bear. The other possible reasons are they wanted to
minimize the family concern, maintain a sense of privacy and they are concerned
that their signs and symptoms and pain reactions would affect their looks and
therefore they tried to avoid or deny the pain. AAs also had a spiritual belief
that 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, diverting
attention, and minimizing of pain versus controlling the pain (Booker, 2016).

As a caregiver, it is important to be aware what variations be in
assessment of pain when caring for different ethnic groups, knowing their
common verbal and non-verbal cues will help the caregiver choose what
appropriate assessment tool can be use so that it will provide a positive data
that can help in providing proper intervention and effective pain relief. About
the culture that I had chosen,  AAs
common verbal description of pain includes aching, tiring, exhausting, sharp,
stabbing, tender, throbbing, and nagging and the nonverbal cues are depending
on the severity and intensity of pain that affecting their normal functioning
and their productivity because according to my research their pain experience
has a high impact on their level of functional activities which includes
difficulty of walking, difficulty in performing activities of daily living,
disturbed sleep, psychosocial impairments, worrying, depression, feeling stressed,
interference with performing work/occupational duties, decrease social
interaction, and impaired sex life (Booker, 2016).Therefore, it is
essential to use the proper assessment tool to provide pain management
effectively. However, choosing the right assessment tool has a factor needed
for consideration which includes their age, developmental stage, patient
condition, type of pain, cognitive ability, preferences and the culture. For
example, a tool that would be appropriate to patient who is unable to communicate
due to various conditions is behavioral observation pain assessment tool and simple
assessment approach tool that involves close observation of behavioral changes
is for cognitively impaired patients (Potter et al., 2014). Culture affects
behavioral responses to pain and treatment. So, it is essential to assess what
is their cultural preferences and able to apply the positive information that
had been gathered (Potter et al., 2014).  For the culture that I had chosen, the assessment
tool that I will use is a behavioral observation tool such as the ABBEY pain
assessment scale because in my understanding about AAs culture, their objective
manifestations don’t match on their subjective symptoms of pain and their
endurance of pain without displaying the feelings and without complaint is AAs
common response and coping style. However, their pain experience has a greater
level of functional disabilities such as difficulty walking, difficulty
performing ADLs and decrease psychosocial interaction (Booker, 2016). Abbey et al. (2002) argued that ABBEY pain assessment scale is designed
to assist and assess the patients in pain who are unable to clearly articulate
their needs and used as a movement based assessment such as while moving,
showering, and during pressure area care. Also, ABBEY scale will measure or
assess six behaviors of the patients which includes verbalization, facial
expression, change in body language, behavioral changes, physiological changes,
and physical changes. a score of 14 plus for severe pain, 8 to 13 is the
moderate pain, 3 to 7 is mild pain and 0 to 2 is the no pain. Therefore, the
assessment tool that I would use based on my understanding about AAs culture is
behavioral 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, herbal
remedies, folk medicine and physical therapy. however, they are unwilling or
hesitant to use an analgesic medication because they believed that taking
analgesic medication viewed as want to versus have to and pain medication will just
hide the underlying problems. They are also fearful of possible complications
or consequences such as addiction, dependence, and side effects and due to fear
of surgery and perception that they may experience the possible complications
instead of benefits their surgery to alleviate pain is often declined or
delayed (Booker,
2016). In my understanding, The variation of
nursing interventions be in management of pain would be Depends on the
information that had gathered from the patients, because according to  book the effective routine approach to pain
assessment and management is using the ABCDE pneumonic which is “A is Ask about
the pain regularly, Assess pain systematically, B is believe the patient and
family in their report of pain and what relieves it, C is choose pain control
options appropriate for the patient, family, and setting, D is Deliver
interventions in a timely, logical, and safe manner, and E is Empower patients
and their families. Enable them to control their treatment to the greatest
extent possible” (Potter et al., 2014, p. 1027). Therefore, I will use this
pneumonic when managing the pain to various patients. for the culture that I
had chosen and based on my research information that I had gathered, I will
choose a complimentary, traditional and alternative therapies in performing
pain management for them because it was their strategies and management styles
for pain due to their belief, traditions or cultural preferences in other words
I will incorporate their cultural and religious practices as my intervention
for them.

As a caregiver, it is important to be aware of cultural or ethnic
differences and acknowledge that the knowledge, attitudes, belief, and
preferences may influence the pain judgment and management to patients. For
example, if the patient reported a mild to intense pain and the nurse
underestimate it or uses an opinion about the patient report of pain it can
affect in determining the proper doses of pain medication. Being bias or not
aware on patient culture can cause nurses to consistently overestimate or
underestimate the patient’s pain which can lead to a source of error in
assessing and managing their pain (Potter et al., 2014). It is important to be
culturally competent by integrating the knowledge, skill, desire, encounters, and
awareness when providing care and according to Leininger and McFarland
definition of culturally competent care it is a “use of culturally based care
and health knowledge in sensitive, creative, and meaningful ways to fit the
general lifeways and needs of individuals or groups for beneficial and
meaningful health and wellbeing or help them face illness, disabilities, or
death” (Potter et al., 2014, p. 112).