Pain is an agonizing experience that is felt by almost everyone. The term “pain” is commonly used in health care and in nursing practice. As nurses, we adhere to the five stages of the nursing process when it comes to patient care which includes assessing, diagnosing, planning, implementing, and evaluating. Pain assessment and evaluation is critical in nursing because pain interferes with the patients emotional and physical functioning, which in turn affects the patient’s wellbeing. Nurses encounter pain complaints be it verbal or nonverbal in the healthcare setting. Analyzing and treating pain is complex because every patient pain tolerance is different.
The goal is to provide pain management interventions that improve the patient’s quality of life while implementing evidence-based guidelines. When it comes to pain, advanced nurses need to understand what pain signifies before coming up with pain management interventions. The basis of this concept analysis of the term pain is to bring transparency to the meaning of pain by examining the diverse ways that it’s employed in health care. By clarifying what pain means and how the term is used in healthcare, advanced nurses can be able to successfully understand the concept of pain.
Crucial attributes of the term are going to be determined accompanied by example cases. Antecedents and consequences will then be concluded followed by an operational definition of the term pain that incorporates crucial attributes. Uses of Concept Pain has been described in a variety of ways by various sources.
According to the Cambridge English Dictionary (2018), pain is “a bad or unpleasant physical feeling, often caused by injury or illness, that you want to stop, or an emotional feeling.” Mosby’s Dictionary of Medicine, Nursing & Health Professions (2009) defines pain as “an unpleasant sensation caused by noxious stimulation of the sensory nerve ending.” Pain is also “whatever the experiencing person says it is, existing whenever the experiencing person says it does” (McCaffery, 1968).
When a patient states that they are in pain, pain can serve as a positive term that indicates an illness is imminent which is a positive warning sign, for instance, a sharp pain on the chest can be a warning sign for a heart attack. According to the International Association for the Study of Pain (IASP), pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of tissue damage.” Pain can be used as a negative term because it causes patients to have an unpleasant feeling that worsens illness.
Characteristics of concepts that appear over and over are called critical attributes (Walker & Avant, 1995). Critical attributes of pain include discomfort, aching, physiological and psychological responses, and verbal and behavioral factors. Patients dealing with pain view pain experience as a phenomenon that causes discomfort and suffering based on the assessment. Physiological responses of pain include increased heart and breathing, sweating and changes in blood pressure, on the other hand, psychological responses include anxiety, fear, and worry. The patient can verbally describe the pain and behavior indicators include facial expressions such as moaning and grimacing.
According to (Walker & Avant, 1995), a model case is “a ‘real life’ example of the use of the concept that includes all the critical attributes of the concept” The following is a model case for the concept of pain. Mrs. Jones is a 70-year-old female who was admitted to the Emergency Department after a fall. She was later diagnosed with a hip fracture and had to undergo hip surgery. Mrs. Jones was transferred to my unit for recovery and pain management.
During assessment, she was moaning and complaining of pain and described the pain as an “aching feeling that is causing discomfort.” While assessing her vital signs, she had a rapid heart rate and breathing. Mrs. Jones also requested for a cold washcloth to be put on her forehead because she was sweating. She later stated that she was anxious and feared that her pain was only getting worse. Pain medication was administered, and she expressed relief. This model case includes all the critical attributes of pain presented above.
Walker and Avant (1995) describe borderline cases as “cases that contain some of the critical attributes of the concept being examined but not all of them.” The following is an example of a borderline case for the concept of pain. Mr. Chinn is a 75-year-old male who was admitted to my unit following knee surgery due to osteoarthritis. During assessment, the patient complained of mild pain and described the pain as a discomfort. The patient’s vital signs were stable, and the patient was calm and resting. This Borderline case shows discomfort as the only critical attribute of pain.
Identifying Antecedents and Consequences
According to (Walker & Avant,1995), antecedents are the “events or incidents that must occur prior to the occurrence of the concept.” Both cases presented above show that a fall and osteoarthritis a joint illness are contributing factors that occurred prior to pain. On the other hand, consequences are “those events or incidents that occur as a result of the occurrence of the concept” (Walker & Avant, 1995,). Consequences of pain include the patient’s reaction and interpretation of pain.
Patients react to pain differently, for example, the patient may complain of mild, moderate to severe pain. On the other hand, pain interpretation determines the patient’s wellbeing, for instance, having a negative interpretation of pain can cause negative effects while having a positive interpretation of pain can yield positive effects. Empirical Referents Empirical referents are “classes or categories of actual phenomena that by their existence or presence demonstrate the occurrence of the concept itself” (Walker & Avant, 1995).
Empirical referent of pain would be a patient’s verbal description of pain, for instance, aching, throbbing or shooting. Several tools have been developed to measure the patient’s pain level such as visual analogue scale, numerical rating scale, and verbal rating scale. Assessing the patient can also determine the quality of pain which include observing the patient’s behavior when in pain such as moaning and grimace. The patient’s verbal description of pain and observing the patient’s behavior is the best determinant of pain.
In summary, the concept of pain was chosen for concept analysis to bring more clarity to the term pain. Pain is a serious problem globally and has been considered as a health problem. Through evidence-based research and literature, nurses have been able to show that unrelieved pain affects the patient’s health. What is very important for advanced practice nurses to take from this analysis is that patients experience pain differently and that the best way to assess pain is through subjective data and the patient’s behavior when in pain. Pain management is an ongoing process and the concept analysis of pain help advanced nurses get a better understanding of the term pain.
- Cambridge Dictionary Online. (2018). In Pain. Retrieved September 29, 2018, from https://dictionary.cambridge.org/dictionary/english/pain
- Haefeli, M., & Elferin, A. (2005). Pain assessment. US National Library of Medicine National Institute of Health, 15, 17-24. doi:10.1007/s00586-005-1044-x
- International Association for the Study of Pain. (2017, December 14). Pain Terms. Retrieved September 29, 2018, from http://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698#Pain
- McCaffery, M. (1968). Nursing practice theories related to cognition, bodily pain, and man- environment interactions. Los Angeles: University of California at Los Angeles Students’ Store.
- Mosby, Inc. (2009). Mosby’s Dictionary of Medicine, Nursing & Health professions. St. Louis, Mo: Mosby/Elsevier.