Bousso, Poles and Cruz (2013) refer to a concept as an abstract image or a representation formulated in the mind. Therefore, it may mean one thing to one person and another thing to someone else. Concepts are important in the work of research in that a probe into their occurrence leads to the development and formulation of theories (Bousso, Poles, & Cruz, 2013). Thus, the development of theories in nursing practice and research is heavily dependent on the analysis of concepts; which are the structural elements of theory, which inform nursing practice and research (Bousso, Poles, & Cruz, 2013). Examples of concepts that advise the development of theories in nursing include and are not limited to boundary lines, caring, cleanliness of environment, nursing intuition and pain
This paper discusses the significance of pain as a concept in the field of nursing. Pain can be a mental imagery of discomfort. Similarly, pain can also be a reality feeling of physical discomfort. A good example of how pain can have two distinct representations would be: “he has pain in his ass” and “he is a pain in the ass”. The former expresses a reality of physical pain in someones behind while the latter is a representation of someone who is a bother. These two representations clearly shows how concepts can be so abstract, having different representations or meanings within different contexts in which they are applied or analyzed. Prevention or alleviation of pain is thus one of the issues of concern in healthcare and nursing practice.
A deeper insight into the Jean Watson's theory of human caring in relation to pain reveals a need for a relationship between a nurse and a patient. Composed of three elements; that of curative factor, a transpersonal caring relationship and the caring moment, Jean Watson's theory of human caring aims to reveal the human perspective of a nurse’s service while being professional at it and her sensitivity and intention to connect with the patient in an environment that allows for a nurse-patient relationship (Watson, 2014). For a nurse to well understand the patient’s pain, it calls for a development of a relationship with the patient that results to a conscious care but remains professional as not to cross the boundaries of intimacy (Lachman, 2012).
Spackman (2012) describes the pain as a dominant human sensation that may be caused by a health condition or the treatment of a health condition and results of reduction in physical, nutritional and social comfort levels. Vaajoki (2013) defines pain as an unpleasant sensory or emotional effect of a known and actual or percieved damage in a part of the body. She continues to stipulate that pain varies from one person to another and more so on the basis of gender, age and other such factors as culture and previous experiences (Vaajoki, 2013). The reason pain is one of the key concepts of nursing practice is that at the very core of nursing is pain management and restoration of a patients comfort from pain (Vaajoki, 2013). This definition of pain indicates that for pain management to be effective, it needs to be approached from a patients perspective and thus a need for a nurse-patient caring relationship fostered by the Jean Watson's theory of human caring.
Effective application of Jean Watson's theory of human caring by a nurse when responding to a patient’s pain stresses the need for conscious care. A conscious approach to care can only be possible if the nurse has connected with the patient by developing a close relationship (Lachman, 2012). The nurse can respond to the pain from a point of knowledge rather than just being judgemental. A nurse has to express every possible element of care to a patient not only in compliance with codes of ethics but also to the extent of understanding the unique needs of a given patient. For example, when a nurse carries undertakes a medication procedure either out of ignorance or incompetence and thus resulting to harm on the patient, is a clear indication of the non-application of the Jean Watson’s theory of caring (Lachman, 2012).
Many concepts in nursing bear as many similarities as differences in their application within other disciplines. For example, in medical sciences, the gate control theory of pain also admits that the definition of pain from one individual to another can vary depending on the prevailing factors in an individual’s situations (Centre for Integrated Healthcare, 2013). According to the gate control theory, the variation is brought about by the variation in nerve impulses transmissions at different times in a person’s life depending upon the prevailing circumstances in that person’s life at a given time. Feelings of pain may sometime be assumed when someone is excited since the transmission of the feelings of excitement to and from the central nervous system may supersede that of pain (Centre for Integrated Healthcare, 2013). These partial opening and closing of central nervous ‘gates’ are what contributes to differences in expression of pain by individuals at different times (Centre for Integrated Healthcare, 2013).
Both the nursing and the medicine approach to the concept of pain bears similarities in the sense of both admitting that the feeling and meaning of pain may vary from one individual to another and may also vary within the same individual at different times depending on that individual’s prevailing circumstances.
The approach to pain from a nursing perspective is different from that of medical science. While medicine takes the approach of the function of the central nerve system role in pain management, nursing assumes a pharmacological approach to pain management (Vaajoki, 2013).
Pain course discomfort and thus reduction in human activity levels (Spackman, 2012). Both prevention and control of pain before it sets in within a patient and management of pain that has already set in within a patient is a primary aspect of health care (Conway & Higgins, 2011). Effective pain management is achieved at the patient’s satisfaction (Liu, Avant, Aungsuroch, Zhang, & Jiang, 2014). Applying the transpersonal caring element of the Jean Watson’s theory of caring, a conscious clinical care influenced by understanding the patients pain is very important. It ensures that the patient is attended to in accordance with their definition of the pain they are going through (Watson, 2014). It is the nurse’s caring responsibility to connect with the patient’s inner life and thus address the patient’s pain from a mutual union formed by both the patient and the nurse (Watson, 2014).
