Concept Analysis Paper on Pain
Concept Analysis Paper on Pain
Concept Analysis Paper
Purpose of Assignment:  Discover the process of concept analysis and its importance in theory development.  The student will choose and analyze a concept of importance to nursing by synthesizing literature related to the chosen concept.
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Assignment:  Submit a scholarly 10-12 page Paper that clearly and accurately addresses the following:

Select a concept
Determine the aims or purpose of analysis? What will be achieved by analyzing the concept you selected?  Why is it important to understand this concept?
Identify all uses of the concept that you can discover. Thoroughly search the literature for how this concept is defined and how it is used in the literature.  A total of four different sources are required and one reference must be from a different discipline other than nursing (sociology, psychology, theology).
Determine the defining attributes of this concept. Concept Analysis Paper on Pain.
Identify model, borderline, related, and contrary and compare how they differ from the concept you chose.
Identify antecedents and consequences of the concept.
Give an example of any empirical referents used to measure this concept. (Tools or surveys?)
Describe how the concept will be useful in your nursing practice.

Concept Analysis and PowerPoint Grading Rubric

Criteria
Possible Points

1. The aims of the analysis are clearly identified
10

2. A thorough literature review is completed using at least four different sources with at least one being from a different discipline
10

3. Defining attributes are listed.
15

4.  Model, borderline, related, and contrary cases are listed and compared with the chosen concept
Concept Analysis Paper on Pain
 
10

5. Antecedents and Consequences are listed and explained
10

6. Empirical referent(s) are listed and explained
10

7.  Description of how concept is used in Evidence Based Practice
10

8.  PowerPoint of 10-12 pages submitted with Paper
15

9.  Correct APA and scholarly grammar style
10

10. Timely submission, 5 points are deducted for every day late.

Total points
100

 
Introduction
Most patients who visit primary healthcare providers to seek for medical help often present with pain as a key symptom. Pain is an extremely stressful and unpleasant feeling which negatively impacts one’s quality of life with significant emotional, physical, psychological and social effects. Apart from impacting individuals, families, and society at large, it also increases healthcare-related costs (Watson & Sminkey, 2014).  This explains why it is a major issue in the American healthcare system. Researchers in the fields of nursing, sociology, and philosophy have studies the concept of pain with most studies focusing on how to measure pain, pain outcomes and how patients experience pain. According to existing literature pain cannot be completely controlled either with the use of medications or technology. Inadequate knowledge of pain management among healthcare providers and the concept of pain are potential reasons for the currently existing gaps in practice.
Concept analysis helps to clarify concepts that are either poorly or vaguely understood in theory and practice for the development of more specific and practical descriptions. An investigator can later construct and tests hypotheses which precisely reflect the associations which exist between theoretical concepts. Similarly, the findings obtained from a concept analysis are essential in developing research instruments or guidelines for interviews when refining some of concepts in a theory that may appear to be ambiguous. In this paper, the concept analysis of pain will be analyzed since it is an issue of public health significance for healthcare professionals and patients. Literature also reveals that unrelieved pain has numerous consequences which negatively impact care.
Aims/Purpose of Analysis
Utilizing the concept analysis approach by Walker and Avant, this paper aims at analyzing the concept of pain.  Attributes used to define pain, the antecedents which influence how pain is perceived and the resultant consequences of pain as a response will be discussed. The empirical referents of pain will also be discussed. Pain is the commonest symptom that prompts individuals to frequently visit primary healthcare providers. It is also inarguable that, there are other concepts such as the concept of fear and suffering which have a close association with the concept of pain which can promote misunderstandings in the clinical setting. However, with this concept analysis, it will be possible to distinguish it from interrelated concepts and promote the best care from healthcare providers. The literature used in this concept analysis was obtained from the online library using CINAHL scientific database and online literature.
Uses of the Concept
Pain is described as i) a form of grief, trouble, sorrow or mental suffering iii) a physical or mental sensation felt by an individual when he/she is hurt ii) a form of distress/suffering iv) suffering in accomplishing a difficult task according to the OED (Oxford English Dictionary). It is a feeling that exhibits agony and sorrow which occurs when specific nerve endings get stimulated (Exhibit, 2014) according to the description from the According to the definition from Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing and Allied Health. It is a warning sign of damage to tissues which signals an individual to pull out from a source.
Philosophical Perspectives of Pain
Some of the great philosophers whose pain perspectives influenced the analysis of this concept are: Aristotle, Plato, and Descartes’. Plato emphasized how both peripheral stimulation and emotional experiences within a person’s soul influenced pain (Doleys, 2017). This idea was later integrated by Aristotle while discussing pain and sensation. According to Aristotle, pain is an unpleasant feeling that is opposite to pleasure. Descartes’ on the other hand emphasized a lot on the connection which exists between the emotion, thoughts and how it’s related to pain (Doleys, 2017). He explained that pain is both internal and external as an emotional feeling and psychological stimulus respectively.
Theoretical Perspectives of Pain
The psychological theory and pattern theory can be used to describe pain from a theoretical perspective. The pattern theory clearly explains that, to perceive pain, three interactive cerebral processes should be involved (Watson & Sminkey, 2014). These processes are: sensory, motivational and cognitive. The sensory process involves the transmissions by nerves from peripheral to the higher centers of the brain via the spinal cord. On the other hand, the motivational process is that which provokes motives and an aversive drive. Lastly, the cognitive process is that which influences the response strategies and may involve activities in attention, culture, and anxiety (Kumar & Elavarasi, 2016).
According to the behavioral/psychological theory, a lot of emphases is laid on the roles of a person’s surrounding environment, culture, cognition, personality, emotional and psychological factors. Therefore, pain can be learned from the conditions of either operant or a respondent (Kumar & Elavarasi, 2016).  In the former, pain is a response to environmental cues with consequences, in the latter, an antecedent stimulus elicits pain. As a learned stimulus, some of its responses can either by through superstitious and avoidance learning or subjective reinforcement.
Nursing Professional Perspective  
The IASP (International Association for the Study of Pain) defines pain as a feeling that a subject experiences it is and occurs whenever he/she says it does. It is an idiosyncratic and unpleasant emotional or sensory experience related to damage to tissues since every person applies it based on individual experiences associated with injury (Cohen, Quintner & van Rysewyk, 2018).  Some researchers, however, argue that not all pain is distressful and unpleasant since it can signal both negative and positive functions. For instance, in cases of injury, pain is a warning sign for potential trauma to tissues. Pain is described as a subjective experience of severe discomfort and an uncomfortable sensation in nursing diagnosis (Williams& Craig, 2016).  Thus, from a professional perspective, pain response and sensation is highly dependent on the physical stimulus and is influenced by psychological, social and cultural aspects.
Uses in Sociology  
According to the sociological viewpoint of pain, pain experiences should incorporate automatic responses, sensation, and feelings. Cultural and social patterns of an individual are believed to significantly impact on how an individual experiences pain. This can best be described through the attitudes of acceptance and expectance which can be learned from peers, parents, and siblings (Lukewich et al., 2015). Sociology focuses more on response to pain as compared to the reaction to pain which widely based on behavioral and emotional aspects. Besides, there are particular social circumstances based on an individual’s cultural background which influence a person’s response to pain (Kumar & Elavarasi, 2016).
Defining Attributes
These are the primary features linked to a concept for it to be properly explored.  The most identifiable defining attributes of pain are:

