Deborah Ambrosio Mawhirter, EdD, RN Authors Conflicts of Interest; NONE Historically, pain affects all human beings. Primary cause for clients to seek medical attention. Pain effects millions of people, estimated national cost of pain ranges from $560 to 635 billions dollars (Gaskin, Richard 2012) Pain is a multifaceted phenomenon affected by the patient s physiological, psychological, social and cultural factors. Pain is a global health issue affecting all cultures. There is a plethora of literature on the lack of nursing knowledge in pain management. 1
Cultural Competence is a vital component for functioning in today s healthcare arena Nurses are in a pivotal position to affect pain management Pain is a tragically overlooked public health problem A call to Revolutionize Pain in America; An Opportunity in Health Care Reform ANA, (Trossman, 2010) Despite major initiatives by accrediting agencies, statewide pain initiatives, and professional organizations, knowledge of pain management is still inadequate. Nursing faculty need to critically review their curricula to determine whether students are being taught in depth and up-to-date pain management information (Plaisance & Logan, 2006) 2
Culture not only affects patient s expression of pain, but influences the way healthcare professionals respond to and mange that pain (Salimbene & Gerace,2007) Are Nursing students culturally competent in pain management? Do You ask your patients what does your pain mean to you? Do you ask your patients what do you call your pain? Do you know your cultural biases? This Study benefits student nurses and guides nursing educators in further developing nursing curricula regarding pain management and cultural pain management, thus preparing graduating students for the workforce. Transcultural Theory (1968, Leininger)- advanced nursing practice utilizing the belief that culture directly affects patient care. Campinha-Bacote (2007), Cultural competence concepts. Cultural competence is a process, not an event; a journey, not a destination; dynamic, not static. Landmark Study of Nurses Knowledge of Pain Management (1987, Ferrell & McCaffery) nurses beliefs about pain management play an important role in assessment and treatment of pain. 3
Preparation in pain management Preparation in cultural pain management Beliefs about pain management Nursing Standards for pain management Cultural awareness Dependent variable: cultural competent pain management The study was limited to senior nursing students in a four year baccalaureate nursing program in a university within the suburban area of in the Eastern United States. Sample : Convenience Subject selection- based on willingness to participate Of 200 nursing students, 182 completed a survey of 65 items using a six point Likert scale, for a return rate of 91%. Dimension Preparation in Pain Management Preparation in Cultural Pain Management Beliefs about Pain Management Nursing Standards For Pain Management Culturally Competent Pain Management (Dependent Variable) Item Numbers Items Range of Scores Alpha 36,53,51,56,58,64 6 6-36.67 17,19,20,25,37,40 45,52,57,61 10 10-60.89 8r,11r,15r,16,26r,34, 11 11-60.79 41,43r,46r,50r,63 1,4,38,39,42,60,65 7 7-42.74 7,10,12,14,23,28,21 29,33,48,62 11 11-60.86 4
Respondent s mean age 27.2 (age 19 54 years) Female, 91.2% Males, 8.7% English Primary Language 74% English was not Primary Language 26% Ethnicity N Percentage African American /Black 43 23.6% White 85 46.7% Latino/Hispanic 15 8.4% Asian 25 13.7% Pacific 2 1.1%. Islander/Hawaiian American Indian/ 1.5% Alaskan Native Other 6 3.3% Missing 5 2.7% Total 182 100% How do Nursing students describe their preparation in pain management? 5
Students responded that they somewhat agreed that they were prepared in pain management. N Range Minimum Maximum Mean S.D. Preparation in Pain Management 180 6-36 12 36 27 4.70 47% agreed their cultural beliefs affect pain management 53% did not agree Patients from ethnic minorities and cultures different from the healthcare professionals treating them, receive inadequate pain management The nurse must consider: The physical, emotional, social and spiritual components of pain. Understand the patient s pain in the context of family, culture, past experiences and the meaning of the pain experience. Ask what the pain means to the patient 6
Nurses should be culturally aware of their own cultural attitudes and beliefs Nurses and students should be aware of personal biases and assumptions about people with different cultures Nurses need to accept cultural differences between self and others understanding the dynamics of differences adapt to diversity. 54% Used Alternatives 47% Did Not Use Alternative Self Reported Treatments Percent Used Homeopathic Remedies/Herbs 35% Heat & Cold therapy 31% Massage 23% Relaxation 22% Acupuncture 11% Distraction 7% Physical Therapy or Exercise 4% Imagery 2% Prayers 2% Hydrotherapy 1% Marijuana 1% Coining, Suction Cups 1% CCPM Pearson r Correlation Healt Perso Belief Nsg St Age care exp edu Eng PPM PCPM PM PM -.008 -.089.037.112 -.142.388**.652**.242**.496** r2 0%.7% 1% 1.2% 2.% 15% 42.5% 5.8% 24.6% N 173 178 179 179 179 178 175 174 175 7
Pain management is a complex puzzle, no single health care profession holds the puzzle piece that solves this puzzle; rather, each health care profession holds a critical piece that contributes to the completion of the puzzle. Pain practitioners are trained to see their patients a multifaceted, whole systems requiring a multidisciplinary viewpoint. Each therapeutic option for pain management is based on collective wisdom that has been handed down from generation, as well as, modern innovation K. Weiner 8
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