Concept analysis of pain in hospital nursing practice

Pain is the most famous member of bodily feelings including orgasms, tickles, itches and tingles among others. These feelings are normally attributed to the locations of the body and seem to have several features like duration, intensity and volume which are attributed to quantities or physical objects. For most patients seeking for clinical help, pain is often the most common problem and the most common nursing diagnosis. Generally, pain can be defined as the distressful, unpleasant and uncomfortable feeling that affects the quality of a person's life especially if it's unrelieved. Unrelieved pain may cause both physical and emotional effects, affect families and increase health care costs on the individual and society. Consequently, pain has become the most serious problem in the health care industry and a significant interest of many philosophers. This has led to paradox of thoughts that pain is a condition that we perceive in the body just like all the other feelings as well as thoughts that it's not.

In the last three decades, nursing researchers have conducted studies on children's pain including pain measurement, experiences and results. Additionally, these researchers have also conducted recent studies on pain which have noted that pain may not be completely managed even with the most advanced technologies and pharmacologic therapies. As discovered, all the efforts of nursing researchers cannot relieve pain completely and many people including children will continue to suffer. The reason for this continuous suffering and failure to completely relieve pain is due to the lack of adequate knowledge on pain management. The other reason for this could be the need to broaden the understanding of the concept of pain which will help in defining the attributes of pain. Expanding the understanding of the concept of pain will also help in discovering antecedents that influence the discernment of pain and the probable consequences of pain.

Common-sense Conception of Pain:

The common-sense conception of pain has two threads that have led to development of a paradox because they are parallel. These two threads are & #8230;

Pain as Bodily Location:

This is the first thread in the common-sense conception of pain that manifests itself in typical ways of attributing pain to bodily parts. Attributing of pain to bodily parts in this thread is through several statements like having a throbbing pain in a person's thigh and having a sharp pain in the back. According to this thread, pain is usually considered as a physical object or definite conditions of a physical object (Aydede, 2009). The use of this thread in the common-sense conception of pain is evident through the frequent use of the verbs "feel" and "experience" when referring to pain. Consequently, this thread of the common-sense conception of pain suggests that people understand pain as objects of their perception because their attention and nursing behavior is normally directed toward painful locations in the body.

Pain as Subjective Experience:

The second thread in the common-sense conception of pain is that pain is a subjective experience, a conception that appears to be true. While this thread seems to be the more dominant of the two threads, it treats pain as perceptual experiences themselves rather than objects of perceptual experiences. The dominance of this thread emanates from the fact that the scientific definition of pain was picked up from it and is generally accepted by the scientific community. According to this thread, pain is considered as an unpleasant feeling and emotional experience that is linked with real or probable tissue damage. Furthermore, this thread suggests that pain is normally described in terms of the real or probable tissue damage. Given that pain is normally subjective, experiences that look like pain such as pricking should not be called pain. Pain also appears to be subjective because of the fact that it's a functional kind of sensation rather than a phenomenal kind (Pagin, n.d.).

Nature of Pain:

The general and most commonly used name for pain is hurt with both of these words being used interchangeably in the health care system to describe how a patient feels. These words are also commonly used to describe painful conditions that are results of exposure to abnormal conditions which affect the body or feelings of unease. The nature of pain is further understood as the unexpected sensation of an unusual stimulus that a person's body is yet to adapt to. However, if a person's body adapts gradually to the sensation of an unusual stimulus, the result would not be the feeling of pain. Pain is also explained as the opposite of feeling pleasant because pleasure is the feeling of a matching stimulus while pain is the feeling of incongruity. While the other four senses can produce the feeling of pain, the most common sense that is associated with the strongest feeling of pain is the sense of touch.

In the health care system, all illnesses and feelings of pain are usually as a result of the imbalance of four bodily liquids which are blood, black bile, yellow bile and phlegm. While the balance of these four liquids results in feelings of pleasure, the interruption of their continuity results in pain. For bodily organs to cause pain, stimuli must interrupt the nature of these organs which is caused by the imbalance of the four liquids. In understanding the nature of pain, the anatomy of the brain plays an important role in pain sensation because the brain is considered as the main organ for the perception of pain. Many bodily tissues have specialized or tissue injury receptors which results in the sensation of pain in the brain when they are activated.

