Moreover, tell you? You won’t do anything

            Moreover, in African American
Culture, they believe that having a good health is a

and perceived it as gift from God, and in contrast, they perceived illness or
becoming ill as a “disharmony, a result of punishment from improper behavior,
not living to His will or the work of the devil.” (Alvarado, 2008) In addition
to, family is extremely crucial especially when a family member becomes  ill. (Alvarado, 2008) They view the family
member’s illness as a family illness, not like other cultures in where they
view illness of a family member as a personal suffering. Families in this culture
come together as whole and support the member that is ill for its fast
recovery. However, if someone in the family neglects to appear amid that time
when one is ill, they may see that person as not to be caring or not concern in
the well being of that person who is ill. (Richardson, 2012)  Moreover, historically, African American
suffered immense pain due to slavery and oppression in the United States, these
feelings of pain have been carried out throughout several generations and thus they
may exhibit stoicism. “Stoicism stems from the time during slavery, when one’s
grandparents endured immense pain and therefore would not be sensible to
complain or “show” pain when experiencing significantly less pain.” (Alvarado,
2008) Therefore, “these feelings may contribute to subconscious thoughts such
as: “why should I tell you? You won’t do anything about it anyway. Historically
you didn’t care so why do you care to know now?” (Alvarado, 2008) Based on
population survey, “27 percent of African Americans and 28 percent of Hispanics
over the age of 50 reported having severe pain most of the time; only 17
percent of non-Hispanic whites did 7.” (Wyatt, 2013) It is reported that
African Americans experience greater pain severity and duration. In addition
to, “Many Black and Caribbean Canadians believe in the power of healers who
rely strongly on the religious faith of the people and often use prayer and the
laying on of hands.” (Lilley,  2011 p.189)

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      Moreover, as the number of culturally
diverse people continue to increase, it is extremely important for healthcare
providers to acknowledge and have sufficient knowledge about the different
cultures within their society.  In order
to understand one’s culture, it is helpful for a healthcare provider especially
nurses to first reflect upon own’s personal beliefs and values in order to promote
an unbiased relationship with the patients. (Alvarado, 2008) Thus it is
essential to self reflect because this will enable healthcare professionals to
acknowledge and be mindful of any biases and prejudice that one might possess.
Nurses should be able to set aside any misconceptions or prejudice when
delivering care to patients, and should not create assumptions based on what
was learned from researches due to possible generalization.  (Alvarado, 2008) An example of misconception
regarding pain in older people is “as a patient gets older, they experience
more pain.” (Alvarado, 2008) Also, some nurses when caring for a patient with a
drug abuse history, and they were prescribed with narcotics, they are fearful
of administering pain medications as exactly as prescribed because they are afraid
that the patient might have respiratory depression or become addicted. Even
though, substance or drug abuse can be a problem, it is important that nurses
should not form biases against these group of patients and that they must still
attend to the patient’s needs which is providing pain relief regardless of the
patient’s substance abuse issues.

          Furthermore, since some African
Americans are stoic, and wouldn’t complain or express that they are in pain
even if they are experiencing significant pain. It is important for nurses to
assess and ask regarding their pain more frequently and to understand their
pain perception. Also, nurses must empower these patients to report pain
accurately and frequently in order to provide appropriate interventions to
relieve pain.  “The notions of
healing and spirituality are very important in dealing with people within the
context of their culture.” (Wilner, 2008). Also, According to Dr. Payne “healing
needs to involve not just the absence of disease, but also the restoration of
all 3 spheres of body, mind, and spirit.” of (Wilner, 2008) Therefore, nurses must
incorporate a holistic assessment to these patients because spirituality and
healing play a huge role in African American culture. African Americans believe
that no one but God can choose life and demise, that God is in charge of
wellbeing and health, and that health beliefs are the best method to influence
healing, and also they believe that miracles or divine intervention can happen.
In addition to, it is imperative to treat their pain especially if it is
chronic pain since it can meddle with one’s capacity to speak with God and all
the fundamentally vital parts of life such as their role in the family, and in
the society and their occupation. (Richardson, 2012) Since most African
Americans are under treated or not adequately treated with their pain, they
tend to look for  additional pain therapy
or refuse more pain medications as a result of dread of addiction, and also
some African Americans are skeptical that their pain will be adequately treated
due to the historical disparities in the healthcare treatment (history of
oppression) and as a result they rather deal with their pain on their own as
they also view pain as a struggle which needs to be overcome or a type of test
of faith. (Richardson, 2012) According to Cleland, (2005)  “African American and Caucasian cultures tend
to verbally express cancer pain through metaphors. This is to try signify where
their pain is, and what it feels like. Using metaphors gives the healthcare
professional an opportunity to try imagine what the patient’s pain feels like.
-Sharp, hot, stabbing, throbbing, frozen.” (as cited in Richardson, 2012 p.31)
Since African Americans are stoical in regards to their pain expression, they
tend to divert their pain through keeping occupied with activities such as
meditation and with praying. “This is because the patient feels it is not
his/her duty to complain when this pain has been inflicted for a reason.” (Richardson,
2012) Thus nurses, must need to frequently monitor or observe other aspects of
these patients of their pain as they might not verbally express it, or
acknowledge to anyone that they are in pain. 
Nurses must enhance their communication skills and must show sensitivity
especially when interacting with culturally diverse patients in regards to
their pain as pain experience is unique to every  individual. When assessing for pain, it is
important for nurses to ask about their pain history as this would enable
nurses to identify and understand what the pain means to the patient and how she
cope or manage his/her pain previously such as what kind of pain medication the
patient has used, its effectiveness, and also how did the pain influence the
patient mentally, physically or emotionally especially if it is chronic pain.
Since pain experience is unique to every individual, patients are the best interpreter of their
pain and nurses must provide the opportunity to express the patients’ pain in
their own words and ways. Since African Americans are stoic, and often they do
not express their pain verbally, nurses can use the Visual Analogue Assessment
tool together with Visual Rating Tool or a PQRST tool. In their culture, there
is an expectation that women and men are supposed to be strong, it is because
stoicism was rooted from the oppression and slavery that their ethnic group had
experienced historically. (Alvarado, 2008) Therefore, they may not express their pain verbally or
may still express their pain but at a much lower level.


