Choose a concept relevant to your nursing practice [present or future]. Following the guidelines given in Chinn & Kramer [Chapter 7], analyze the concept and develop cases: model, contrary, related, and borderline. The paper length should not exceed 10 pa

Concept Analysis of Pain

Pain is a factor that is felt differently from person to person and from culture to culture. It is

subjective in nature and as care providers we are taught not to question its existence rather to

believe it exist through the eyes of the person feeling the pain. Pain is triggered in the nervous

system. Pain may be intermittent or constant, dull or sharp. Pain can be acute as in the case of a

cut or maybe chronic as in the case of back pain. According to Wells, Pasero, & Mcraffery

(2008) thirty-five (35) million patients were discharged from U.S. hospitals in 2004; of these

patients, forty-six (46) percent had a surgical procedure and sixteen (16) percent had one or more

diagnostic procedures. They also asserted that pain is common, and expected, after surgery. Ted

Further, Wells, Pasero; Mcraffery, 2008 inadequately managed pain can lead to adverse physical

and psychological patient outcomes for patients and their families. Pain is also one of the most

frequent cited nursing diagnoses. This makes pain a critical problem in healthcare.

Nursing researchers have conducted many studies to identify and understand pain.

According to Walker and Avant (1995) the purpose of concept analysis is to helps nursing

scholars to identify the similarities and difference between concepts. Further it helps us identify

the differences between irrelevant and defining attributes of a concept. Mahon (1994) and

Montes-Sandoval (1999) used the Walker and Avant’s method of concept analysis to determine

their similarities of pain. These are that pain is a personal experience, an unpleasant, distressful,

unwanted, uncomfortable experience. Mahon added that pain is psychological and socio-cultural

response to a noxious stimulation.

The dictionary defines pain from the philosophical, theoretical and a sociological

perspective. The Oxford English Dictionary defines pain as a sensation which one feels when

hurt, suffering, distress and is specific to the physical and psychical sense. From a philosophical

perspective dating back to Plato (427-347 BC) he proposed the idea of the soul, pain and

pleasure. Aristotle (384-322 BC) viewed pain as an emotion, state of feeling. While Descartes

(1596-1650) emphasized the relationship between mind and soul in relation to pain.

There are four major theories that discuss pain form a theoretical perspective. These are:

specificity theory, pattern theory, gate control theory, and psychological/behavioral theory. The

concept of pain as it relates to sociology is seen through cultural views. According to Zborowski

(1969) pain is believed to be a social and cultural pattern of the individual have significant

influence. Further he assets that attitudes towards pain are learned from parents and society.

Pain in professional fields is best explained by McCaffery (1977), as “whatever the experiencing

person says it is, and exist whenever he says it does”. Presently this is what we teach in nursing

schools.

It is important to distinguish the concept of pain from other closely related concepts such

as suffering and discomfort. According to Loeser and Egan (1989) suffering is defined as a

negative affective response to pain or to other emotionally filled events, such as fear, anxiety,

isolation or depression. Therefore, pain may induce suffering, however, not all pain will induce

suffering. Person may suffer even in the absence of pain. Discomfort on the other hand is not

defined in the nursing literature. (Cheng, Foster, & Huang, 2003, p. 23). Sheridan (1992) states

that mild pain is referred to as discomfort. In the McGill pain questionnaire discomfort is used to

state the intensity of pain.

According to Chen, Foster & Huant, (2003) Based on this principle, the critical

attributes of the concept of pain include: (a) unpleasant and distressful experiences

originating from physical sensation and having both positive and negative meanings for an

individual; (b)an individual human experience; (c) a state of feeling in both sensation and

emotion (verbal), and behavioral components; (d) physical and psychological responses to

the stimulus; (e) function of pain, including protective and warning signs; (f) pain responses

are learned and influenced by personality, environment, emotions, social and culture.

When constructing a model case all attributes of the concept should be included. A

example for the concept of pain follows: Mr. S is a 42 year old Taiwanese male who was

diagnosed with colon cancer. Recently his tumor was found to be enlarged and his doctor

advised him to have surgery. Mr. S was assigned to a nursing student, Alice that found him

lying on his right side with his knees bent after surgery. He was holding his arms close to his

chest, eyebrows were furrowed and look tired. When the nursing student approached, he

closed his eyes but was cooperative. Taking his vital signs, the student found that his heart

rate and blood pressure were elevated. Mr. S told her that he was in pain pointing to his

lower left abdominal area. Thus, pain medications were administered. Two hours later Mr. S

said he felt better but followed with telling the nursing student that two years prior he had

abdominal pains and bloody stools. He added that he was worried that he would have cancer

and that is why he went to the doctor to be checked. He has a family history of colon cancer

and remarked that it was in his genes. He continued saying “I knew what would happen to

me sooner or later, and I accepted this fact. It’s better than I am not married, or I would be a

burden to my family. (Cheng et al., 2003, p. 24) An analysis of this case illustrates attributes

of pain. Mr. S showed the protective positioning of pain and expressed pain. This showed his

pain as unpleasant and distressful experience both through verbal and nonverbal responses.

