Sociocultural Context of Pain Management in Oncology and Palliative Nursing Care

Authors: Andrea Zielke-Nadkarni

Abstract:

Pain management is a question of quality of life and an indicator for nursing quality. Chronic pain which is predominant in oncology and palliative nursing situations is perceived today as a multifactorial, individual emotional experience with specific characteristics including the sociocultural dimension when dealing with migrant patients. This dimension of chronic pain is of major importance in professional nursing of migrant patients in hospices or palliative care units. Objectives of the study are: 1. To find out more about the sociocultural views on pain and nursing care, on customs and nursing practices connected with pain of both Turkish Muslim and German Christian women, 2. To improve individual and family oriented nursing practice with view to sociocultural needs of patients in severe pain in palliative care. In a qualitative-explorative comparative study 4 groups of women, Turkish Muslims immigrants (4 from the first generation, 5 from the second generation) and German Christian women of two generations (5 of each age group) of the same age groups as the Turkish women and with similar educational backgrounds were interviewed (semistructured ethnographic interviews using Spradley, 1979) on their perceptions and experiences of pain and nursing care within their families. For both target groups the presentation will demonstrate the following results in detail: Utterance of pain as well as “private” and “public” pain vary within different societies and cultures. Permitted forms of pain utterance are learned in childhood and determine attitudes and expectations in adulthood. Language, especially when metaphors and symbols are used, plays a major role for misunderstandings. The sociocultural context of illness may include specific beliefs that are important to the patients and yet seem more than far-fetched from a biomedical perspective. Pain can be an influential factor in family relationships where respect or hierarchies do not allow the direct utterance of individual needs. Specific resources are often, although not exclusively, linked to religious convictions and are significantly helpful in reducing pain. The discussion will evaluate the results of the study with view to the relevant literature and present nursing interventions and instruments beyond medication that are helpful when dealing with patients from various socio-cultural backgrounds in painful end-oflife situations.

Keywords: Pain management, migrants, sociocultural context, palliative care.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1338696

References:

