Concept Analysis: Pain - Research Paper Example

?Running head: CONCEPT ANALYSIS Concept Analysis: Pain (school) Concept analysis: Pain Introduction Selection of concept Pain is a common patient complaint and a common nursing diagnosis. Most patients suffer from pain at one point or another during their hospital stay. In most cases, pain is the primary reason often driving patients to seek medical care (Mobily, Herr, and Kelley, 1993, p. 537). Pain causes discomfort, stress, and anxiety to patients and unrelieved pain can sometimes prove devastating to patients, often compromising the quality of their lives and preventing them from carrying out their daily activities (Ferrel, 1995, p. 21). Pain is therefore one of the major issues in health care delivery. Various researchers have sought to understand the experience of pain, including the pain experience and its outcomes. Studies indicate that it may not always be possible to manage pain with the most advanced medical technologies or medical therapies (Kotzer, 2000, p. 83). In a study by Beyer (2000, p. 63), the author discovered that 71% of children with sickle cell disease experienced moderate to severe pain and even with advancements in the management of pain in sickle cell disease, these symptoms cannot be relieved. Hester and Foster (1993, p. 5) discuss that the limited knowledge which health care has on pain management seems to be one of the reasons why the gap in pain relief management exists. Previous studies have attempted to establish a concept analysis of pain using Walker and Avant’s method, and these studies indicate that pain is a subjective and personal, often stressful experience (Mahon, 1994, p. 14). Other elements which relate to pain were however, not described, including the definition of pain, its function, pain responses, and impact of pain. Failing to understand these elements of the pain experience can lead to an unclear conceptualization of pain. Determination of its aims and purposes Concept analysis can assist in establishing a clear understanding and definition of pain. This paper therefore now seeks to expand the conceptualization of pain. It seeks to clarify the specific attributes of pain and its possible impact. Walker and Avant’s concept analysis shall be used in this analysis. This analysis generally seeks to ensure that nursing scholars can evaluate the elements and qualities of a concept. It shall include eight steps: selection of concept, determination of its aims and purposes, identification of all the uses of the concept, determination of its defining attributes, construction of a model case, construction of borderline, related, contrary, invented, and illegitimate cases, identifying antecedents and consequences, and defining empirical referents (Walker and Avant, 1995, p. 3). Identifying uses of the concept Dictionary definitions According to the Oxford English Dictionary, pain is generally defined: as the sensation felt when one is hurt in body or mind; the opposite of pleasure; mental suffering; grief; sorrow; bodily suffering. O’Toole’s Encyclopedia and Dictionary of Medicine described pain as the feeling of being distressed or being in agony due to stimulated nerve endings which receive pain stimuli (1997, p. 1181). These definitions provide more technical descriptions of pain. Philosophical perspectives On a philosophical angle, Plato described the concepts of pain and pleasure; he believes that pain comes not just from peripheral and physical triggers but also from emotional experiences (Bonica, 1990, p. 3). Pleasure often comes after pain is relieved and both stimuli – pain and pleasure – impact on the body. Aristotle also had similar thoughts on pain as he declared pain to be an emotion, and an unpleasantness (Bonica, 1990, p. 4). Descartes described how the mind and soul as well pain are very much related to each other. In general, the philosophical understanding of pain is that it is unpleasant and it has a psychological and emotional impact on the mind and the body (Rey, 1993, p. 93). Theoretical perspectives There are four major theoretical perspectives explaining pain and the pain experience. These theories include: specificity theory, pattern theory, gate control theory, and psychological theory. The gate control theory is the theory most commonly applied in the health care field. Melzack and Wall (1965, p. 972) were the first proponents of this theory and they believed that pain involves the sensory-discriminative, motivational-affective, and the cognitive-evaluative processes. The sensory-discriminative dimension is concerned with the nerve transmission of stimuli from the peripheries to the brain. The brain then processes the information, including its location and intensity. The motivational-affective aspect is concerned with the brainstem reticular formation as well as the limbic system which stimulates motivation and aversive drive (Cheng, Foster, and Huang, 2003, p. 22). Based on the cognitive-evaluation dimension, cognitive elements, as well as cultural