Concept Analysis of Pain in the Nurse Practitioner Role- Theoretical Applications and Model Case
Name:
Definition/Explanation Of The Selected Nursing Concept: Pain
Pain is an unpleasant sensory or emotional stimulus that arises from actual or potential damage to tissues (Liyew et al., 2020). According to the Merriam-Webster dictionary, pain is “a localized or generalized unpleasant bodily sensation or complex of sensations that causes mild to severe physical discomfort and emotional distress and typically results from bodily disorder (such as injury or disease).” It is the most common nursing diagnosis and the most frequent presenting complaint about patients seeking medical help. Pain can be classified according to various criteria depending on presentation or causes. However, classification based on duration to acute or chronic is the most clinically significant and determines interventions. While there is no universal consensus on acute or chronic pain, and definitions tend to overlap, several theories define acute pain as lasting for less than 30 days and chronic pain as pain lasting for more than six months. However, the most critical classification of chronic pain is pain that has lingered for more than the expected healing period. Nurses are strategically placed to hear the often painful experiences of patients and advise physicians on the need for pain management interventions. Therefore, improving pain assessment, management, and communication knowledge between patients, nurses, and other healthcare providers is vital for effective pain management (Liyew et al., 2020).
Three Defining Attributes
Defining attributes of pain refers to the characteristics associated with pain. Usually, more than one attribute is linked to a concept for analysis. Stilwell et al. (2021) compared four theoretical and empirical pieces of evidence to attributes of suffering according to Cassell to frame attributes of pain-related suffering. The attributes of pain include (i) unpleasant experiences that arise from physical sensations which have both positive and negative perceptions of the individual, (ii) it is an individual human experience, and (iii) it is a feeling that has behavioural, emotional and sensational components. Pain is subjective, and therefore, patient perception is critical when discussing it with patients (Narain, 2021). Nurses and other care providers need to consider this when defining pain.
Antecedent And Consequence Of The Concept: Pain
Antecedents refer to incidents preceding the concept. They may be environmental, individual, or cultural antecedents that modify or are related to pain as a concept. These antecedents interplay to modify pain as a stimulus or how it is perceived. Environmental factors may trigger pain. Personal factors include body and mind, and these are affected by pain. Consequently, pain causes tissue damage or threatens to cause it. Personal knowledge and attitudes towards pain influence individuals’ coping mechanisms to deal with pain. Personal issues such as physical and emotional status, gender, personality traits, and socioeconomic status influence pain. Emotional status, like stress levels or anxiety levels, will modify the ease of feeling pain, while personality influences pain perception. Positive attitudes toward pain influence the choice of methods to deal with pain. People in different socioeconomic classes express pain differently. Cultural values determine how individuals interpret and react to pain. These antecedents have a consequence on this concept.
These consequences manifest in the interpretation of pain and the subsequent reaction to pain. Pain reaction manifests as pain behaviour, which can be voluntary or involuntary responses. Involuntary responses are subconscious reactions usually mediated by the autonomic nervous system. They include changes in heart rate and various reflex reactions. Voluntary responses are under conscious control, involve motor activity, and include verbal and nonverbal reactions like complaints and positional changes. Another consequence is that persons experiencing pain may derive meaning from their experiences with pain. These meanings could be positive or negative and directly influence the choice of coping.
One Antecedent Of Compassion
Pain affects the immediate family or primary support system accessible to the patients. This is directly influenced by the culture within which the person experiencing pain resides. Culture shapes the perception of pain, and compassion for the pain experienced by the person is drawn from this perception. The family, for example, plays a critical role in influencing the responses to pain.
One Consequence Of Compassion
Feelings of compassion will influence voluntary responses to pain. Individuals will choose to complain or cry about their pain, express their pain in different non-verbal ways, or avoid expressing it altogether, depending on the levels of compassion in society. Verbal expressions of pain may be intrapersonal, interpersonal, or more complex and symbolic to other persons. These will modify the coping strategies and, therefore, living with pain.
Model Case: Pain
A model case should have all the attributes of pain and illustrate them effectively. The following is an example:
Mrs. G is a 54-year-old African American woman diagnosed with right breast cancer eight years ago. During her recent visit to her oncologists, investigations found that her tumour had enlarged and could metastasize. Her doctor advised her to undergo a mastectomy. While hospitalized, Betty, a student nurse, found Mrs G lying in the knee-chest position with clenched fists, eyebrows furrowed and looked fatigued. Betty took her vitals and determined increased blood pressure and heart rate.