Vaajoki (2013) notes that pain assessment which advises the best approach to a specific patient’s pain management are core elements of nursing practice. Pain relief services or therapies in patients have on many occasions been reported as underserved, majorly due to ignorance and incompetence. This amounts to ineffective application of the Jean Watson Theory of human care since acts of ignorance or incompetence such as administering the wrong prescription, an overdose or lesser dose to a patient may be lethal resulting to very serious repercussions (Lachman, 2012). Effective care in pain management should be safe, right and effective.
Attributes are ideas related to and identifies the characteristics of the main concept that is central in a discussion . The key notable attributes discussed in this paper in relation to the concept of pain in nursing are as follows:
It is noted that pain causes suffering due to the discomfort caused . The discomfort may result from actual or perceived physical tissue or organ damage .
Different patients have Different Perspectives
The expression and the meaning of pain vary from one patient to another and at different times to the same patient . These variations are influenced by the prevailing circumstances in an individual’s life.
Patient-centred Care is Important
For effective pain control and management by a nurse on a patient, the care should be administered from a patient’s perspective of pain . It is possible to offer patient-centred care by cultivating a mutual relationship with a patient as a nurse. However this does not mean that intimacy boundaries have to be broken . Professionalism must still be maintained.
Antecedent and Consequence
With reference to walker and Avant’s model, antecedents are preceding events to a concept while consequences are succeeding events resulting from the occurrence of the concept .
One possible antecedent to the concept of pain in a patient could be an infection . The occurrence of an infection in a patient may prompt the patient to visit a healthcare facility to seek a remedy that may be pharmacological or non-pharmacological and . The visit to the healthcare facility influenced by the existence of pain experienced by the patient is an example of a consequence the pain may lead to.
An Empirical referent is an element that makes it possible to measure and thus indicate the existence of a nursing concept . Pain is unique to an individual depending on that individual’s prevailing circumstances and occurs in many dimensions . Pain can be indicated through various expressions. Signs of physical, nutritional and social discomfort can be empirical referents of pain . Pain may also be emotionally or sensory stimulate .
1 model case is created by the student and discussed substantively by demonstrating within the case each of the following areas:
Brüggemann, Wijma and Swahnberg (2012) defines a model case as a representative use of the concept that clearly explains the defining attributes associated with that concept.
A male student at an Inter-schools Football Match
“The inter-school football games had advanced to the quarters. I was playing the front left midfielder position with a number 7 shirt on. It was going to be a hotly contested match against our opponents. My strength was in my left foot. I approached the twin defenders of our opposing team while dribbling the ball. I managed to evade the first defender’s tackle but while I was getting my stability after that first evasion the second defender came crashing his spiked boot on my left ankle sending me down on the ground with such a great thud and left me writhing in pain and bleeding. It felt like my ankle bone was broken. It was very painful that I could not rise up. I was subsequently rushed to the school clinic for an initial observation before being referred to the county hospital”
The defining attributes from the case above indicates a rough tackle on the student that preceded him being hurt. Similarly him being hurt manifested or possibly measured by his bleeding consequently resulted to him being rushed to the hospital for check up.
An Inter-schools Football Match
Earlier on during the same football match, I had noticed our centre midfielder committing a rough tackle on the defender who played a harmful tackle on me. The referee seemed to have missed to see that which in my conviction made this defender to be on a vengeance spree. As he walked away from that initial tackle, the expression on his face said his pain and agony though he chose to play on”
In this borderline case, there is an event that precedes pain and is recognized through an agony facial expression. However there is no notable consequence as a result of pain
An Inter-schools Football Match
“It was just fifteen minutes into the game. Our right wing midfielder passed a long ball my way because I was all clear and was not very far from our opponent’s goal post slightly within the close range of the outside the penalty mark. With a single tap of my foot on the incoming cross, I sent the goalkeeper the wrong way granting my team the first goal of the match.”
This is a contrary case since it lacks any attributes of pain .
It is quite evident that the concept of pain is a very key component in nursing practice and research. Pain causes discomfort though depending on who is asked and their prevailing circumstances at the time of asking, it is possible to get varying answers in reference to pain. Whether the consideration of pain is done through a nursing theory or a non-nursing discipline chances are there will be notable similarities and differences in both perspectives. The concept of pain in the context of Jean Watson’s theory of caring stipulates that provision of conscious care is very effective at addressing a patient’s care needs. Conscious care is achieved by a nurse when he or she cultivates a mutual relationship with a patient guided by the Jean Watson’s theory. It helps to understand pain from a patient’s perspective rather than just acting out of assumed knowledge and thus the opportunity to offering the right medication.
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Centre for Intergrated Healthcare. (2013, July). The Gate Control Theory of Pain. Retrieved January 31st, 2016, from U.S. Department of Veterans Affairs: http://www.mirecc.va.gov/cih-visn2/Documents/Patient_Education_Handouts/Gate_Control_Theory_of_Pain_Version_3.pdf
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