Concept analysis is a form of research that allows a person to explore a theory/ concept to the fullest degree in an organized way. This concept analysis will take Walker & Avant’s steps to form a better understanding into pain. The steps include: selection on concept (pain), Aims or purposes, literature on the pain, concept uses, determine defining attributes, model cases, alternative cases, identify antecedents and consequences, and empirical referents. Aims or Purposes of Pain Analysis Patient occurs in every person in some form.
An understanding of what pain is and how to treat and assess it will allow the patients and nurses to achieve a better outcome. With an understanding of the concept of pain and how it affects the care nurses give then the better the patients’ outcomes. Working on a surgical unit I am faced with pain daily and learning how to assess it allows me to understand each patient’s views of pain. I can be faced with two patients with the same surgery, but the pain scale totally different. “All pain is Real and Pain is what the patient says it is” (McCaffery, 2002).
The Purpose of this analysis of pain is to take the Walker & Avant steps to unfold what pain is. Literature On Pain First one needs to define pain. Pain is as (a) the sensation which one feels when hurt (in body or mind); (b) suffering, distress, the opposite of pleasure; (c) in specifically physical and psychical senses: bodily suffering; mental suffering, trouble, grief, sorrow: (d) trouble as taken for the accomplishment of something difficult according to the Oxford English Dictionary (2013).
Pain can breakdown into four theories: specificity theory, pattern theory, gate control theory, and psychological/ behavioral theory. Specificity theory” proposed that injury activates specific pain receptors and fibres that, in turn, project pain impulses through a spinal pain pathway to a pain centre in the brain” (Melzach, 1996, p130). With the specificity theory many chronic back pain patient were diagnosis as psychologically disturbed not with pain. Out of the testing the specificity theory come the pattern theory which had multiple theories which mostly lead to the Gate control theory.
One of the pattern theories looked at all ‘cutaneous qualities are produced by spatiotemporal patterns of the nerve impulses rather than by separate modality-specific transmission” (Melzach & Wall, 1965, p973). Next came the Gateway control theory. The Gateway Control theory is a stimulation of the skin evokes nerve impulses that are transmitted to three spinal cord: cells in the substantia gelatinosa, dorsal-column fibers, and central transmission cells (Melzach & Wall, 1965, p974). This theory explains how pain can increase to a person.
If one of the three areas is triggered than the response aka pain increases. Finally we have the psychological/ behavioral theory. This theory looks at pain being a result of emotions, feelings, and mental behavioral no physical injury needed ( Turk & Okifuji, 2002). In this theory explains how pain can be expressed by feelings. There need not be injury, but looks at how someone thinking. Reviewing all the different literature, there is a clear point that I can make. It is that pain can be one or two: physical or psychological.
The other subtopics of pain like environment, social get fix into one of the top two. I feel that pain is felt different in each patient, and their bodies have chemical to let them know. Possible use of Pain Concept There are different uses of the pain concept in the medical field. First pain is an everyday experiences that is expressed through the use of language and is then legitimized (Waddie, 1996). If a patient as a history of depression or chronic pain they have pain every day and the concept is used to help explain their pain. As nurse we use the concept of pain to find base line of the pain and to assess new pain. In surgical patients they may have multiple types of pain from the incision, emotional, and history. The concept educates the nurse of the different form that pain can present itself. Pain can also guide how we treat the patient. Emotional pain would not be treated with the “so know pain pills”, but with talking or listening to patient. Concept of pain also address the different form of patient and how the nurse and patient response to it. If a patient is having somatic pain from an incision the nurse could react by applying heat or ice.
Pain is what the patient says it is. Defining Attributes Defining attributes is to list the characteristics that are associated with a concept. According to Walker & Avant, concept analysis needs to consist of more than one defining attribute: however determine the attributes that are appropriate for the purpose of exploration of the concept (1995). With this principle in place, the attributes of pain are: physical and psychological responses to the stimulus, and unpleasant and distressful experiences originating from physical sensation and having both positive and negative meaning to the individual.
