Culture+and+Pain+Management,+Who+knows+what+to+do?

**Student Number:** n8318760 **Tutor and Time:** Judith Meiklejohn Thursday 1-2pm
 * N ame: ** Elizabeth Ellis



** Cultural Artefact: ** The artefact above is a creative art piece and can be used to portray the ideology of pain, and its role within society as the silent and invisible companion, that does not discriminate, and is universal to all cultural and ethnic groups. The larger than life depiction of the human form appears to show no discerning cultural features and a hollow ‘self’, representing our invisible spirits and disputing the opinion that cultural differences affect the actual sense of pain.

** Public Health Issue **: This discussion will focus on the concept of pain and the cultural differences that affect an individual’s ability to experience and express pain. Some of the main disparities between cultures can be identified by relating them to common social theories. These disparities are not absent from primary service provider and patient relationships. As such, it is important for primary services providers to have an understanding of how their perceptions affect their ability to identify and treat medical issues. This is further complicated by each patient’s response and ability to comprehend the pain management systems already in place within the Australian healthcare system. These issues are further discussed in the literature review below.

**Literature Review:** As discussed above, the Australian healthcare system faces significant challenges dealing the culturally diverse nature of the Australian society. The following discussion explores this issue by combining data and opinions from respected sources and medical journals to provide a comprehensive overview of the problem as a whole. This is done by firstly outlining the extent of Australia’s cultural diversity. Secondly, the way in which different cultures interpret and express pain is discussed and outlined using examples. Finally, the requirement for primary service providers to understand and work with these cultural nuances is discussed.

Australia is very well known for its cultural diversity, with approximately 213 000 new permanent residents calling Australia home in the 2010-2011 financial year, an increase of 2.1% on the year before (Department of Immigration and Citizenship, 2011). Of these new arrivals only 28% came from Westernised countries with cultures that parallel those within Australia. The remainder arrived with more significant cultural differences, including their customs and religions, and in some cases severe language barriers. These differences greatly affect the ability of primary healthcare providers within the Australian healthcare system to properly and equally treat all of their patients.

One particular cultural discrepancy that healthcare providers have to understand is the differences of pain experience and pain management within different cultural settings. Despite any person’s ability to feel pain being comparable to nearly all others, it is a trend in their reactions of expressing this pain and the responses that they expect from others that encourages the existence of set cultural expectations and stereotypes (Carteret ,2011).

From this, it can be established that pain and the behaviour it encourages has social variables, in addition to those biological and psychological (Carteret, 2011). As such, by understanding the factors influencing a patient’s actions, their treatment can be monitored to ensure the correct pain relief is administered. In 2011, Carteret divided the typical responses into two main categories, they were stoic and emotive. The term stoic refers to one’s ability to withhold expressing emotion or complaint, whereas emotive, refers to openly conveying any feelings.

While each patient is an individual, evidence provides an indication that patients from specific backgrounds can be inclined to display specific behaviours. For example, it has been observed that emotive patients tend to originate from Hispanic and Middle Eastern backgrounds. In comparison to their stoic counterparts, who are typically from Northern European and Asian regions (Carteret, 2011). Despite being able to identify origin, it is still a patient’s individual actions that should be considered when reviewing pain management. In order to understand why a culture’s expectations may comprise of ‘poker face’ births, such as those valued within Asian cultures, it is necessary to comprehend their personal incentives. Concentrating on that scenario, it is well known that people of Asian descent value dignified behaviour, however, far less acknowledged are the social repercussions of complaining and drawing attention to one’s self. It is believed that Asian people are raised to value hierarchy, thus to complain of pain to a doctor makes you a nuisance (Carteret, 2011).

Being able to identify a patient’s response is the first step in understanding their cultural background. However, it is not only the patient’s circumstances that effect their treatment, but also the level of understanding held by their healthcare provider. A recent American study involving Caucasian, African American and Hispanic patients with similar injuries noted that, if left to their own accord, all three groups would self administer comparable amounts of pain relief. However, if administered by a healthcare professional, African American and Hispanic patients would generally receive less (Briggs, 2008).

This brings to light the idea of being ‘culturally competent’. In order to be skilled in treating patients from all differing cultural backgrounds, a healthcare professional must be able to take into consideration their own cultural and family values, understand their own personal prejudices of people with differing beliefs, and be accepting of any differences and capable of understanding them (Weissman, Gordon & Bidar-Sielaff, 2004).

The above discussion outlines the diverse nature of the Australian society and the challenges this presents to the Australian healthcare system. The discussion began by outlining the issue then provided examples of how the issue can effect patient treatment using medical research. This outlined the importance and relevance of the issue to primary care providers within the Australian healthcare system. As such, it is clear that training providing understanding within the Australian healthcare system is an integral part of total care management.

Healthcare is an essential element of any community and by being able to understand the multicultural aspects of healthcare; it can be ensured that quality care can be provided to all. However, in order to understand this multifaceted dilemma several details need to be understood. Firstly, identifying exactly who is in need of assistance and what setbacks they are currently facing when consulting with primary care providers, and secondly, by recognising the most effective method of improving the current healthcare system by employing social theories. Together, with these strategies it is possible to promote a more accepting healthcare system for all Australians, without discriminating due to their heritage.
 * Cultural and Social Analysis: **

The first the most important barrier to overcome in relation to properly treating patients from a different cultural background is that of language. Treatment of patients who are unable to properly comprehend health related questions can not only be dangerous for patient health at the time, but also in the future as negative experiences affect their likeliness to want to pursue healthcare again. Therefore, targeting communication, even with simple visual aids, will greatly improve the issue.