[1] E. Aulbert, „Psychische Grundlagen von Schmerzempfinden, Schmerzäußerung und Schmerztherapie,“ in Lehrbuch der Palliativmedizin, 3rd ed., E. Aulbert, F. Nauck, and L. Radbruch, Eds., Stuttgart: Schattauer, 2007, pp. 246-254.
[2] B. Kröner-Herwig, „Chronischer Schmerz – eine Gegenstandsbestimmung,“ in Psychologische Schmerztherapie, 5th ed., H. D. Basler, C. Franz, B. Kröner- Herwig, and H. P. Rehfisch, and H. Seemann, Eds. Berlin: Springer, 1999, pp. 3-16.
[3] C. R. Green, R. C. Tait and R. M. Gallagher, ”The unequal burden of pain: confronting racial and ethnic disparities in pain,” in Pain Medicine, vol. 4 no. 3, pp. 277-294, 2003.
[4] B. Glier, Y. Erim, „Schmerz bei Migranten aus der Türkei,“ in Schmerzpsychotherapie, 7th ed., B. Kröner-Herwig, J. Frettlöh, R. Klinger, and P. Nilges, Eds. Berlin: Springer, 2011, pp. 244-258.
[5] J. I. Kizilhan, „Interkulturelle Aspekte bei der Behandlung somatoformer Störungen,“ Psychotherapeut, vol. 4, pp. 281-288, 2009.
[6] M. Sleptsova, B. Wössmer, and W. Langewitz, „Migranten empfinden Schmerzen anders,“ in Schweiz Med Forum, vol. 9, no. 7, pp. 319-321, 2009.
[7] R. R. Edwards, M. Moric, B. Husfeldt, A. Buvanendran, and O. Ivankovich, “Ethnic Similarities and Differences in the Chronic Pain Experience: A Comparison of African American, Hispanic, and White Patients,” in Pain Medicine, vol. 6, no. 1, pp. 88-98, 2005.
[8] M. Verwey, „Schmerzpatientinnen und –patienten mit Migrationshintergrund aus der Perspektive von medizinischen und paramedizinischen Fachkräften,“ in Curare, vol. 27, no. 3, pp. 225-238, 2004.
[9] A. Kilcher and R. Spiess, „Die hausärztliche Betreuung von Migranten/- innen mit chronischen Schmerzen,“ in Schweizerische Ärztezeitung, vol. 84, no. 10, pp. 452-460, 2003.
[10] T. R. Allison D.P.M. Symmons, T. Brammah, P. Haynes, A. Rogers, M., and I. Roxby, “Musculoskeletal pain is more generalised among people from ethnic minorities than among white people in Greater Manchester,” in Ann Rheum Dis, vol. 61, pp. 151-156, 2002.
[11] P. St.Hill, J. Lipson, and A. I. Meleis (Eds.), Caring for women cross culturally. Philadelphia: Davis Comp, 2003.
[12] C. L. Edwards, R. Fillingim, and F. Keefe, “Race, ethnicity and pain,” in Pain, vol. 94, pp. 133-137, 2001.
[13] C. Campbell, R. Fillingim, and R. R. Edwards, “Ethnic differences in responses to multiple experimental pain stimuli,” in Pain, vol. 113, pp. 20-26, 2005.
[14] A. Cano, A. Mayo and M. Ventimiglia, “Coping, pain severity, interference. And disability: the potential mediating and moderating roles of race and education,” in The Journal of Pain, vol. 7, Jul, pp. 459- 468, 2006.
[15] I. Kavuk, C. Weimar, B.T. Kim, G. Gueneyli, and M. Araz, “One-year prevalence and socio-cultural aspects of chronic headache in Turkish immigrants and German natives,” in Cephalalgia, vol. 26, pp. 1177- 1181, 2006.
[16] C. G. Helman, Culture, Health and Illness. 5th ed., London: Hodder, 2007.
[17] J. Spradley, The ethnographic interview. Fort Worth: Harcourt Brace Jovanovich, 1979.
[18] C. Geertz, The Interpretation of Cultures. Selected Essays, New York: Basic Books, Inc., Publishers, p. 70, 1973.
[19] C. Hüper and R. Kerkow-Weil, „Schmerz im Migrationskontext,“ in Transkulturelle Kompetenz 2nd ed., Domenig D., Bern: Huber, 2007, pp. 541-558.
[20] G. Blechner, „Kultursensible Schmerztherapie,“ in Dr. med. Mabuse, vol. 135 (Jan/Feb.), pp. 56-59, 2002.
[21] U. Kaiser, „Sedna, die Meeresgöttin der Inuit - von Tabuverletzung und der Reise des Schamanen,“ in Krank warum? 2nd ed., F. B. Keller Ostfildern, Ed. 1996, pp. 286-290.
[22] A. Zielke-Nadkarni, Individualpflege als Herausforderung in multikulturellen Pflegesituationen. Bern: Huber, 2003.
[23] D. L. Wong, M. Hockenberry-Eaton, D. Wilson, M. L. Winkelstein, and P. Schwartz, Wong’s essentials of pediatric nursing. 6th ed., St. Louis: Mosby, 2001, p. 1301 (http://www.nacmedicalcenter.com/en- US/aboutUs/hospitalNews/newsAndArticles/Documents/9c590a7e6d58 4a05a45cb51c2f042e3eFaces1.jpg) (10.5.2015)
[24] D. Stuppy, “Research briefs. The Faces Pain Scale: reliability and validity with mature adults,” in Applied Nursing Research, vol. 11, May, no. 2, pp. 84-89, 1998.
[25] DNQP (Deutsches Netzwerk für Qualitätsentwicklung in der Pflege) (Ed.), Expertenstandard Schmerzmanagement in der Pflege. Schriftenreihe des DNQP. Hochschule Osnabrück: Osnabrück, 2005.