When looking at the first attribute of physical and psychological responses to the stimulus, studies show that patients with pain score three or less to function well in their recovery and have a better mood (McCaffery, 2002). In the second attribute, an unpleasant and distressful experience from a physical sensation and having both positive and negative meaning to the individual, can relate to postoperative patients. Turn, cough and deep breathe causes both positive and negative pain to the patient.
Post-surgical patients have positive pain when they are decrease postoperative complications like PE and pneumonia by turn, cough, and deep breathing. The negative side is that the patients increase their surgical pain may adding pressure to it (Al-Jurf, 1979). Model Cases Model cases need to include all for the attribute listed in the analysis of pain. An example could be a 35 years old women admitted with a bowel obstruction followed by a laparoscopic colon resection with ostomy placement. Patients reported no history of surgeries, no bowel history, no chronic pain, and no home medications.
Patient follows no special diet. When admitted to the surgical unit she was sad, scared, and in increase pain. Physically the patient presented with tears in eyes, high blood pressure of 167/99, holding abdomen, and would not look at the nurse. As the nurse, I gave pain medication and explained that I would do as much as I could to help make her comfortable. See refused to look at me. Later that day, when taking care of the ostomy she turned away and told me “Now I am ugly and everyone with look at me like I am crazy”.
As the nurse I ensure her no one will know unless she wanted them to. I showed her to dress cover up the ostomy. I also told her that the ostomy was just here for three months to give her bowels a time to heal and then she will be back to take it down. This story was able to show both attributes of pain. A first, physical and psychological response to the stimulus was the pain forms the incision and ostomy (physical) and psychological to the body change she faced with. Both are a form of pain.
Next, in the second attribute, an unpleasant and distressful experience from a physical sensation and having both positive and negative meaning to the individual, the ostomy care was painful physically in the fact that I had to give pain medication this was negative, but on the other hand the pain allow her to learn a new way to cover her ostomy so others would not know she had it (positive). In a study by Lawrentschuk, Pritchard, Hewitt, and Campbell, they researched the pain in two groups of patients: group one surgery patients with same size dressing and group two with double dressings (2003).
The patients were asked pain level 12 and 24 hour post-surgery, pain dimension, pain intensity, and post-surgical analgesia (simple oral and Morphine). The results showed that patients described pain as physical pain and emotional stress. Most patient in the end marked that the pain was hard to handle, but got better each day. This study relates the two attributes of pain by the physical pain form the surgery and the psychology pain as the emotional stress. Plus the patient agreed that the pain they had was positive and negative because it hurt in the beginning but got better. Alternate cases
When looking at pain I can think of children in regard to contrary cases of pain. In Cheng, Foster, and Huany concept analysis of pain, story of a child going to the clinic of hepatitis B shot. Next the mother later brought her back for a well visit and the child would not let the mother go “held her mother tightly with her eyes closed” (Cheng, Foster, & Huany, 2003, p25). The moment the nurse walked into room the child cried and wanted to go home. This was not pain but fear therefore it is contrary cases of pain. In borderline cases same critical attributes of the concept are present not all of them.
In different cultures and ethnicity it is hard to assess pain and the concept of pain may be borderline. In Sheiner, Sheiner, Shoham-Vardi, Mazor, and Katz, Articles talk about how different ethnic groups react to pain and how the nursing team needs to assess for pain. The study looked at Jewish and Bedouin women in labor. The Bedouin women would report to staff that pain was ok, but the staff evaluate physical signs of pain like tears, holding abdomens, and balling up in bed (Sheiner, Sheiner, Shoham-Vardi, Mazor, and Katz, 1999).
The Bedouin women showed some parts of the concept of pain by physical expression, but also not showing pain by saying that the pain was ok. Antecedent and Consequences When looking at the concept of pain one needs to evaluate the patient’s culture. Antecedents are the events or incidents that happen before the existing concept (Walker & Avant, 1995). One can take the study from Sheiner, Sheiner, Shoham-Vardi, Mazor & Katz on the Bedouin women. In this culture the women are not to ask or request pain invention. It is part of their culture to handle what the body gives them.
