Pain is one of the main reason why people seek health care, it 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 Potter & Perry pain can be cause 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 & Perry, 2014)
Every culture has their own perception and responses about pain because it consists of many different and connective parts that may influence the pain. The first factor 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 “heightens the pain perception, intensifies pain, and decrease the coping abilities” (Potter & Perry 2015, p. 1023). About heredity, “recent research that genetic information passed on by parents might increase or decrease sensitivity to pain” (Potter & Perry 2015, p. 1023) and 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 a research that “Increase attention has been associated with increased pain, whereas distraction has been associated with diminished pain” (Potter & Perry 2015, p. 1024). 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 & Perry 2015, 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 it can aggravate the pain due to stress that affects the coping abilities and the perception of pain. The 3rd 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 4th factor that influences pain is psychological factors which are 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. 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.
I had decided to talk about the perception of pain in African – American culture which is also known as Black – American culture, they are primarily rooted in the west and central Africa and they are cultural contributions of African Americans to the culture of united states (https://en.wikipedia.org/wiki/African-American_culture). 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” (AA’s Perception of Pain, 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 “the good patients should not talk or complain about pain because it makes worse and does no good, and pain is something that one just must be live with and bear” (AA’s Perception of Pain, 2016). and 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 (AA’s Perception of Pain, 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 non verbal 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, this 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 (AA’s Perception of Pain, 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 (Potter & Perry, 2014). For example, “patient who is unable to communicate their pain due to their age and medical condition requires a special consideration in assessing their pain, the tool that would be appropriate is a self-report or behavioural observation pain assessment tool and for cognitively impaired patients might required a simple assessment approaches which involve close observation of behavior changes especially with movement” (Potter & Perry 2015, p. 1027). 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 & Perry, 2014). For the culture that I had chosen, the assessment tool that I will use is a behavioural observation tool such as the ABBEY pain assessment scale because in my understanding about AAs culture, their objective manifestations doesn’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 (AA’s Perception of Pain, 2016). For ABBEY pain assessment scale, it 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 behaviours 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 behavioural assessment tool such as the ABBEY scale.
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 for them, “taking an analgesic was viewed as want to versus have to, some of them believe that pain medication hid the underlying problems and others were fearful of addiction, dependence, and side effects. Also, surgery to alleviate pain is often delayed or declined due to fear of surgery and perception that surgical complications outweigh the benefits” (AA’s Perception of Pain, 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, According to Potter and Perry 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 & Perry 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 a pain management for them. Also, incorporating their religious practices.
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 & Perry, 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 well being or help them face illness, disabilities, or death” (Potter & Perry 2014, p. 112).