i) an unpleasant experience that causes extreme distress that originates from physical perception and results to both negative and positive meanings ii) an individualized human experience iii)a sensational state with emotional, behavioral and psychological aspects iv) mental and physical responses to a stimulus v) individualized responses influenced by socio-cultural factors, personality, emotions and the surrounding environment (Doleys, 2017).

Cases
Model Case
A model case is that which incorporates all of a concept’s defining and critical attributes. The following is a perfect example:
Mrs. Thompson, a 38 year-old African American recently diagnosed with colorectal cancer and had a planned colostomy as recommended by her surgeon. During hospitalization to undergo the planned surgery, Stacy, a RN who was taking care of her noted that she often lay on the bed with bent knees with tightly held arms close to her chest. Upon making an inquiry, Stacy also noted that although she cooperated, her eyes remained closed. A physical exam of her vital signs revealed that the PR and BP were slightly elevated.
Thompson informed Stacy that despite being in severe pain that radiated to the lower outer abdominal quadrant. This prompted Stacy to immediately administer pain medications. One hour later, Stacy questioned how Thompson felt and she replied, “I feel better.”  For around six seconds, Thompson paused and said, “One year ago, I had a bloody stool and abdominal pain during bowel movements. I was scared that I could have an advanced form of cancer. Later on, I was diagnosed with colorectal cancer. I must admit that the genes in my family were bad. My paternal grandmother died of cervical cancer, my aunt died of endometrial cancer and my sister died of leukemia. Here I am diagnosed with colorectal cancer.” Shaking his head, he continued, “Sooner than later, I was certain of what would happen to me and I openly admitted the state of affairs Concept Analysis Paper on Pain. I am happy that I was not married since I would have left my husband and children vulnerable in this journey of sickness.
The case described clearly depicts all the attributes of pain. Mrs. Thompson complained of pain, positioned herself protectively and demonstrated pain on her facial expression. Her behavioral, verbal and non-verbal responses revealed that the feeling she experienced was not only distressful but also unpleasant.  Similarly, she tried to avoid learning how to respond to pain which is a sign of mental response to pain. The indication to undergo colostomy following the diagnosis of colorectal cancer signified physical damage of tissues from the pain stimulus. Mrs. Thompson was suspicious of her cancer two years ago when she had symptoms of persistent abdominal pain and stool in blood.  The cultural and social dimensions of pain were illustrated by Mrs. Thompson’s response to bad familial genes. African Americans generally consider cancer to be an incurable condition which causes severe physical pain. African Americans also believe that a responsible woman should care for her husband and family. Although she was diagnosed with a severe form of cancer, she was comfortable that she wasn’t a burden to her family (Doleys, 2017).  Based on her responses, she has accepted her pain and illnesses. This has likely been influenced by cultural and social factors, her environment, personality and experiences in the past Concept Analysis Paper on Pain.
Borderline Case
A borderline case does not have all of a concept’s defining attributes.  A perfect example of a case scenario that reveals a borderline case is as follows:
FG is a 56-year-old Asian American who was a religious leader diagnosed with esophageal that in its advanced form. During routine care, the nurse who attended to her noted that his eyes were always closed and that he maintained a specific position which gave him comfort  his left side with bent legs. He was very spiritual, hopeful and faithful. When with his family, they occasionally prayed together. When questioned how he was doing, FG always replied that he was fine. He also denied experiencing pain and appreciated her concern Concept Analysis Paper on Pain. His PB and PR were slightly elevated. The nurse was always curious about FG’s response to pain since her clinical knowledge informed her that patients whose cancer has metastasized often experience some degree of pain which requires pain medications.  The nurse became curious about why FG did not have this response and raised this concern with him. FG responded, “Mine is a negligible physical discomfort which is incomparable to the discomfort Jesus experienced when he died for our sins on the cross. I wouldn’t mind experiencing the same suffering for God’s love.” Two days later, FG died.
The case clearly lacks all of the defining attributes of pain. FG’s behavioral responses demonstrated pain although this was never verbalized. The mental sign of pain was also revealed by learning the behavior of avoidance. When the patient’s family visited, they fellowshipped together; a social pattern within the family that influenced the responses of the patient to pain. How the Asian-American culture influences FG’s response to pain was not revealed. Instead, family and religious factors had a lot of influence on FG as compared to other factors. Concept Analysis Paper on Pain.
Contrary Case
This case does not have any of the primary defining characteristics of a concept. A perfect example of a contrary case is as follows:
Ivy is a 1and a half yrs. She was brought to the outpatient pediatric clinic in her mother’s and father’s company for routine immunization.  Upon arrival at the facility, Ivy was fearful and had a lot of anxiety thus; she tightly held onto her mother and couldn’t remain calm. When an attending nurse tried to start a conversation with her, Ivy started crying and acknowledged that she didn’t anyone close to her apart from her mother. She persistently cried and asked her mother to return home.