In the perception of pain, bodily organs can either be sensitive or non-sensitive with the sensitive ones producing pain sensation when stimulated while the non-sensitive ones transmitting other sensations with no pain. There are three conditions for pain perception which are the organ receiving the sensation, a connecting vessel and an organizational centre. These various types of pain include itching, breaking, penetrating, coarse, compressing, stretching, pricking, pulsating, numbing, fatigue, stabbing, disintegrating, soft, heavy and bitter pains (Tashani & Johnson, 2010).

Theories of Pain:

There are four major theoretical perspectives of pain which discusses pain namely specificity, pattern, gate control and psychological/behavioral theories. In defining pain based on these theoretical perspectives, there is an agreement that pain involves psychological stimulus. This is regardless of the fact that the existence of a psychological stimulus doesn't determine the resultant pain behavior in an individual.

According to the specificity theory, the human body has a separate sensory system for the perception of pain just like the separate systems for hearing and vision. This system has specialized receptors for identifying pain stimuli, specialized peripheral nerves and passageway to the brain. While this theory also states that the brain has its own area for processing pain signals, it's not a correct structure. On the other hand, the pattern theory suggests that there is no separate system for the perception of pain and that pain receptors are shared with other senses. According to this theory, people feel pain when there is an occurrence of specific patterns of neural activity. The certain patterns of neural activity that result in pain occur only under intense stimulation like being hit hard.

The psychological/behavioral theory of pain stresses on the importance of knowing the role of learning, culture and personality. Additionally, this theory emphasizes on the knowledge of the psychological, behavioral, emotional and environmental factors in relation to pain. In this theory, pain is perceived as knowledge from the respondent and operant conditions. While the respondent condition suggests that pain is brought out by an antecedent stimulus, the operant condition suggests that pain is experiences as a response to environmental signals. To view pain as a complete concept, the behavioral, psychological, emotional, cultural and environmental factors should be considered.

The most commonly used theory of pain in the professional field is the Gate Control Theory (GCT) which was developed from the specificity and pattern theories. According to the Gate Control Theory, pain stimulation is usually done by small, slow fibers which enter the dorsal horn of the spinal cord. After these fibers which are known as T-cells have entered the spinal cord, other cells pass on the impulses from the spinal cord to the brain. Once in the dorsal cord of the spinal cord, the T-cells can have an effect on the smaller fibers that contain the pain stimulation. While they can restrain the communication of stimulation is some cases, they can also permit stimulation to be communicated into the central nervous system in other cases. Given that large fibers can hinder small fibers from communicating with the brain, they in turn create an imaginary gate that either opens or closes the pain stimulation system.

Furthermore, the theory suggests that the hypothetical can sometimes be overwhelmed by a huge number of small activated fibers. When the pain stimulation level is greater, the gate will be less adequate in preventing the communication of pain stimulation. The opening and closing of this hypothetical gate is influenced by three factors which are the sum total of activity in the pain fibers, the total activity in other peripheral fibers and messages that fall from the brain. According to this theory, it can be concluded that a person's experience of pain is based on the condition of the hypothetical theory. The gate can both be opened and closed through physical, emotional and behavioral factors of an individual ("Types and Theories of Pain," 2006).

Defining Attributes:

The process of defining attributes involves listing the characteristics that are linked with a concept with each concept analysis consisting more that a single defining attribute. While any concept analysis will contain more than one defining attribute, it's important to identify attributes that are suitable for the exploration of the concept. Based on this important principle in concept analysis, the critical attributes in understanding the concept of pain include distressful and unpleasant experiences derived from physical feelings with positive and negative meanings. Other attributes include a personal human experience, a condition of feeling in emotion and sensation as well as the physical and psychological reactions to stimulus.