Further, Mrs. G had her eyes closed throughout the interaction with Betty. She informed Betty that she was experiencing pain in her left breast, for which Betty gave her some analgesics. One and a half hours later, Betty asked Mrs. G how she was feeling, to which she reported that her pain had subsided. After a few seconds, she continued, “I had redness and swelling on my right breast a few years ago and was diagnosed with breast cancer. My sister had uterine cancer while my father died of throat cancer, and now, I am the only one left. We have bad genes. I knew I would die soon and accepted it. I never wanted to have a family of my own not to burden them.”
Analysis
The case demonstrates all attributes of pain as Mrs G expressed her pain verbally and non-verbally, showing that pain is an unpleasant experience that manifests in emotional and behavioural responses. She also can link the onset of symptoms to the diagnosis, showing that the pain is individualized. Her response about ‘bad genes’ points to her culture and how they view the disease. Additionally, her resolve not to begin a family and anticipation of the burden on her family shows how her personality, experience, and sociocultural factors manifest in this case.
Theoretical Applications Of The Concept: Pain
There are several nursing theories for pain. Kolcaba’s theory for comfort defines comfort as an outcome after human needs for relief, ease, and transcendence have been met. Therefore, there are different ways of achieving comfort (Tahlil, Kamil & Marthoenis, 2020). These include considering physical, environmental, social, and psychospiritual perspectives. In this case, the physical component of pain was met when the student nurse gave analgesics to the patient, resulting in pain relief. Mrs. G, 90 minutes after taking the pain management pills, reported that she felt better. The psychospiritual relief is evident when the patient rationalizes her experience using her self-awareness, the immediate environment, and experience. She reflects on her family’s experiences with cancer and her decision not to have a family.
Reflection
The concept of pain is a recognized severe problem for both patients and care providers. Nursing literature has documented the adverse consequences of failure to manage pain effectively. The conceptualization of pain is highly significant in nursing practice. This concept analysis will be useful in my practice as a nurse provider as it highlights a clear link between the problem and moves towards resolution. It will help me identify, define, describe, and conduct focused nursing diagnoses and interventions to manage pain in my patients. It is vital to understand pain as a concept and its attributes and to modify antecedents in nursing practice. Application of this knowledge in nursing science improves clinical care and, therefore, outcomes. Florence Nightingale emphasized holistic care founded on understanding the patient and their unique needs when contacting healthcare systems. Subsequently, this will help nurses appreciate the effects of pain as an outcome of illness and respond to the actual patient’s needs. Patients, therefore, will receive high-quality care that is safe, evidence-based, and culturally competent. Ultimately, this will ensure that patients are satisfied with the nursing care accorded to them and help them take responsibility for the pain.
References
Liyew, B., Dejen Tilahun, A., Habtie Bayu, N., & Kassew, T. (2020). Knowledge and Attitude towards Pain Management among Nurses Working at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Pain Research and Management, 2020. https://doi.org/10.1155/2020/6036575
Narain, L. (2021). “Breakthrough” to Describe Pain: A Concept Analysis 1 MedDocs Publishers. Analysis. J Psychiatry Behav Sci, 2021(1), 1063. http://meddocsonline.org/
Stilwell, P., Hudon, A., Meldrum, K., Pagé, M. G., & Wideman, T. H. (2021). What is Pain-Related Suffering? Conceptual Critiques, Key Attributes, and Outstanding Questions. Journal of Pain. https://doi.org/10.1016/J.JPAIN.2021.11.005
Tahlil, T., Kamil, H., & Marthoenis, A. (2020). Challenges in Nursing Education and Research.
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Question 
This assignment presents a modified method for conducting a concept analysis of one important and valuable concept of the nurse practitioner’s role. A published nursing theory must support the concept for this assignment. The selected concept is identified and then the elements of the analysis process are applied to synthesize knowledge for application as demonstrated through the creation of a model case. Theoretical applications of the concept are also discussed. Non-nursing theories may not be used. Scholarly literature is incorporated throughout the analysis.
Concept Analysis of Pain in the Nurse Practitioner Role- Theoretical Applications and Model Case
Only the elements identified in this assignment should be used for this concept analysis.
Possible Concepts: The following concepts are not required; students may select one of these concepts or find another concept. Each selected concept must be associated with a nursing theory; the use of non-nursing theories is not allowed. If you have any questions regarding your concept or the nursing theory, please consult with your faculty member for assistance. Please note: the concepts of caring or cultural humility are not permitted for this assignment.
Pain
Criteria for Content :
Definition/Explanation of the selected nursing concept
Defines/explains the concept using scholarly literature (a dictionary may be used for this section only)
Support from nursing literature is required.