Culture influences all the many aspects of our dialy lifes. Our perceptions, emotions, belief systems and behaviors are all defined buy the culture we embrace. Our cultural influences along with our religion, gender, family structure,social organisation, and relationships define our relationship to the world. All these also define how we deal with pain.
How patients perceive and react to pain is culture-bound, the result of family “lessons, past occurences, and their personal meaning of their pain experience.With the increase in America’s cultural diversity and JCAHO standards that equate assessment and management of pain as a patient’s right, nurses face a challenge with pain relief.
“Culture means shared life ways” D. Pacquiao R.N. “Culture is the framework that directs human behavior in a given situation. The meaning and expression of pain are influenced by people’s cultural background.”
For some Hindu’s, pain must be endured. It is part of preparing for a better life in the next cycle. The devout Hindu who sense iminent death prepares for a ‘good death by remaining conscious in order to experience the events to come.
Many Jewish people voice their pain openly as pain must be shared, recognized, and validated by others. Jewish patients intense complaining doesn’t necessarily mean intense pain. Rather it may relate for the need for other’s to listen and validate.
Not every culture conforms to an expected set of behaviors. For Hispanic’s the expression of pain vary widely. Some are stoic and slow to express distress. Other’s are expressive and will share their smallest discomfort. (V.Pacquiao R.N.2008 )
African Americans report the same number of discomforts as others yet their experience of pain differs. They report higher pain intensity, they experienced pain longer, and that pain has a more significant impact on their lives. (A.Horgas R.N.2008 ) “The different impact of pain for African Americans may be a manifestation of disparities in the health care system, which has historically provided limited access to healthcare for many minority patients”
Black patients with broken arms or legs were less likely to be given painkillers in an Atlanta emergency room than white patients. (NY Times 1-29-09)
“Nurses interpret pain behavior through their own cultural lens and often make culturally learned judgments” S. Salimbene R.N.
Listen and probe carefully to find out what is really happening with each patient’s pain.
Review your patient’s cultural profile on communication.
Be familiar with the most common patient related barriers to pain management. (Lasch 2000)
Fatalism, fear of addiction, fear of tolerance, concerns of side effects, the need to be a ‘good patient’ (not complaining).
Find out what your patient wants.
Be a good listener.
Learn the core values of many cultures.
Show respect in all cares.
Establish a strong trust.
Be culturally competent.
Respect economic factors.
Adjust for language challenges.
Understand gender issues.
Be aware of your own cultural and family values.
Look at your own personal biases and assumptions.
Pain is unique for everyone.
Offer educational Materials.
Provide an open environment.
Use pain assessment tools.
Adapt to diversity.
By Jennifer Matanky R.N.
Jennifer has been relishing the art of nursing for over 12 years.