This case example has no defining attributes of pain. On the contrary, the classical concepts that it presents is that of fear. Fear usually occurs as a reaction either as an event or a particular form of danger. Immediately the threat is removed, fearfulness is also forgotten. Ivy is fearful of what will happen in the clinic since she remembered her past experiences in the clinic Concept Analysis Paper on Pain. It is also likely that she remembered she was at the clinic for immunization which will result in pain.
Antecedents and Consequences
Antecedents
            Antecedents refer to incidences which occur before a concept. The most notable antecedents are cultural, environmental and personal values which are interrelated.   The environment harbors a pain trigger which can affect an individual’s mind, body or both resulting in significant damage of tissues. A person’s attitude and knowledge as it relates to an event have an essential role in pain perception. This may also be determined by pain experienced in the past, pain acceptance or expectance and coping mechanisms (Watson & Sminkey, 2014).  Personal values are determined by a person’s current status physically and emotionally, gender, personality, and socioeconomic status. The emotional aspect is primarily characterized by the levels of anxiety and stress such that in high levels, pain can easily be felt and vice versa. Besides, a person whose attitude towards pain is optimistic makes use of positive methods to address pain and vice versa. Women’s sensitivity to perceiving pain is higher as compared to men thus, the latter are openly allowed to express it (Doleys, 2017) Concept Analysis Paper on Pain.
The socio-cultural viewpoint reveals that pain can be discussed in different ways depending on one’s socio-cultural status.  A perfect example is given by Doleys (2017) whereby, individuals with a high socio-economic status express their pain more and are aware of it when compared to those from a lower socioeconomic status. As another antecedent of pain, cultural values shape how individuals from specific cultures perceive and respond to pain.
Consequences
Based on Walker ad Avant’s concept analysis approach, consequences refer to incidences that occur as an outcome of a concept. The consequences of pain can directly be associated with how an individual reacts to and its subjectivity.  The reaction to pain can best be explained from a physical and biological perspective whereby, the behaviors can be categorized as either a voluntary or involuntary response (Bastian et al., 2014).  Involuntary responses are unconsciously controlled by the autonomic nervous system and are non-verbal. These may include changes in the heart rate and heart rhythm and reflex reactions. On the other hand, responses that are voluntary at are consciously controlled and involve motor activity. They involve both non-verbal and verbal reactions such that, an individual can cry, moan or change position for relief (Bastian et al., 2014). The verbal perspective can be expressed using the following symbols: interpersonal, intrapersonal and complex communication.
The other consequence of pain is meaning development for the pain experienced.  A person can transfer pain encounters and positively or negatively give to it meaning and this determines how they cope with pain. Thee major processes used to seek for the meaning of pain are widely used namely: understanding the immediate causes, the immediate effects and lastly the ultimate causes (Bastian et al., 2014). Although healthcare providers are less likely to be informed on the meaning of a pain experience, the meaning will significantly impact a person’s interaction with the environment and how they relate with others Concept Analysis Paper on Pain.
Empirical Referents
Empiric referents provide an explanation on the best strategy to measure pain and how the concept should be in reality. Based on this analysis,   is inarguable that the attributes may be abstract which explains their real presentation and can be used to develop measuring tools and instruments. Pain is a feeling that is distressful, unpleasant and uncomfortable. As described by Lukewich et al., (2015), it’s the most effective and reliable indicator based on a patient’s verbalization. Concept Analysis Paper on Pain However, there are case scenarios where verbalization may not be enough probably due to restricted verbal abilities. Pain should be measured based on where it is located, its quality and intensity. Assessments can be completed through behavioral cues such as being restless, avoiding movement or crying.
A widely recommended tool that can be used to measure pain is the McGill Pain Questionnaire (Lukewich et al., 2015). It is an assessment tool which comprises of three pain measures namely: the current intensity of pain, the index of rating pain, and the selected number of words. A numerical rating scale can also be used to measure the severity of pain where a patient is asked to rate his pain on a scale of 1-10. The verbal rating scale is another effective measure of pain. It requires a patient to fill a questionnaire that describes the intensity, location and severity of their pain more comprehensively to improve provider’s knowledge in making a diagnosis.
Application In Nursing Practice
Nurses have an ethical responsibility to manage patients experiencing pain and the resultant consequences of unrelieved pain in clinical practice.  In the recent past, fulfilling this ethical obligation was met with numerous constraints including deficits in knowledge, moral disengagement and biases. However, the knowledge gained from this pain concept analysis will be used in the clinical setting to identify patients’ origin and perception of pain, how they response to the pain stimulus and some of the most effective coping mechanisms used by patients for relief.  Since pain is a subjective experience, this knowledge will be applied in determining the cultural, environmental and personal values that influence a patient’s perception and response to pain to promote culturally competent care. In order to successfully implement effective strategies to manage pain, knowledge on the concept of pain is mandatory. This benefits both the patient and healthcare providers and result to better health outcomes. Concept Analysis Paper on Pain.
 
