Chinese Describe different natures of pain (physical,

Chinese Culture and PainPerception The purpose of this paper is to explore theeffects of the Chinese culture on pain perception, responses and management.

 Cultural backgrounds can have a significantrole in how a person perceives and copes with their pain, many studies haveidentified the vast difference between cultures.  “Culture shapesmany aspects of the experience of pain, including pain expression, layremedies, social roles, expectations, perceptions of the medical system,when/how/where to seek care, healthcare practices, illness beliefs andbehaviors, and receptivity to medical care interventions” (Campbell, 2012)Describe different natures of pain (physical,emotional)As stated by Potter, Perry,Stockert, Hall and Peterson (2014):Pain is much more than a physical sensation caused by aspecific stimulus.  An individual’sperception of pain has important affective (emotional), cognitive,behavioral, and sensory components that are shaped by past experience, culture,and situational factors.  The nature ofthe stimulus for pain can be physical, psychological, or a combination of both.(p. 141)As stated above, the differentnatures of pain are dealt with differently depending on many factors and knowingthis, I believe treating pain can be very difficult as there is no single or clear-cutway of measuring it.  “Even though theassessment and treatment of pain is a universally important health care issue,modern medicine still has no accurate way of measuring it.

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”  (Carteret, 2017) For example, two people fromdifferent ethnic backgrounds can undergo the exact same surgery or trauma and maycope with and articulate their pain in very different manors.  Pain can also be a very emotionally taxingexperience for some; “Pain is acomplex problem that is physical and/or mental in nature while being subjectiveand highly individualized.  It is tiringand demands a person’s physical, emotional, and mental energy.” (Perry, Potter, & Ostendorf,2014 p. 345)Describe the Relationship Between Ethnic Backgroundand PainMany factors contribute tothe way a person will deal with pain, their childhood, family life, teachingsfrom parents and guardians, religion and culture, to list a few. Carteret (2017) found thefollowing:Although nearly all people experience pain sensationssimilarly, studies show there are important differences in the way peopleexpress their pain and expect others to respond to their discomfort.

 There are also culturally-based attitudesabout using pain medication.  Anunderstanding of the impact of culture on the pain experience is important inassuring effective and culturally-sensitive patient care. (Carteret, 2017)The length of time thepatient from a different culture has been in Canada will also impact theircultural influence in dealing with pain and some original cultural habits maybe diluted in with Western, Canadian lifestyle and beliefs.As stated by Potter et al.,(2014):Some culturesare demonstrative about pain; others are introverted.  Your knowledge of the level of a patient’sassimilation into Canadian society may be helpful.  For example, if several generations of anAsian patient’s family have lived in Canada, the influence of the Asian culturemay be limited.

In contrast, a recent immigrant from another culture may havedifferent beliefs from those of the larger Canadian population. (p. 1026)As it can bevery difficult to assess how strong a person’s cultural influence is, I believewe must do our best to create a positive working relationship with our patients,build rapport and have open-ended conversations with our patients about anycultural standards we should be aware of.

 In my opinion, it is important we reassurethem that our goal is to help them return to the best possible status of holistichealth, while respecting and integrating any cultural beliefs as much as we areable.  Discuss ethnic differences in pain perception andpain responses. “Cultureshapes individuals’ responses, behaviours, and attitudes about pain, and howthey react to and cope with pain.  Peoplelearn what is expected and accepted by their culture. Some cultures aredemonstrative about pain; others are introverted.” (Potter et al., 2014, p.

143) As Carteret (2017) stated:Patients from Asian cultures may often exemplify stoicism inthe face of pain, which relates directly to strong cultural values aboutself-conduct.  Behaving in a dignifiedmanner is considered very important, and a person who is assertive or complainsopenly is considered to have poor social skills. (Carteret, 2017)As mentioned by Carteret(2017), those of the Asian decent often highly respect those who are educatedand have high social status, therefore they may refrain from outwardlyrevealing the severity of their pain in the presence of a health careprofessional.  “Asian societies havetraditionally emphasized status differences between people based on variablessuch as age, sex, education, and occupation.

 A doctor or nurse will most surely be seen asa person of high status, not to be questioned or bothered with complaints aboutdiscomfort.”  (Carteret, 2017) Manystudies have been done on how the various cultural backgrounds deal with pain,and although the information is valuable, we should always remember to refrainfrom generalizing patients based on their culture or religion.  For example, many people in the Chinese culturebelieve in the use of Chinese traditional herbs, but some may not, we shouldnever assume.  We must always ask abouteach person’s unique personal preferences.  “Rigid use of generalizations leads tocultural stereotyping which in turn can lead to serious inaccuracies.

” (Carteret,2017) Explain how a nurse’s own culture, personal bias,values and beliefs may alter the ?interpretation of patients’ pain experience. A nurses’ own culture, bias, values and beliefs can affecthis/her perception of a patient’s pain as the nurse may not acknowledge acertain type of pain as seriously as another culture would. Potter et al., (2014) foundthe following:”If a nurse believes that pain is to be bornequietly as a demonstration of strong moral character, that nurse may be annoyedby a patient’s insistence on being given pain medication and, in denying thepatient’s discomfort, may exacerbate the patient’s pain.”  (p. 111)If a patientis constantly complaining of pain a nurse may begin to doubt the true severityof the pain.  “There are many factorsthat influence clinicians’ tendencies to doubt patients’ reports of pain.

 It is important to acknowledge that theknowledge, attitudes, and preferences of health care providers, including yourown, will influence pain care decision making.”  (Potter et al., 2014, p. 1022) With that beingsaid, I strongly feel nurses need to be aware of our own beliefs and we mustremove our own feelings and opinions when providing patient care.