considerations and anxiety impact on the pain experience. This dimension is founded on the assessment of various data, including previous experiences and usual responses to pain. Theorists Melzack and Wall (1965, p. 972) discussed that pain involves various responses of the action system, coming from different reflex responses and persisting via complicated strategies to stop the pain. The psychological theory establishes that knowledge of learning, personality, culture, and environmental elements impact on the pain experience. In other words, pain is a conditioned response (Fordyce, 1990, p. 291). Based on operant conditioning, pain is seen as a response to elements from the environment which impact on general consequences. As the environment is reinforced, pain behavior is reinforced and makes the pain persistent (Fordyce, 1990, p. 292). Fordyce (1990, p. 292) also discussed that the usual learned reactions to pain, which may include avoidance learning and superstitious learning can also impact on the pain experience. Based on the above discussion defining pain and the pain experience, it can be deduced that pain more often than not involves a psychological response. However, such psychological elements may not always impact on the actual pain experience. Other elements, including the cognitive, cultural, emotional, and environmental factors must therefore also be considered in assessing pain as a holistic experience. Use of the concept in sociology The sociological understanding of pain focuses on cultural inheritance. The experience of pain includes the sensation itself as well as the automatic response, including related stimuli. Zborowski (1969, p. 23) declares that social and cultural elements have a crucial effect on the pain experience. He further utilized pain expectancy and pain acceptance to emphasize crucial attitudes towards pain. Such attitudes are based mostly on parents, other family members, and friends. Individuals are often expected to conform to these attitudes and expectations. Zborowski (1969, p. 23) highlighted the importance of pain responses because the responses to pain are often based on emotions; nevertheless, the way individuals would respond to pain would also be based on specific social scenarios and cultural exposure. Concept of pain in the health profession McCaffery (1977, p. 11) defined pain as a subjective experience, something based on what the person describes and whatever he indicates the pain to be. Pain also provides various purposes—both negative and positive. It can be warning signs for diseases or internal injuries and in some instances it can bring about severe suffering and anxiety (Ross and Ross, 1988, p. 34). In general therefore, pain is based on physical sensations, however the way it is perceived is also based on psychological, social, and cultural elements. Determining defining attributes The significant attributes of the pain concept are the following: unpleasant and stressful experiences coming from physical stimuli impacting both positively and negatively to an individual; individual and personal human experience; the state of feeling physical, emotional, and behavioral elements; physical and psychological reactions to stimulus; pain responses are based on the environment, society, and culture (Cheng, Foster, and Huang, 2003, p. 24). Constructing a model case Mrs. G is a 35 year old, married, Caucasian female who was diagnosed with breast cancer five years ago. She had the mass on her left breast removed soon after her diagnosis, but she did not opt for mastectomy. Recently however, another mass was detected on her right breast. Now another surgery, including a double mastectomy was recommended. This time, she agreed to have her surgery. During her surgery, Jane, a student nurse was assigned to her. When Jane looked in on the patient, she was lying on her side holding tight to the bed rail and holding her arms over her breast area. She was crying and grimacing. Her blood pressure and heart rate registered slightly higher than her normal levels and she told Jane that she was in extreme pain in her breast region. Jane administered pain medications. After one hour, the pain subsided. Mrs. G later expressed that she suspected her breast cancer would eventually come back because of her personal history; moreover, her family history with the disease placed her at a significant risk of developing the disease in both her breasts. She also expressed that she had low tolerance for pain and she was taught that all pain experiences can be managed with pain pills. She asked for immediate pain relief and often more than what was ordered. She was however given only what was indicated in her medical chart. This case clearly indicates a pain experience. Mrs. G expressed that she was in pain, and her behavior, including the protective guarding and the facial grimace indicate an unpleasant experience of pain. The avoidance learning response to pain was apparent. Mrs. G suspected that her breast cancer might return because of her history