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Intellect

Cultural perceptions of pain must factor into nursing care, says BYU researcher

As cultural diversity increases in the United States, nurses must develop greater sensitivity to the influence of culture on how patients view and cope with pain, says a Brigham Young University researcher.

"The perception of pain and the way patients deal with it changes from culture to culture," says Lynn C. Callister, a BYU professor of nursing. "Nurses need to be aware of cultural background to best assess and treat acute and chronic pain."

For example, a nurse caring for a patient from a Western culture may already know that an expression of pain should be addressed immediately, based on that culture's belief that discomfort of any kind is bad. However, the same nurse may not be aware that research suggests that people in Eastern cultures have a higher pain tolerance and may turn inward instead of asking for medication.

"Neither culture is wrong in the way it deals with pain," says Callister, herself a registered nurse who has studied the cultural meaning of childbirth for 17 years. "But a nurse should know how to evaluate a patient's pain in either situation and properly treat it."

Callister's analysis of existing cross-cultural studies relating to pain appears in the current issue of the journal Home Health Care Management and Practice. The article looks at various cultures' pain tolerances, including attitudes toward childbirth pain and the perception of acute and chronic pain.

The analysis brought together studies that showed that Mexican-Americans view pain as an expected and accepted part of life, that Indian patients living in East India have a higher pain tolerance than those in the United States and that Filipino patients may never mention their pain based on that culture's stoic attitudes.

Additionally, the analysis of childbirth pain studies reveals a cross-cultural attitude that mastering such pain is often viewed as self-actualizing. Women in North and Central America, Scandinavia, the Middle East, China and Tonga who are active in their religious faith seem to accept pain as an inevitable part of life and rely on a higher power for strength.

"Some cultures make pain a very private and personal experience," says Callister. "Others are verbally expressive, sometimes screaming or crying out."

Pain assessment may become problematic when patients and nurses have differing cultural backgrounds, says Callister. To best overcome this gap, nurses should establish a common vocabulary for exploring issues of pain and comfort, with culturally sensitive pain assessment being integrated into the process.

"The meaning of pain for a particular patient needs to be explored," says Callister, emphasizing that stereotypes must be avoided in the process. "Making meaning of pain in the light of cultural background may be a powerful way for patients to cope."

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