 As only the patient truly knows how much painthey are in and it is not our place to doubt them.  “Nurses are entitled to their personalbeliefs; however, they must accept the patient’s report of pain and actaccording to professional guidelines, standards, position statements, policiesand procedures, and evidence-informed research findings.” (Potter et al., 2014,p. 1023) What might some variations be in assessment of pain whencaring for the ethnic group you chose? What are the verbal cues? What are thenon-verbal cues? “The major concepts that influence Chinese patients’perspectives on cancer pain and its management include Taoism/energy, Buddhism,and Confucianism.”  (Chen, Miaskowski, Dodd, & Pantilat, 2008)Chen et al.

, (2008) found theConfucian beliefs include the following; A Confucian believes that pain is an essential element oflife, a “trial” or a “sacrifice.” Therefore, when a personsuffers with pain, he or she would rather endure the pain and not report it toa clinician until the pain becomes unbearable. (Chen, et al., 2008)Knowing this about theChinese culture tells us how important it will be to watch for non-verbal cuesthat they are experiencing pain.  If theywill not directly communicate their pain to us, we must observe for the cues.  Examples of verbal cues that the patient isexperiencing pain are as follows; “crying,moaning, or screaming.

” (Potter et al., 2014, p. 142)Non-verbal cues of pain include; “Facialexpressions, bracing, rocking, body stiffening, jaw clenching, grimacing,frowning.”  (Potter et al., 2014, p. 142)The patient may also show the following behavior and affect when experiencingpain; “Withdrawal, stoicism, fear,anxiety, anger, or feelings of hopelessness.

”  (Potter et al., 2014, p. 142) Another toolthat helps us understand a patient’s pain is understanding the 3 basic types ofpain: acute, chronic and pathology.  “Pain may be categorized by duration, such as acuteand chronic pain, or pathology, such as cancer pain and noncancer pain.”  (Potter et al., 2014, p. 1021) If we canidentify the type of pain and how long the patient has experienced it, it cangive us a head start on finding the best treatment for the pain.  I believe the main variance in assessing a Chinese patient’spain will be watching for non-verbal cues, and using our clinical knowledge andexperience to predict the severity of the pain.

Which pain assessment tool would you use? Why? “Pain assessment is the basis of all pain management and painis often referred to as the fifth vital sign.”  (Potter et al., 2014, p.

1026) There aredifferent approaches to assessing pain, commonly used is the pain scale, havingthe patient rate their pain from 0-10, I would start off with this basic tool, thensecondly, I would ask open ended questions to assess the level of impact thepain has on their activities of daily living, I would do this as I believe itwould provide insight on the true severity of the pain.  For example, if the patient has been unable toget out of bed since the onset of the pain, then I will know the pain is toohigh for normal daily functioning and is impacting their quality of life.  If the patient refrains from communicating howmuch pain they are in this maybe a good way of measuring it.

 I would also monitor their verbal and non-verbalcues of pain as well. If appropriate, I would ask the patient and their familyto assist in pain management by educating me on what has previous worked for mypatient.  I would do all the above as Ibelieve assessing pain from as many techniques as possible will give us abetter holistic picture of the patient and their pain.

What might some variations of nursing interventions be inmanagement of pain when caring for the ethnic group you chose? Pharmaceutical:Traditional? Alternative? Inter- professional? A large majority of Chinese culture believe in the use of herbalremedies, referred to as TCM; “Traditional Chinese medicine (TCM) originated inancient China and has evolved over thousands of years.  TCM practitioners use herbal medicines and variousmind and body practices, such as acupuncture and tai chi, to treat or preventhealth problems.” (NCCIH., 2017) If my patient requested, I wouldencourage the use of Tradition Chinese Medicine whenever possible, however,since they can have dangerous interactions and adverse effects when combined withWestern medicine, I would consult with and notify the physician about anynatural remedies being used. For example; “Coumadin (Warfarin) interacts with awide range of herbs, it is best to avoid combining Coumadin with all herbsunless the patient has guidance from an experienced health professional.”  (Thai, 2004) In the Canadian health care setting westernmedicine is the primary form of medicinal treatment, so as Carteret (2017)states below, I would ensure I thoroughly explain the use and the benefit ofthe drugs prescribed by the doctor.  Educatingmy patient from a different cultural background will be of utmost importance asthey likely could have a knowledge deficit regarding Canadian forms oftreatment.

 “It is important to explainthe rationale behind use of pain medication to all patients, and to askpatients from different cultural backgrounds which type of medication ispreferred in their culture.”  (Carteret,2017). To accommodate for any spiritual or cultural supports, prayer or rituals,I would work with the patient and the patient’s family to create a schedule forcare that allocates time for such things.  I would work along with the rest of the healthcare team to implement the best care plan for my cultural patients.  “Explore potential religious/spiritual copingstrategies with your patients such as meaning-making, distraction, spiritualsupports, and relaxation techniques.

”  (Potter et al., 2014, p. 143) I would ask themif there is any cultural consideration that myself and the health care teamshould be aware of, and I would implement those to the best of my ability andresources.Conclusion            The purpose of this paper was to explore the effects of the Chinese culture on painperception, responses and management.

  Discussed was the complexity of howindividuals deal with pain. In summary, I believe we as health care providersmust respect all cultural beliefs especially those other than our own, and thepatient’s holistic wellbeing must always be our focus.   We also should educate ourselves on thecommon cultural core beliefs and rituals so that we are prepared to provide thebest culturally sensitive, patient focused care.


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