In addition to language barriers, the concept of pain and pain management can be significantly different depending on the patient’s cultural background. For this reason, Australia is currently encouraging all health employees to take part in improving their personal aptitude for dealing with patients from different cultures, including being able to understand their own biases and also those of who they are treating. While this initiative is effectively increasing the awareness of these differences, a much more effective method would be to standardise this up-skilling across the entire health workforce (Centre for Culture, Ethnicity and Health, 2010).

Relating the idea of health to social theory and popular philosophies, pain is an ideal focus. It has been noted that pain can be associated with three main philosophies and they are; the Dualism Theory; mind and matter, the Identity Theory; not simply one ‘self’, and the Functionalism Theory; everything is done for physical gain. Each examines the relationship between mind and body. Taking from what was mentioned above and also from the literature review, it is necessary to not only devise a system that will take into account the differing social determinants to benefit the entire population, but to ensure treatment of the individual is the primary goal.

**Artefact Analysis:** As shown above, the artefact chosen to portray the significant cultural health topic gives a somewhat abstract view of how pain can be viewed objectively. It’s seemingly invisible nature, disables any form of discrimination between cultures allowing for equality, something that is quite hard to achieve even today. Using this image as a stimulus for the issues of pain management between different cultures, it is easy to highlight the similarities that all people encompass.

Considering the point of view of a ‘new Australian’, the idea of being concerned by an actual medical condition rather than the possible hassle of miscommunication with the healthcare provider is positive. It would be very encouraging to rid racism and any form of inequality from health altogether.

Becoming aware of the disparity between the treatment of people from different cultures and their own important life values and customs, has greatly improved my own ability to communicate and understand how to factor in other people’s cultural requests, above anything else. To be cultural competent should be the goal of all healthcare workers and the time for total equality should be now.

**References**

Briggs, E. (2008). Cultural perspectives on pain management. Journal of perioperative practice, 18 (Bankston, C. (2011). Hmong Americans. Retrieved 9 October, 2011 from http://www.everyculture.com/multi/Ha-La/Hmong-Americans.html

Carteret, M. (2011). Cultural aspects of pain management. Retrieved 17 October, 2011 from http://www.dimensionsofculture.com/2010/11/cultural-aspects-of-pain-management/

Catlett, E. (Photographer). (2010). Invisible man. [Web Photo]. Retrieved 9 October, 2011 from http://www.howtocopewithpain.org/blog/2995/the-invisible-project/

Centre for Culture, Ethnicity and Health. (2010). Cultural Competence. Retrieved 12 October, 2011 from www.ceh.org.au/culturalcompetence.aspx

Defrin, R., Eli, J., & Pub, D. (2011). Interactions among sex, ethnicity, religion, and gender role expectations of pain. Gender Medicine, 8(3), 172-183. Doi:10.1016/j.genm.2011.04.001

Department of Immigration and Citizenship. (2011). Immigration update 2010-2011. Retrieved 19 October, 2011 from http://www.immi.gov.au/media/publications/statistics/immigration-update/update-2010-11.pdf

National Health and Medical Research Council. (2005). Cultural competency in health. Retrieved 7 October, 2011 from http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/hp19.pdf

Smye, V., Rameka, M., & Willis, E. (2006). Indigenous healthcare: advances in nursing practice. Contemporary nurse, 22(2), 142-154. Retrieved from http://www.contemporarynurse.com/archives/vol/22/issue/2/article/726/indigenous-health-care

The Royal Australia College of General Prctitioners. (2007). Multicultural health. Retrieved 9 October, 2011 from http://www.racgp.org.au/scriptcontent/curriculum/pdf/multiculturalhealth.pdf

Victorian Health Promotion Foundation. (2008). Ethnic and race-based discrimination. Retrieved 9 October, 2011 from http://www.vichealth.vic.gov.au/~/media/ProgramsandProjects/MentalHealthandWellBeing/Publications/Attachments/ResearchSummary_Discrimination.ash

Weissman, D.E., Gordon, D., & Bidar-Sielaff, S. (2004). Cultural aspects of pain management. Journal of palliative medicine, 7(5), 715-717. Doi: 10.1089/jpm.2004.7.715


 * Reflections**

1 Name: Chrisotpher Ng Student Number: n7688687

Hey, I must say I found your article to be the most interesting of all that I read. I definitely found it to be an eye opener to the fact that so many people, girls in particular, are not happy in their own skin. I found the statistics in relation to mental health among young people quite scary, 26%?!? All I could do was think how sad it was to know that even some of my close friends could probably feel unhappy within themselves. I am familiar with the artefact that you chose and think that it was a perfect fit. Great job!

2 Name: Amanda Giang Student Number: n7388187

Hey, I found your article very interesting. Where I come from (small country town), all anybody ever does it drink. It’s the past time for the scarily young and is actively encouraged by those older than them. The idea of people pushing the limits and no longer drinking reasonable amounts is definitely something I have seen, and to be honest I find it very scary. I was unaware of those five Buddhist religion’s precepts until now, and have found myself ‘Googling’ more of their ideals! Thanks you for the great read!