Pain as a Mutual Experience for Patients, Nurses and Families: Unique International Perspectives from the Peoples' Republic of China, the United States, Malawi and Spain

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PART I

Introduction

Pain, a universal phenomena, has captured the attention of researchers, philosophers and practitioners for many years. This article shares findings from a descriptive research study that explored pain recognition, pain intervention and perceived pain relief in laboring women, children and older adult patients from four very different countries. Researchers included co-investigators from each site and a team of more than 20 nurses from China, the United States, Malawi and Spain.

Abstract: This article shares findings from a descriptive research study that explored pain recognition, pain intervention and perceived pain relief in laboring women, children and older adult patients from four very different countries. Researchers included co-investigators from each site and a team of more than 20 nurses from China, the United States, Malawi and Spain. This international, multi-site study investigated specific aspects of the phenomena of pain which are known to be of interest to nurses internationally. Critical issues related to feasibility of this study depended, in large part, on the ability of principle investigators to have access to a sample comprised of sub-samples of nationally different subjects that would represent the population of interest. Access to the four study countries was made possible through professional relationships previously developed by either one of the principal or co-investigators.

Key Words: Pain; International Perspectives; The People's Republic of China; U.S.A; Malawi; Spain

The study began in 1992 when the principal investigators were invited to The People's Republic of China to help nurses from Shanghai Medical University learn about the research process by doing research. The study focused on pain and pain relief because the phenomenon of pain and its relief is of common concern to nurses.

Research Questions and Purposes

Two research questions were raised. The first asked if pain, as a universal phenomenon, can be examine across countries? The second question, whether nurses from distinctly different countries, using similar methodologies, can work together to study a problem of concern to all, reflected the cooperative, international nature of the research.

The same three purposes guided each of the four site-specific research studies and the cross-country analyses of data. The purposes were to explore and describe (a) how pain is recognized, (b) measures used to relieve pain, and (c) perceived effectiveness of pain relief measures in laboring women, children and older adults, each with a nurse and some with a family member. A fourth purpose, unique to the final phase of this study, was to examine whether Orem's Self Care Deficit Theory of Nursing could appropriately be used to understand and evaluate pain recognition and relief behaviors in nurses from an international perspective.

THEORETICAL RATIONALE

The theoretical rationale that guided the research, related to the first three purposes of the overall study, was based on a widely accepted view that pain is a perceived phenomena and that the level of pain awareness is determined by neurochemical and sociopsychological factors within a cultural framework.

The fourth purpose of the study evolved because of researcher concern that the literature provided few studies with evident nursing theory. In addition, because this is a study conducted by nurse researchers and initiated to examine behaviors related to pain as a universal phenomenon of concern to nurses, it is appropriate to question whether a nursing theoretical framework can provide the scientific basis for such data interpretation. Since Orem's Self-Care Deficit Theory of Nursing is widely used in research and curriculum development in several countries, it was chosen to examine the appropriateness of using a current nursing theory to examine cross-cultural data.

Orem's General and Self-Care Deficit Theories of Nursing Constructs

According to Orem, nursing is a specialized health service whose focus is people with self-care or dependent-care inabilities (1991). …