Pain Concept Analysis
Pain is the most frequent diagnosis in the clinical set up. In the health care sector, pain is recognized as the most conspicuous identifier of underlying issues in health and can be used as a measure of the problems associated with patient complaints. Pain has been identified as the most critical problem in the healthcare sector as pertains to patients. It is distinct from various other concepts presented in healthcare and other forms of care such as in psychology. The concept of pain as presented in healthcare is quite different from its representation in other fields such as sociology and psychology. Pain transverses the physical realm to include even feelings in the emotional and the mental contexts. From the explanations given by different authors, pain as a concept is the foundation of many other concepts. Other concepts drawn from pain include pain management and chronic pain transition hence pain can be considered as one of the principal concepts in healthcare.
Although some studies have previously been conducted to explore the concept of pain in the healthcare sector, these studies are not sufficient to fully explore the subject given its extent. This justifies the decision to carry out other studies in pain concept in order to add to the already available information. The ensuing study critically analyses the concept of pain in healthcare to explain its extent. In this regard, pain concept analysis includes presentation of its attributes, the antecedents and consequences of pain as well as model, borderline, related and contrary cases are provided. The objective of this study is thus to provide a deeper comprehension of the pain concept in healthcare. Understanding this concept is crucial especially for a medical practitioner in the position of the head of surgery. This is because surgical procedures are characterized with pain before, during and post-surgery, and effective pain management can only be achieved once the pain has been fully understood. Understanding the concept of pain can also help the surgery team to distinguish between actual pain and other feelings such as anxiety and depression which may also result in symptoms similar to those of pain. Understanding this concept can thus enable medical practitioners to help patients understand and cope with pain.
The literature review section in this paper aims at identifying what the concept of pain entails from the perspectives presented by different authors. Cheng et al while explaining why pain is the most critical problem in healthcare, asserts that pain refers to feelings of unpleasantness, distress and discomfort. As such, the authors claim that pain can be either emotional or physical and can have several causes (Cheng et al., 2003). Other authors have also distinguished pain in accordance to varying definitions. For instance, Montes- Sandoval (1999) describes pain as the sensation felt as a result of physical and/ or mental pain. Although these descriptions do not permeate the concept into details of the causes associated with pain, they are capable of explaining the expectations from someone in pain. Other authors such as Fordyce (1990) also described pain from the behavioral context of the concept. Distinctions exist in the definition of pain across different fields due to the perceived impacts of the concept on the lives of individuals. As such, pain, just like various other concepts can be said to be multi-disciplinary and thus fully comprehensible only by exploration from different perspectives.
According to Cheng et al (2003), pain presents in disciplines such as sociology, psychology as well as in healthcare. This makes it crucial to find a description that fits application in a variety of contexts and thus enables practitioners from different fields. In this regard, the authors suggest application of the dictionary definition of pain which designates pain as the opposite of pleasure and also as suffering either mentally or bodily. When the latter definition is taken, pain can be associated with grief and other feelings such as sorrow which characterize emotional pain. From the suggestions of Fordyce (1990) presentations involving pain should be understood deeply to enable holistic management processes. This implies that pain management in the clinical as well as in other settings should entail considerations of other deeper issues such as sorrow and anxiety in order to achieve individualistic and wholesome healing. Dealing with physical pain alone may not be sufficient in some cases where the pain only signifies other issues (Montes- Sandoval, 1999).
Understanding the concept of pain is commonly achieved through application of various pain concept theories developed at different times. Some of the theories provided by Cheng et al as relevant to the concept of pain include specificity theory, gate control theory, behavioral theory and pattern theory. The behavioral theory is the perspective from which Fordyce looks at pain as a product of behavioral characteristics (1990). Despite being different in the messages they intend to send, these theories are similar in the fact that they all relate pain to the presence of a stimulus to which the body reacts either physically, emotionally or mentally. Pain is associated with various outcomes which makes it essential to understand. The effects of pain are what create the impression that pain is the most critical problem in healthcare. For instance, Montes- Sandoval asserts that pain results in reduced quality of life of the individual involved and can also have physical and emotional effects which may affect even the families and friends of those experiencing pain (1999). This finding is supported by evidence from other authors who describe both emotional pain and physical pain as having the potential of destroying relationships where people are unable to cope (Fordyce, 1990). Although most of the authors do not mention other impacts of pain, it is inevitable that pain also results in economic loss for the victims and their relatives as those in pain have to seek medical attention or other forms of assistance depending on the pains they feel.
