Cultural Aspects of Pain in Childbearing Women
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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