         Morevoer, the pain assessment tool
that nurses could use is the Visual Analogue Scale. “The VAS is a ten
centimetre line. The patient is asked to mark along the line between ‘no pain =
0’ and ‘worst pain imaginable’. After the patient marks it, it is then measured
and documented.” (Richardson, 2012) thus nurse must observe for any non verbal
cues of pain such as “frowning, crying, the patient making worried shapes with their
eyebrows, pale complexion, and possible sweating from intense pain.”
(Richardson, 2012) withdrawal from social interaction or even praying can
signify that they are in pain since they rely strongly to God in the power of
his healing. In addition to, nurses can also use the mnemonic pain assessment
tool of Kernicki  which. is the PQRST
(Provokes, Quality, Region, Severity/Symptoms, Timing, and ask the patient to
rate their pain from 0- No pain to 10- the worst imaginable pain. “If a patient
states their pain is between one to three on the pain scale, then their pain is
said to be mild; from four to six, then their pain is then considered to be
moderate; and pain rated seven or above is considered to be severe or
excruciating pain.” (Richardson, 2012) This would enable the nurse to ask
questions in relation to the patient’s pain and collect accurate data/information
in order for physicians to accurately make a diagnoses.

          Moreover, some nursing interventions
in regards to pain management within this culture include educating the patient
about the importance of pain medication and how it can affect the body or lead to
further complications when pain is inadequately treated and as well as the
therapeutic effects (pain relief)  it is
because some African Americans may refuse pain medications as they fear of
becoming addicted to it, thus it is critically important to include educating
patients factual information about addiction and the difference between
addiction and tolerance in order to subside their fear, and reinforcement
teaching must be initiated. In addition to, according to Alvarado “Past history
of slavery and abuse from other cultures may result in the reluctance to
communicate their level of pain.” (2008) Nurses must talk with the patient and
explore the patient’s feelings, concerns or the meaning of pain to them and
provide adequate teaching regarding pain. Also, nurses must be aware and
acknowledge the culture’s way of managing/dealing with pain such as use of
herbs, folk healers prayer, “laying of hands,” and “speaking in tongues” before
turning to “western” medicine. (Alvarado, 2008) Therefore, nurses should ask
and review about the methods of pain management that they have done before looking
for assistance from the modern/western medicine. Also, it is important for
nurses to remember that family is extremely important within this culture
especially to one’s recovery from pain experience, thus nurses must include
family members in any healthcare decision making, healthcare treatments of the
patient and also during patient education to achieve patient optimal outcomes.

         In conclusion, it is crucial for
nurses to gather factual, accurate and complete data when assessing patient’s
pain as pain must be controlled and managed timely and appropriately since Comfort
is one of the top priorities when delivering high quality of patient care.
Since pain experience is solely subjective and comes with unique pain
expression to every patient, pain assessment must not be generalize as this
would result to under treated pain and is risk for injuries or complications.
Nurses must work with patients when establishing their plan of care specific to
each patient especially in regards to interventions (ranging from medications
to alternative or complementary therapies) to relieve pain, and evaluate the
effectiveness of the chosen interventions, and as well nurses should incorporate
patient’s health beliefs when planning for pain management interventions. It is
also important for nurses to use creativity when assessing patient’s pain and
utilize a pain assessment tool which best fits the patient’s cultural needs.
Nurses must be able to recognize pain expressions or, verbal and non verbal
cues of pain in a patient specific to each culture to be able to provide
culturally competent pain assessment. “Being capable of providing proper pain
relief will not only aide the patient in healing but will also allow one to
gain a positive hospital experience..” (Alvarado, 2008)