Attributes of Pain
Although many studies have explained what pain is from different perspectives, Walker and Avant (1995) posit that concept analysis can only effectively begin from clarification of the defining attributes of a concept. In this regard, the concept under analysis is pain. Cheng et al identify various attributes associated with pain. According to these two authors, the first attribute associated with the concept is that pain entails distressful or unpleasant feelings associated with physical sensations which can be either positive or negative. This attribute classifies pain in the clinical context since it is restricted to a physical feeling. The physical sensations that result in pain may be either positive in their intention or negative. Apart from this, there are also other attributes that are used to describe pain. These other attributes are more applicable in a wider context and not confined to the clinical setting as the first attribute.
The second attribute associated with pain is that pain is a state of feeling various components such as sensational, emotional and behavioral components at the same time. This attribute relates to the multidimensional nature of pain through its description. In most cases, pain results in sensational feelings, particularly where the physical sensations had previously been produced. These feelings result in emotional distress and / or behavioral changes as the victims react to the pain they feel. As such, it may be difficult to characterize pain without consideration of some of these concepts. For instance, one cannot effectively describe pain where there is no physical sensation associated with it. At the same time, pain description cannot be fully achieved without an emotional impact because one cannot in such a case identify the impacts of the pain felt.
Additionally, pain is also characterized by high specificity. In this account, specificity of pain is such that pain cannot transverse its boundaries. The areas of the body in which impact is felt are the areas that develop the painful feelings. It is impossible therefore to have a scratch on the hand and feel the pain on the foot due to the specificity of the problem. Pain is also an individual human experience. This implies that one person’s pain cannot be transferred to another, neither can someone feel the same degree of pain that another feel. Moreover, it is impossible for one to exactly clarify the pain that another person is feeling. Pain is also characterized by physical or psychological response to stimulus. This implies that for pain to be felt there has to be a stimulus. In the healthcare sector, the stimulus has to be physical resulting in physical injury. On the other hand, the other fields such as sociology and psychology associate pain with a stimulus although the stimulus does not have to be physical. As such, the association of pain with a physical stimulus should only be limited to the healthcare sector. This also brings out the existence of another attribute.
In the clinical setting, pain functions to either protect or provide warning for the existence of deeper problems. This explains why pain is used as the most potent sign of other problems in healthcare. The pain felt, being physical, can help the medical practitioner to predict the potential source of health problems in a patient. It is from such pain that one can be diagnosed and thus protected from other deeper routed problems in health. Finally, pain response is influenced by different factors such as personality traits, environmental factors and emotional alignment. In some cases, the religious beliefs held by an individual may hinder them from fully responding to their pain. While such environmental factors have great influence on pain response, they may also hinder effective treatment in the provision of clinical services since the practitioners mainly depend on the patient reports for provision of satisfactory treatment.
Developing the Model Case
The model case holds the key attributes associated with the concept. As such, it can be addressed as the concept requires. In the presented case, a 42-year-old male patient who had been involved in an accident was brought into the emergency room. The patient, Mr. T was brought in complaining of pain on his right arm. He complained of excruciating pain and even asserted that he felt as if the arm had been burnt. Besides the verbal complaints, the patient also held his arm using his left hand and winced in pain every time the arm was touched. The patient was first given pain killers to dull the pain he felt. Later, the patient was taken through an X-ray analysis where it was discovered that he had sustained a fracture during the accident. He was then assisted through administration of first aid. An analysis of this case shows that it possesses the key attributes of pain. For instance, the pain felt was individual and highly specific on the arm. It was also caused by a physical sensation and manifested through physical, emotional and behavioral characteristics. Furthermore, the pain on the arm was a warning of the fracture that had occurred on it.
Development of Additional Cases
A borderline case presents some of the attributes associated with the concept under analysis. In this case, another patient Mrs. J came into the hospital hysterical and complaining of dizziness. When asked whether there was any specific place in which she felt pain, she reported that she had no specific locations. She however said that she felt general pain all over her body. This reported pain could not be linked to any physical sensation that could have resulted in it. It thus became necessary for the nurses to conduct tests on her to determine if she had some of the conditions that result in general malaise but the results indicated otherwise. Consequently, it was decided that her pain was an indication of emotional stress and was issued with antidepressants. From this case analysis, it is evident that attributes of pain such as distressful experiences and physical and emotional response were prevalent in the case. The pain was however non- specific and not caused by any physical sensations.