Model Case:

Based on the fact that a model case should include and illustrate all the attributes of the concept, the following example presents a model case for this concept.

Mr. T is a 35-year-old single American male who was diagnosed with colon cancer a couple of years ago. As he underwent a medical check-up recently, it was discovered that his tumor had enlarged and was therefore advised to undergo a surgical operation by his doctor. As a nursing student, I assigned to take care of him when he was hospitalized for the surgical operation to remove the tumor. In one of the occasions when I went to his bed, I found him lying on his right side with his arms close to his chest, wrinkled eyebrows and looked very tired. Even though he was very cooperative in our conversation, he closed his eyes for most of the time.

Given that his blood pressure and heart rate were slightly high, Mr. T told me about the pain he experienced in his lower left abdominal area. Two hours later after I had given him medication; Mr. T felt better and told me about how he was diagnosed with colon cancer several years ago after he experienced similar pains. Furthermore, Mr. T lamented about the bad genes of his family since his father and brother died of lung cancer and leukemia respectively. In conclusion, he explained to me how he had accepted his fate was grateful that he wasn't married because his present situation would have been a burden to his wife and children.

Analysis:

Mr. T's situation illustrates all the attributes of pain that had been explained earlier because he complained of being in pain and exhibited the defensive position and facial expression of pain. Through his behavioral and verbal expressions, Mr. T showed his pain as a distressful and unpleasant experience that he was going through. The sign of psychological reactions to pain is also evident in Mr. T's case because of the presence of the avoidance learning response. Given that colon cancer is an illness that requires surgery, it indicates the possibility of physical tissue damage from the stimulus. After experiencing similar abdominal pains with blood stool several years ago, Mr. T received warning signs of the illness and went to hospital for check-up where he was diagnosed with colon cancer.

The social and cultural dimensions of pain in this case are also evident from Mr. T's reactions to the bad genes in his family. However, Mr. T felt relieved of his pain from the fact that he was not married and would create a burden for his family. This demonstrates the fact that pain is a physical feeling with both positive and negative meanings. In conclusion, Mr. T seems to accept his illness and fate because of his learned responses to pain. These reactions may be influenced by his personality, previous experience as well as the social, cultural and environmental factors.

Borderline Case:

Given that a borderline case is one of the cases used in clarifying the concept of the model case, it contains some similar attributes of the main concept. However, this case does not necessarily contain all the attributes of the main concept though it may consist of majority of the criteria. In the concept analysis of pain, the following example is a borderline case.

Mr. X was diagnosed with lung cancer whose cells had metastasized to the lymph nodes that were close to the primary tumor. While taking care of him, I always found him holding a cross and praying while lying on his bed. Furthermore, Mr. X would always spend some considerable amount of time praying with his family whenever they visited him. Given that patients with cancer cells that had metastasized to the bone were always in pain and asked for medication, I was curious because Mr. X always said that he was fine. He always refused to admit that he was in pain citing his faith in God's son whose suffering couldn't be compared to his. While he never answered my question on whether he was in pain, he died a few days later.

Analysis:

While this case doesn't represent all the significant attributes of pain, it relates to the concept of pain since Mr. X's behavioral signals of pain are evident though he never admitted his pain verbally. Mr. X's responses to pain were mainly influenced by his family social pattern and religious factors more than any other factor.

Contrary Case:

Given that a contrary case is a model that doesn't present the main concept; the following example is a contrary case in the analysis of the concept of pain.

Mrs. R brought her four-year-old son for a routine medical check-up after last month's polio immunization. Upon her arrival to the hospital, Mrs. R's son saw the nurses and held his mother very tightly while not allowing her to put him down. He started crying while shouting that he didn't want come to the hospital and preferred to go home. Even though one of the nurses tried to explain to him what she will do, he continued crying while stating that he wanted to go home.

Analysis:

While this example may be linked with pain because the son had been to the hospital before and had memories of the pain he experienced during polio immunization, a closer examination reveals that it presents the concept of fear. Consequently, the example doesn't consist of the defining attributes of pain since the child wasn't experiencing any pain.