Dealing With A Patient Experiencing Physical Pain Nursing Essay
Using the literature from health psychology and sociology to provide a rational, explain what you should consider when attending a patient who is experiencing pain.
Pain is defined as 'an unpleasant feeling caused by injury or disease' and 'suffering in the mind' (Oxford Mini School Dictionary). There are many types of pain and there are different things to consider when attending a patient with each of these different types. These different types are emotional, spiritual and social pain but the most common type of pain that a healthcare practitioner will have to deal with is physical pain.
When dealing with a patient who is experiencing physical pain the first priority should be to find out whether that pain is being caused by a problem which can be treated at that time. Treating the source of the pain will be an effective long term solution but if this is not possible the healthcare practitioner must consider relieving the pain itself. This can be done through the use of painkilling drugs such as paracetamol or, for more severe pain, morphine (UK Ambulance Service Clinical Practice Guidelines 2006).
Physical pain can be either acute or chronic. Acute pain is defined as 'a pain of a rapid onset and short duration' (Carrol & Bowsher 1995). Acute pain can be seen as a warning since it alerts a person to a problem that may not have otherwise been noticed. For example, an internal injury could go unnoticed and deteriorate over a long period if it was not for the acute pain alerting the patient to it. Once a problem has been noticed the pain is no longer any use to the patient and can in fact have detrimental effects on them (e.g. increased heart rate) (Carrol & Bowsher 1995). It is therefore vital that healthcare practitioners manage the pain appropriately.
One thing that should be considered when attending a patient with acute pain is the patient may not have experienced pain like this in the past and it may therefore be far above their pain threshold. A study carried out on soldiers showed the vast differences in pain threshold that are found between different people. He found that when civilians and soldiers had similar injuries, the civilians requested far more pain relief than the soldiers (Carr & Goudas). This shows that different people will need differing levels of pain relief for the same injury which is why the pain threshold is something to be considered when treating a patient with acute pain.
When attending to patients who are experiencing chronic pain there are many different issues to be considered. The word chronic is defined as something which is continuing for a long time or recurring frequently (dictionary.com). The fact that a patient has had their condition and has been in pain for a long period of time means that, unlike patients with acute pain, they are likely to have quite a high tolerance to pain. This tolerance means that they are less likely to express their pain which could lead to them not getting the amount of pain relief they need.
Another consideration when attending a patient with chronic pain is what pain relief to give them. It is likely that the patient is on medication to help with their ongoing condition and this medication could interfere with the pain relieving drugs that the practitioner wants to administer.
A practitioner should consider measuring the severity of pain that a patient is experiencing and one way of doing this is to use a pain scoring system. For adults asking them to score their pain from 1 to 10 is appropriate but in children and some mentally impaired adults it is better to use the Wong and Baker faces. They are a line of different expressions ranging from happy to sad and the child is asked to point at the one which best matches the pain that they are feeling (UK Ambulance Service Clinical Practice Guidelines Pocket Book 2006). Asking the patient to do this before and after the treatment allows the practitioner to see how effective their attempts to relieve the pain are. The practitioner could consider using the same scoring systems to find out if the pain has got better or worse since it first began. Further questions could be about how the pain feels (stabbing, dull, etc.) and if it radiates since the answers to these could help with a diagnosis.
The gender of a patient can alter the way in which they perceive pain. Studies have shown that men have higher pain tolerances than women. This difference could be attributed to social factors such as the need for males to show their masculinity. They would therefore try to show a higher tolerance to pain than they actually have in order to live up to what they perceive as society's expectations (Forshaw, 2002). This should be considered when attending patients in pain since males may be reporting less pain than they are actually experiencing.
In some cases the reported site of the patient's pain may not be it's source. The practitioner must consider the possibility of referred pain. Referred pain is when pain is presented in an area other than its source. For example, a pain in the patient's shoulder can indicate a problem with the gall bladder (Caroline, 2008). This is important for a practitioner to know since they could spend all their time focusing on an area which is completely fine.
Practitioners should consider the possibility that the pain that their patient is experiencing is being caused or intensified by an underlying, perhaps undiagnosed, psychological problem such as depression. Psychological problems such as depression can lead to hypocondriacal delusions which means that it is unlikely that medical practitioners would be able to relieve the patient of their pain. Patients with this condition would need to be referred to a psychiatrist (Diamond & Coniam, 1997).
Another psychological problem which should be considered by a practitioner is stress. Stress is defined as "Any interference that disturbs a person's mental and physical wellbeing" (The British Medical Association). Many physical illnesses can be caused by stress and these physical illnesses could be the cause of a patient's pain. Stress can cause problems such as indigestion and muscular pains which, in turn, cause a patient to experience pain (The British Medical Association). The practitioner could consider administering pain relief to the patient for short term benefit but for a long term solution the patient should be referred to a stress specialist who could teach them techniques to control their stress and, in turn, relieve their pain.
The pain a patient is experiencing may not be physical. There are other types of pain that a person can endure, one of which is social. Social pain could be defined as the feelings caused by social estrangement, for example, after a relationship has ended. Eisenberger & Lieberman believe that the neurological system which alerts a person to a physical injury by using pain as a signal also deals with social pain. The same system is alerted to the social problem and reacts in the same way as it would for a physical injury, i.e. by causing pain (Eisenberger & Lieberman). When a practitioner is attending a patient who is experiencing social pain they should consider reassuring them that they are capable of overcoming their pain.
Another type of pain that a patient could be experiencing is spiritual. When dealing with people who are experiencing spiritual pain it is important for a practitioner to consider the risk of the patient committing suicide. It has been found that patients with spiritual pain are more likely to consider or attempt suicide (McGrath 2003). This is because they can no longer see any meaning to their life. Spiritual pain is often associated with patients who have had strokes or who have diseases such as cancer (McGrath 2003). Practitioners must also consider the emotional state of a patient who is suffering with spiritual pain since studies have shown that they feel angry and frustrated because they believe that what is happening to them is wrong and unfair (McGrath 2003). Although this is an understandable reaction to their circumstances, it could cause difficulties for the healthcare practitioner who is attending to them.
It is clear to see that there are many things for a healthcare practitioner to consider when attending a patient who is experiencing pain. They must think about the medical reasons for the pain and how they can use their medical expertise to treat them. They should be looking for a cause for the pain which, if treated, could alleviate the pain without having to administer pain relief. They must think about the differences between chronic and acute pain sufferers and how they should be treated. Finally they must consider the type of pain that the patient is experiencing, whether it is physical, social, spiritual or psychological and what they can do to help the patient in each case. But the main consideration of the practitioner should be, if at all possible, to relieve the patient of the pain that they are suffering.
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