Cultural Aspects of Pain in Childbearing Women

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As the American population increases in ethnic diversity, nurses must prepare to care for women from various cultures. The American Nurses Association has stated that a is vital at all levels of nursing. Culture is known to affect the patient's perception of pain and the nurse's inference of pain in the patient. Pain is expected in childbirth, and nurses should learn how culture influences individual women in their expression of pain. Because each woman is unique, nurses must combine information about culture with clinical assessment of the patient to provide culturally sensitive care. JOGNN, 25, 67–72; 1996.

Section snippets

Transcultural Nursing

An understanding of how pain varies for women of varying cultures and how to best provide appropriate nursing care begins with an understanding of some concepts from the field of transcultural nursing. The American Nurses Association (ANA) recognized the importance of these ideas in its Position Statement on Cultural Diversity in Nursing Practice, 1991 (ANA, 1991). This document declared that a knowledge of cultural diversity is

Sensitive nursing care and appropriate client advocacy cannot be

Cultural Concepts

Culture has been defined by many writers. Barnouw, in his thorough review of culture and personality, makes an important point with this definition: "Culture is the way of life of a group of people, the complex of shared concepts and patterns of learned behavior that are handed down from one generation to the next through the means of language and imitation" (1985, p. 5). Highlighting the words leartied behavior, emphasizes that learned patterns are only relatively fixed because culture can be

Pain and Culture

Culture is a well known influence in the expression and perception of pain and a mediator in the inference of pain in others. Pain is a subjective experience of physical, psychologic, or spiritual experiences and can be modified by neurochemistry, cognition, and sensory and socioenvironmental factors. Social scientists and clinical researchers have reported strong associations of culture with pain responses, beliefs, and behaviors.

In the 1940s, Chapman and Jones performed some of the pioneering

Evaluating Pain in Childbirth

"Pain in labor and childbirth is expected by some women in all societies but may be interpreted, perceived and responded to differently" (Kay, 1982, p. 17). Chinese society values silence, and women experiencing the pain of childbirth typically believe they will dishonor themselves and their families by loud or wild response to pain. In Mayan society, women get support and encouragement during each contraction; however, if the women becomes overwrought with pain and fatigue, she may find

Clinical Application

Experiencing intense pain can impair one’s ability to think clearly and make decisions. The obstetric nurse may first encounter a patient when she in the throes of labor pain. The anxiety provoked by hospital admittance or illness is magnified when it occurs in the context of an unfamiliar culture. Nursing techniques that decrease feelings of alienation will increase the patient’s and family’s comfort and decrease anxiety.

It is helpful to identify in advance the most commonly encountered ethnic

Verbal and Nonverbal Communication

For women who are not fluent in the local language, the nurse should speak slowly and clearly. It is not necessary to speak more loudly. Intonation also can be effective in getting across a point when the language is not understood. A calm, soft voice is soothing; a clear, friendly voice can instill confidence; and a firm, direct tone sometimes can help the patient overcome fear and panic. Some cultures have defining qualities of speech and nonverbal communication that may be radically

Tools

When language is a barrier, it can be helpful to use visual graphs or scales. Check with the pediatric or anesthesia department in your institution to see if they use a visual pain scale. There is a color pain scale, which is commonly used in pediatrics. One visual analog pain scale uses a slide rule that can be used to assess pain in women who can not describe their pain in words. This tool can be helpful during the postpartum period for properly tailoring intravenous or epidural

Postpartum comfort

A number of culturally specific practices may influence comfort for postpartum women. Comfort requires meeting physical and emotional needs immediately after delivery. Acceptable foods and beverages for the postpartum period vary across cultures. In some Western hospitals, the common offering after delivery is a tall glass of ice water or a soda. However, many Asian women may want a warm beverage if they believe in a yin-yang theory of health and illness. After delivery, they believe they must

Supporting Cultural Sensitivity

Does your hospital, birthing center, home health agency, office, or nursing school meet the spirit of the ANA position statement of cultural diversity in nursing practice? Nurses can assess the sensitivity of the clinical environment by honestly answering the questions listed in Table 2. Evaluating existing barriers is the first step toward improvement.

Anyone working in perinatal nursing and wishing to improve understanding of women and families of other cultures cannot do better than to begin

Conclusion

Some nurses may think that learning specifics about other cultures will increase stereotyping and lead to less individualized treatment. Galanti (1991, p. 2 ) explains how generalizing and stereotyping may appear similar but function differently. A stereotype is an endpoint: an assumption about a person is made based on some common information about the person’s group of origin, and one acts on that assumption, whether or not it is accurate for the individual. A generalization is a beginning

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