The abdominal pain and bloody stools showed that Mr. S suspected the disease, and his

knowledge that he had bad genes demonstrated the social and cultural dimensions of pain. In

his culture cancer is viewed as an incurable disease accompanied with extreme pain. Also

viewed by his culture is the believe that a good man has responsibility for his family. Thus,

by not being married he was relieved he would not be a burden to his family. (Cheng et al.,

2003)

A borderline case contains some of the same attributes of the main concept but not all

of them are included. The case of Mr. A is a 62-year-old Taiwanese man who was a minister.

He was diagnosed with renal cancer with metastases to his left femoral bone. Alice took care

of him and she found him closed eyes lying on his right side with legs bent praying and with

a cross in hand. Alice asked him how he was doing and if he had any pain, he said he was

fine and denied pain. He thanked her. His blood pressure and heart rate were elevated. Alice

was concerned given his diagnosis most patients would experience pain and asked again. Mr.

A responded by saying “God was crucified on the cross and died for mankind”. He added

that God suffered for all humans and his love is more than anything else in the world. He

added I just have physical discomfort. So he wanted to experience how God suffered and

understand how God loves people. But he never answers the question of pain. (Cheng et al.,

2003). The analysis of this borderline case shows not all attributes being represented. Mr. A

never voiced his pain however his behavioral cues of pain were observed. Alice also noticed

that when visited by his family they prayed together which showed his social patterns

influenced by the patient’s pain responses. The family and religious factors influenced Mr. A

more than any other factors.

A contrary case is a case which presents not the concept. Thus, in the case of Mary

she is a 3-year-old girl being seen in the clinic for hepatitis B shots a month ago follow up.

When Mary saw the nurses, she held her mother very tightly with her eyes closed and would

not allow her mother to put her down. She began to cry and told her mother she did not want

to go to the clinic. Though the nurse was trying to explain what she was going to do that day

Mary continued to cry and told her mother she wanted to go home. An analysis of the

defining attributes of pain were absent from this example. However, is presents the concept

of fear. Fear is a reaction to a specific danger or event which is identifiable. (Cheng et al.,

2003, p. 25) The cause of fear for the child is what would take place in the clinic. Mary

probably recognized the clinic and identified the clinic with the shot.

Now we will identify the antecedents and consequences of the concept of pain.

Antecedents are the events or incidents that happen before the existing concept. (Cheng et

al., 2003). Examples of interrelated antecedents are personal and cultural values as well as

environmental factors. Environmental factors such as a venipuncture or a hospitalization are

associated with pain. Person’s attitude about pain may affect how the person experiences

pain. Personal issues include physical and emotional condition as well as personality, gender

and socio-economic class. Conditions such as sleeping pattern are examples. Emotional

conditions includes stress and anxiety. Consequences are defined as the events that happen as

a result of the concept. Pain reaction and ability to cope with pain which could be voluntary

or involuntary responses. These involuntary responses are usually autonomic nervous system

such as changes in heart rate and blood pressure. Voluntary responses such as rubbing the

site of the pain may be seen.

The final step in concept analysis is defining empirical referents. Which is defined as

how the concept is measured or what the observations of a phenomenon are presented.

(Cheng et al., 2003, p. 27). From the analysis of pain, the critical attributes may be abstract

thus empirical reference present. Because pain is an unpleasant, uncomfortable and stressful

personal experience the client owns verbalization are the most reliable indications of pain.

However, verbalization may not be adequate for all people. Behavioral cues are important to

assess patient’s pain.

In conclusion the concept of pain for this paper was selected since it is a serious

problem for both patients and caregivers. Healthcare providers continue to learn how to

assess, manage and treat pain. Pain as a concept continues to be studied in research,

discussed in education and provide guidelines to be used in practice.

References

Cheng, S., Foster, R. L., & Huang, C. (2003). Concept analysis of pain. Retrieved from

https://www.semanticscholar.org/paper/Concept-Analysis-of-Pain-Cheng-

Foster/0f85b34a10bd85f73cadf3ee3c56a81455276a91

Chinn, P. L., & Kramer, M. K. (2018). Knowledge Development in Nursing Theory and process

(10 ed.). St. Louis, Missouri: Elsevier.

Wells, N., Pasero, C., & McCaffery, M. (2008). Chapter 17. In R. Hugges (Ed.), Patient safety

and quality: An Evidence-Based Handbook for Nurses (pp. 1-45). Rockville MD: Agency

for Healthcare Research and Quality.