During labor the patient is in pain, but before they get there, there is already an understanding that pain is to be handle without medications or asking for help (Sheiner, Sheiner, Shoham-Vardi, Mazor & Katz, 1999). According to Walker and Avant, consequences are events or incident that happen as result of the concept (1995). This can be seen in surgical patients. Before we patient goes to surgery we ask them what they think their pain should be on the scale 0-10. Pain is a reaction to an individual’s own interpretation of the meaning. If a patient states pain is a 5, a 5 may be interpreted different for another patient.
A patient may state pain will be higher or just always give the same number for pain. The request for pain medications is consequence of the concept of pain. Empirical Referents Due to pain being different in each patient the best way to evaluate it is by patient’s own verbalization. There are different pain charts and scale made to make assessing patient pain easier. The nurse needs to know which tool is best for the patient. In “Teaching your patient to use a pain rating scale”, it is important to educate on how to use the scale and what you mean by pain (McCaffery , 2002).
Pain is different in each patient, therefor the scale needs to be explained that pain is what the patient says it is. The McGill Pain Questionnaire is the most preferred tool. In some patients that are unable to give a number of pain, like children, confused, and behavioral reasons, an assessment of the nonverbal cues are used. Assess for crying, restlessness, and avoiding moving (McCaffery, 2002). Conclusion During the concept analysis steps I found that pain is not clear cut way to assess by patient’s pain. There is more involved in what pain is and how patients may represent pain.
As a nurse working on the floor we forget that pain is indeed what the patient says it is not what we think it is. Pain can be explained as four different theories: specificity theory, pattern theory, gate control theory, and psychological/ behavioral theory. Each theory as it’s only view and could fix to express a patient’s pain. Pain contains many different attributes in this paper I forced on the physical and psychological responses to the stimulus, and unpleasant and distressful experiences originating from physical sensation and having both positive and negative meaning to the individual.
I learned that pain can represent itself in different ways; from an incision causing pain to emotional pain from a new ostomy. Model cases will represent the concept in all it’s glory. The model case will show all of the attribute present in the case. Next, there can be cases that may not have all or none of the attributes present. In borderline cases, there is a gray line between pain concept and not. There are some attributes but not all of them. In the contrary cases, none of the attributes are present. The end product is that pain is important to assess and to take notice of in all patients.
Remember that pain is what the patient says it is. References Al-Jurf, A. (1979). Turn, Cough and Deep breathe. Surgery, Gynecology & Obstetrics. 149(6), p 887-888. Cheng, S. , Foster, R. & Huang, C. (2003). Concept Analysis of Pain. Tzu Chi Nursing Journal, 2(3), p20-30. Retrieved from http://www. docstoc. com/docs/94932886/Concept-Analysis-of-Pain. Sheiner, E. , Sheiner, E. , Shoham-Vardi, I, Mazor, M. , & Katz, M. (1999). Ethnic differences influence care giver’s estimates of pain during labour. Pain. 81(3), p299-305.
Retrieved from http://www. sciencedirect. com/science/article/pii/S0304395999000196. Lawrentschuk, N. , Pritchard, M. , Hewitt, P. , & Campbell, C. (2003). Dressing Size and Pain : A Prospective Trail. ANZ Journal of Surgery. 73(4), p 217-219. McCaffery, M. (2002). Teaching your patient to use a pain rating scale. Nursing, 32(8). Melzach, R. (1996). Gate control theory: on the evolution of pain concepts. Journal of the American Pain Society. 5, p 128-138. Melzach, R. & Wall, P. (1965). Pain mechanism: A New Theory. Science, New Series. 50(3699), p 971-979. Oxford University Press. (2013). Pain. Oxford Dictionaries. Retrieved from http://oxforddictionaries. com/us/definition/american_english/pain? q=pain. Turk, D. & Okifuji, A. (2002). Psychological Factors in Chronic Pain: Evolution and Revolution. Journal of Consulting and clinical Psychology. 70(3), p 678-690. Waddie, N. (1996). Pain, anxiety, and powerlessness. Journal of Advanced Nursing. 16, p 388-397. Walker, L, & Avant, K. (1995). Strategies for theory construction in nursing (3rd ed. ). Norwalk, Ct: Appleton & Lange.