American Sentinel N522PE Module Eight: Special Topics – Pain Assessment & Cultural Competency

Discussion 8

Consider the special topics of pain assessment and cultural competency. How are these nursing assessments conducted in your nursing practice? Are your assessments current and based upon contemporary evidence or are these in need of policy and procedural revision? If revision is needed, what might you suggest be changed? If you perceive the assessments are clinically relevant what evidence supports your current practice? American Sentinel N522PE Module Eight: Special Topics – Pain Assessment & Cultural Competency

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Discussion Participation Guidelines & Grading Criteria.

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Example Approach

Culture can influence how one expresses, manages, and experiences pain. Pain is universal, but the way one person says pain can differ from another individual. Other factors that play a role in the way someone interprets and tolerate pain rates are family beliefs and religion. For example, I recently took care of a gentleman in the ICU suffering from COVID, who was of Japanese descent, and his father was a former Marine. He was taught that stoicism was part of his heritage from a young age, and he needed to act “tough” like “a Marine.” Although this is just a basic example, the identification and treatment of pain can be much more challenging for a provider if they cannot understand the complexity of pain in an individual.

According to the Institute for Clinical Systems Improvement, pain scales have been part of pain treatment for many years and have become standard practice (2018). In my facility, we use various pain scales such as the Critical Care Pain Observation Tool (CPOT), Wong-Baker Faces Pain Scale, FLACC Scale, and a Numerical Rating Pain Scale.

Our hospital policy requires us to assess pain a minimum of every 4 hours or sooner as needed. If we give pain medicine due to pain, we are required to re-assess for the effectiveness within one hour of giving the medication. Suppose a patient is in the ICU and sedated. In that case, we use the CPOT scale, which “is the most reliable tool currently available to assess pain in patients” (Phillips et al., 2019) who are unable to communicate. We assess our pain assessment on various factors such as increased heart rate, respiration, blood pressure, facial grimacing, and an increase in restlessness.

References

Institute for Clinical Systems Improvement (2018). Asses, quality of life, function, and pain.

Phillips, M. L., Kuruvilla, V., & Bailey, M. (2019). Implementation of the Critical Care Pain Observation Tool increases the frequency of pain assessment for non-communicative ICU patients. Australian critical care: official journal of the Confederation of Australian Critical Care Nurses, 32(5), 367–372. https://doi.org/10.1016/j.aucc.2018.08.007

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Well done. Describe the current scope of practice laws regarding the prescribing of narcotics as a NP.

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Hi Rebecca. I also work in the ICU where we use the CPOT frequently. The critical care pain observation tool is used for patients who are unable to communicate. It is based on the patient’s facial expression, body movements, compliance with the ventilator if the patient is intubated or vocalization like moaning or crying out, and muscle tension. We assess use these scores at least every four hours to determine if the patient is in need of pain medication. We then reassess their score to determine if the pain intervention was successful. I also feel that it is important to be educated and aware of the perception of pain across the different cultures to be able to adequately treat the patient’s pain.

Thanks for sharing!

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Hi Rebecca and Dr. Clarin,

I agree with your post. A clinician has to know his own cultural perception of pain in order to objectively assess a patient’s perception of discomfort. Inaccurate assessment of pain can be influenced by clinician’s past experiences and unjustified stereotyping of the behavior towards pain. Pain threshold and pain tolerance are in varying degrees for all individuals. According to Woo (2016), pain tolerance can be affected by beliefs, drug use, herbal treatment, experiences or religious practices. A thorough nonjudgmental assessment of pain will most likely yield accuracy, thereby leading to proper treatment and pain interventions. Pain management relies heavily on the patient’s statement of pain and the possible nonverbal cues that could help explain the pain. For patients who have contradicting pain manifestations, the best way is to understand completely the patient’s health status. This will be based on history and response to questions. This will need the clinician’s evidenced-based intuition to uncover the real characteristics of pain and how the pain is perceived.

Reference

Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for advance practice nurse prescribers. F.A. Davis Company.

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Thank you, Rebecca, for your post on the military culture and pain treatment. The complex mechanisms that initiate pain in patients trigger debilitating responses. Pain can change a person’s ability to function and communicate (Bickley & Szilagyi, 2017). Your description of the son of a Marine depicts a standard competency component for assessing those in the military. Military patients hesitate to receive care because of the stigma of mental health illnesses (Nedegaard & Zwilling, 2017). The military Veteran does not want to appear weak. The military is a “warrior culture” that prepares them for “combat readiness” (Atuel & Castro, 2018). The chain of command hierarchal power structure in military culture is critical to understanding the Veteran’s role and status (Atuel & Castro, 2018). Healthcare professionals would benefit from receiving formal military, cultural competence training (Nedegaard & Zwilling, 2017). This concept is key to understanding the Veteran’s cognitive status in pain and compliance with treatment. It is essential to first identify the patient in pain, considering they do not want to show weakness. The Veteran’s Health Administration has added adjunct treatment to avoid the use of opiates. In my facility, we have chiropractic care, acupuncture, yoga, and massage therapies to improve the Veteran’s well-being.

References

Atuel, H. R., & Castro, C. A. (2018). Military, cultural competence. Clinical Social Work Journal, 46(2), 74–82. https://doi.org/10.1007/s10615-018-0651-z

Bickley, L. S., & Szilagyi, P. G. (2017). Beginning the physical examination: General survey, vital signs, and pain. In Bates’ guide to physical assessment and history taking (12th ed., pp. 111–146). Wolters Kluwer.

Nedegaard, R., & Zwilling, J. (2017). Promoting military, cultural competence among civilian care providers: Learning through program development. Social Sciences, 6(1), 1–11. https://doi.org/10.3390/socsci6010013

283 words American Sentinel N522PE Module Eight: Special Topics – Pain Assessment & Cultural Competency

American Sentinel N522PE Module Eight: Special Topics – Pain Assessment & Cultural Competency