7

Managing Pain

My colleague, Jeff, was not allowed to work on the ward while his mother was an in-patient. The first morning, I cared for Jeff's mother. While walking around the ward to assess the patients under my care, I spoke with her and asked her if she had any pain. She responded, ‘No, I am fine’, to which I replied, ‘Well if you have any pain, please let me know and I can give you some painkillers, if you think you need them’. I then left her and spent time with the other patients, but when I left her bed area to answer the phone, I saw her holding her abdomen and grimacing.

I made my way to her bed and asked her how she was feeling. She again replied ‘Fine’, although her body language showed otherwise. I, therefore, commented that I thought she looked uncomfortable and asked her if she was now experiencing any pain. However, she again replied, ‘No, I'm fine’, but because of her behaviour, I was not convinced and felt that she probably was experiencing some discomfort. I then looked at her drug chart and discovered that she had not had any analgesia for over six hours, but obviously, I did not want to keep asking her the same question over and over again.

I, therefore, took a different approach and sat on her bed and started to talk about how she felt in general. We quickly struck up a conversation about how she was feeling and soon established a rapport. At this point, I gently asked her if she was uncomfortable to which she finally admitted that she was ‘quite uncomfortable’. When I asked her why she had not told me sooner, she replied that she did not want to bother me. I immediately arranged some analgesia for her and emphasized the importance of her telling me if she was experiencing any discomfort in the future.

I didn't think any more of the incident until Jeff arrived on the ward later in the day with his wife and father to visit his mother. We spoke together and I explained how his mother was doing, and I briefly mentioned the incident to him. I felt that, as with many patients, especially the elderly, it was probably due to the fact that she just didn't want to ‘trouble me’. However, Jeff explained to me that this roundabout form of communication (particularly the apparent switching from no to yes [or vice versa] and back again) is found in many cultures, especially those in South-east Asia, but is almost never seen in northern Europe, the USA or the UK.

On reflection, I suppose that this particular incident is perhaps an important issue in cross-cultural nursing. However, I was unaware of this kind of behaviour and probably would have never found out about it, unless I'd experienced it first hand. What it did make me realize, though, was the importance of using a range of communication skills, especially when caring for those from a different culture. It really makes me think about how, as nurses, we should communicate with patients in order to acquire important information from them. I'm now aware that good communication is not just about talking, or even listening: it's also about observing and assessing the situation, so that you use the most appropriate approach and skills (verbal and non-verbal) in that situation.

Vocabulary

1. Grimacing: An ugly expression made by twisting your face, used to show pain, disgust, etc.
2. Rapport: Connection
3. Analgesia: Painkiller
4. Body language: The process of communicating what you are feeling or thinking by the way you place and move your body rather than by words

Reading Comprehension

1. Who was Jeff? Why was he not allowed to work on the ward?
2. ‘No, I am fine.’ Why did Jeff's mother say these words?
3. What made the speaker feel that the lady was experiencing some discomfort? How did she find that she was quite uncomfortable?
4. What is good communication? What range of communication skills are the nurses expected to know?

Language

The above narration uses a number of connectives or linking words like the first morning, while, if, then, and, when, although, therefore, at this point, however, etc. Connectives are used to indicate order (first, above all, etc.); add something (and, more, etc.); compare things and ideas (as, likewise, similarly, etc.); express reason and purpose (as, because, hence, etc.); condition (if, unless, etc.); concession (though, although, etc.); opposing or limiting statements (but, however, or) and contrast (but, however, nevertheless) as well to impart continuity to a narrative.

Pronunciation: Sounds /θ/and/ð/

Some words have /θ/ sound but their derivatives have /ð/.

Say the following pairs of words aloud:

Writing

What, according to you, is the importance of communication skills in the nursing profession?