References
Bastian, B., Jetten, J., Hornsey, M. J., & Leknes, S. (2014). The positive consequences of pain: A biopsychosocial approach. Personality and Social Psychology Review, 18(3), 256-279
Cohen, M., Quintner, J., & van Rysewyk, S. (2018). Reconsidering the International Association for the Study of Pain definition of pain. Pain reports, 3(2).
Doleys, D. M. (2017). Chronic pain as a hypothetical construct: a practical and philosophical consideration. Frontiers in psychology, 8, 664.
The exhibit, D. (2014). Excerpt from Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, & Allied Health (5th) Concept Analysis Paper on Pain.
Kumar, K. H., & Elavarasi, P. (2016). Definition of pain and classification of pain disorders. Journal of Advanced Clinical and Research Insights, 3(3), 87-90.
Lukewich, J., Mann, E., VanDenKerkhof, E., & Tranmer, J. (2015). Self‐management support for chronic pain in primary care: a cross‐sectional study of patient experiences and nursing roles. Journal of advanced nursing, 71(11), 2551-2562.
Pain. (n.d.). In the Oxford English dictionary. (2nd. ed.).
Watson, A. C., & Sminkey, P. V. (2014). Pain management: Screening and assessment of pain as part of a comprehensive case management process. Professional case management, 19(3), 126-134.
Williams, A. C. D. C., & Craig, K. D. (2016). Updating the definition of pain. Pain, 157(11), 2420-2423. Concept Analysis Paper on Pain.