A contrary case presents attributes that do not characterize the concept under analysis. For instance, another patient came into the hospital crying and calling for assistance. Despite efforts to come her down, the patient, in her mid-twenties continued to mention the name of her child. At that point, the staff was unaware that the mentioned individual was her son. It was however later discovered after she was calmed down spoken to, that her son had been brought to the hospital earlier after suffering seizures in their house. This case does not present any of the attributes of pain. As such, it cannot be characterized as a case of pain.
Antecedents and Consequences of Pain
The concept of pain, based on its attributes is significantly affected by various other phenomena. From the definition given by Walker and Avant (1995), antecedents refer to factors that come prior to the development of the concept being analyzed. In this regard, the first antecedent associated with pain is the environmental orientation of the victim. The environment in this case is described as the event that triggers the pain. Such events may include puncture of veins, fracture of limbs and other conditions. Individual attitude may also precede pain in certain instances. However, individual attitudes are mainly identified in cases where the pain described is emotional rather than physical. Apart from this, pain can also follow personal issues such as physical and emotional conditions. With respect to this, pain can come about due to the pre-existence of conditions such as chronic diseases and emotional instability. Prior emotional disturbances can result in emotional pain while chronic illness can result in chronic pain. For instance, individuals with sickle cell anemia most frequently feel pain not because of environmental triggers but because of their personal conditions. Similarly, individuals undergoing depression or grief feel emotional pain due to their prevalent conditions at that time.
Cultural values may also result in pain at some times. Although cultural values do not directly result in pain, they influence the perseverance of individuals in pain and the interpretations about pain at the time of experience. For instance, there are certain religious beliefs that go contrary to hospital visits. In cases where patients are of such beliefs, it would be difficult for them to report in case they felt pain, or even to give reports that would help medical practitioners help them curb their pain. Traditional beliefs also have the potential of influencing pain perception and perseverance in the same manner, especially where individuals undergoing certain cultural rights are judged based on their bravery and the potential for pain reporting.
Consequences in concept analysis are defined by Walker and Avant (1995) as the outcomes associated with a concept. The concept of pain can be further understood from the consequences associated with it. From the work of Cheng et al (2003) pain is linked to outcomes such as voluntary and involuntary reactions. Such reactions enable the victims of pain to respond to their pain in way that clearly indicates that they are in pain. For instance, the voluntary reactions are mainly verbal and may include interpersonal communication, interpersonal communication and direct communication with others on the level of pain felt by an individual. On the other hand, involuntary actions are mainly reflex in nature and are carried out unconsciously. The second consequence associated with pain is the development of meaning. According to Cheng et al, pain can also result in the development of meaning where individuals feeling pain begin to associate their pain with certain conditions or beliefs. In this aspect, such individuals, when feeling pain begin to characterize that pain and link it to particular outcomes. This is however common where the pain felt is chronic.
The attributes associated with pain are abstract and thus difficult to measure in all cases. As such measurement of pain relies on verbal reports from the sufferers in most cases. Medical practitioners rely on the verbal explanations given by the patients to quantify pain. Measuring pain in this way involves consideration of the location of the pain, the quality associated with the pain and the intensity of the pain felt by the patient. In addition to this, health care professionals also rely on behavioral cues for the measurement of pain. Such cues include crying, restlessness and avoiding movement among others. In some cases, practitioners use the McGill Pain Questionnaire to evaluate pain in patients (Melzack, 1975). The questionnaire measures pain on three measures which include pain ratings, the number of words used and the present pain intensity.
The concept of pain is inevitable in nursing practice since it is the most diagnosed concept in healthcare. As such, understanding this concept will not only help in enhancing nursing competence but will also help in assisting customers come to terms with the pain they feel. In this way, understanding pain can help to get assistance for patients who come with the assumption of pain yet suffer from other related concepts such as fear and anxiety
Cheng, S., Foster, R. and Huang, C. (2003). Concept Analysis of Pain. Tsi Chi Nursing Journal.
Fordyce, W.E. (1990). Learned Pain: Pain as a Behavior, In J.J Bonica. The Management of Pain 2nd Ed. Philadelphia: Lea and Febiger, pp. 199- 291.
Melzack, R. (1975). The McGill Pain Questionnaire: Major Properties and Scoring Methods. Pain, 1, 277-299.
Montes- Sandoval, L. (1999). An Analysis of the Concept of Pain. Journal of Advanced Nursing, 29(4), 935- 941.
Walker, L.O. and Avant, K.C. (1995). Strategies for Theory Constructing in Nursing 3rd Ed. Norwalk, CT: Appleton & Lange.