with the disease, as well as her family history. This demonstrates the social and cultural elements of pain. In the American culture, cancer is one of the major incurable diseases which can cause extreme pain. However, this culture also believes that all kinds of pain can be treated by pain medications. This added to the patient’s low tolerance for pain, mostly as part of her learned response to the sensation. This is part of her personal experience to pain. Development of additional cases: Borderline case Mr. C is a 53 year old American pastor who was recently diagnosed with colon cancer. His doctor established that cancer cells have reached his liver. When Jane was caring for him, she saw that Mr. C was always lying on his side with his eyes closed. He was also often praying, with or without his family. He also often did not express any pain he felt, insisting that he was doing fine. Jane was curious about this lack of pain, and soon asked the patient about it. The patient expressed that he was emulating Jesus who never complained about pain. He considered the pain experience as his way of emulating Christ’s suffering. About three weeks in the hospital, the patient died. This case does not exemplify all the crucial elements of pain, however it is still very much related to pain. Although Mr. C never expressed pain complaints, all his behavioral cues indicate that he was in pain. The patient’s family response and attitudes also indicate the social patterns and responses which the patient has been accustomed to. Family, religious, and social elements played a significant impact in Mr. C’s reaction to pain. Contrary case Randy is a three year old boy who was brought to the clinic for his hepatitis B vaccination a few weeks past. He was then brought to the clinic for a routine check-up after a few weeks. When Randy saw the nurses, he immediately clung to his mother and started crying. When the nurses tried to coax him, the more that he started crying. He also insisted on wanting to go home. The crucial elements of pain are not apparent in this example, but what is present is fear. Fear is a person’s reaction to danger or an unidentified danger. As soon as the threat is eliminated, the fear usually vanishes (Yacom, 1984, p. 352). The cause of his fear is on what he sees would likely take place in the clinic. This situation may be related to pain, but on closer examination is more attributed to fear. Identifying antecedents and consequences Environmental, personal, as well as cultural beliefs are antecedents which impact on the pain experience. The environment often refers to the event which triggers the pain and the body may be impacted by the event which damages the person’s tissue. His knowledge, including his past experiences can also impact on the pain experience (Nelson, 1993, p. 31). Personal beliefs include the individual’s current physical and emotional status, gender, or socio-economic class. Sleeping patterns, muscle tension, high stress levels all impact on the pain experience (Nelson, 1993, p. 24). Females are usually more sensitive to pain and those with a higher socio-economic status are often more sensitive as well. Defining empirical referents Since pain is an unpleasant and a personal experience, a client’s personal expression of pain is the most reliable measures and characteristics one can make of pain. However, solely using these verbalizations may not always serve as reliable pain measures. In instances where patients have verbal restrictions, other elements can be used to evaluate pain, and measuring pain must include its location, its intensity, as well as its quality. Behavioral elements are qualities which can be used to assess pain include crying, restlessness, protective actions, and changes in muscle tone. The McGill Pain Questionnaire is considered one of the more reliable tools in measuring pain (Melzack and Wall, p. 973). It includes measures of pain in relation to the pain rating indicators, number of words chosen, as well as pain intensity. Conclusion In general, the concept of pain was chosen for concept analysis because pain is considered a major issue in health care, proving to be a problem for both patients and health care professionals. Nursing research also indicate evidence on the impact of unrelieved pain. However, establishing knowledge on pain relief seems to be continuous process. It is the goal of this concept analysis to somehow assist nurses in further understanding the idea and experience of pain and establishing nursing interventions to relieve the patient’s pain. References Bonica, J. (1990). History of pain concepts and theories. In Bonica, J., The management of pain (pp. 2-17). Philadelphia: Lea and Febiger. Beyer, J. (2000). Judging the effectiveness of analgesia for children and adolescents during vaso- occlusive events of sickle cell disease. Journal of Pain and Symptom Management, 19(1), 63-72. Cheng, S., Foster, R., and Huang, C. (2003). Concept analysis of pain. 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