The+Unnoticed+Scream

Name: Daniel Pincus Student Number: n8298475 Tutor: Judith Meiklejohn

This Page will look at the importance of emergency healthcare professionals (EHP) being culturally aware when dealing with patients who are experiencing pain


 * Artefact**



This famous Norwegian painting is the artists interpretation of a person experiencing a pain. Not only do many people look at this painting and think of someone who is experiencing pain, but many people have tried to repaint their own interpretation of this timeless image. The different interpretations of this image represent that each person has their own personal way of dealing with and expressing pain. Each persons culture and beliefs influence their own interpretation of pain. With only 500 thousand of over 22 million people being indigenous to Australia (Australian Bureau of Statistics, 2011) there is a large verity of cultures and beliefs that emergency health care professionals need to deal with.


 * Public health issue:**

The Major issue here is, that the if a health care worker isn’t culturally sensitive then they could insult the patient they are trying to help. Depending on the level of insult, the patient and health care worker could loose rapport, or the patient could no longer trust the health care workers, which could lead to serious issues. The reason this could lead to serious issues is that the worker does not just represent them selves but they also represent the organisation they work for, for example if its a paramedic they represent the ambulance service. This could lead to the patient not wanting to need to call the ambulance again, which could lead to serious harm being caused.

__**Literature review:**__ Australia Is a growing multicultural society. Earlier this year the Australian Bureau of Statistics (2011) stated that there are currently 275 different cultural and ethnic groups within Australia at the moment. Each of these groups has their own way of expressing and dealing with pain (Mossey, 2011). Not only this but some groups also try to control who treats who, some Islamic cultures only let women treat other women. So with all the different cultures in Australia it is important for EHP’s to understand that some people are from different cultures and this needs to be respected where possible.

Bonham (2008), looks into the cause and solution for the disparities in how different cultures express and treat pain. It was found that every person reacts to and experience pain in their own unique and individual way. A persons life experiences, cultural norms, environment all have their role to play in how a person experiences and expresses their pain. After talking to patients who are from different cultures who experienced pain in emergency departments, Bonham (2008) came to the conclusion that some people will be to nervous to return to emergency departments when they experience the same pain again. As some of the patients that where interviewed where quite sick in all likely hood they would need to return to the emergency department to get some form of treatment, so if they didn’t want to return then there could be some serious complications with their conditions.

Edwards, Doleys, Fillingim & Lowery (2001), showed that patients from different cultures and ethnicities have different pain tolerance levels. They took a two different ethnic groups who experience some form of chronic pain and measured the patients tolerance to controlled noxious stimulus. This study found that there was a significant difference between the two groups pain tolerance levels. Edwards, Doleys, Fillingim & Lowery (2001) study showed that it is important for EHP’s to talk to the patient and find out as much as they can about the pain they are in before treating them instead of assuming they are in pain.

Kellner (2011), found that in German hospitals patients in who have migrated to Germany or are first generation Germans experience more pain then those who have have a longer history in Germany. It was found that the reason for this is that the health care workers are not used to dealing with patients from their culture. This means that they are unable to notice how the patient expresses the pain they feel so the pain they experience goes untreated. The other explanation that was suggested was that the healthcare worker noticed that the patient was in pain and treated them the same way that they treat other patients. No matter the cause this is an issue that needs to be fixed.

Mossey (2011), looks into the issue of different cultures and ethnic groups experiencing pain differently. It is found that almost half the population of America will experience pain at one point or another in there life time. The issue is that minorities are over represented in this section of the population. This literature review article found that non-Hispanic whits are less likely to be under treated when experiencing pain then racial and ethnic minority groups. People who are from different cultural backgrounds consistently received less then adequate treatment for pain. Even when controlling age, gender and pain intensity it was found that the people from minority groups didn’t receive the proper level of treatment for their pain. It was found that pain intensity was consistently under reported in these patients. Mossey (2011) suggests that the under reporting of pain in patients from minorities in the population is the key reason for the lack of adequate treatment. The reason for the under reporting was linked to the health care workers being unable to recognise the way that patients who are part of minority groups express the pain they are in. While concluding Mossey said that patients who associate with minority groups need to be empowered to accurately report pain intensity levels, and the healthcare workers need to be more culturally sensitive.

Emergency health care professionals need to be culturally sensitive when treating patients who are experiencing pain. The reason for this is that Australia has many different cultural groups (Australian Bureau of Statistics, 2011), and each group has its own way of expressing the pain they are in (Mossey, 2011). E Bonham (2008), found that not only do different groups express their pain differently, but everyone has their own unique way of expressing the pain that they are in and this is influence by their culture and ethnicity. Not only this but different cultures and ethnic groups have different pain threshold, as was found by Edwards, Doleys, Fillingim & Lowery (2001). Kellner (2011) and Mossey (2011), found that in hospitals patients who are from minority groups experience pain more severally then the majority of people. Kellner (2011) suggested that it was because they where not receiving enough pain relief, this was part of the grater issue. Mossey (2011) found that the healthcare professionals where unable to accurately identify the severity of the pain that patients, from minority groups, are experiencing. So physicians where consistently under-recording the level of pain that their patient was experiencing, so inadequate treatment was provided. This was related to the physicians inability to be culturally sensitive. This is a major issue within all areas of healthcare, not just emergency healthcare professionals.

__**Cultural and Social Analysis:**__

There are a number of social and sociological theories that are can explain why healthcare professionals need to be culturally sensitive. There are also theories that propose a reason why some Health care professionals may initially struggle with being culturally sensitive.

The first socials theory that explains why it is important for health professionals to be culturally sensitive is, the theory of globalization. This refers to the growth of the world, both technologically and socially. Another way of looking at it is everything in the world getting closer and easier to access. Globalization explains why so many people from different cultures are willing to migrate to Australia. Because so many people are migrating that is why Australia has 275 different cultures and ethnic groups. So, because of globalization, when healthcare professionals are treating patients in pain they must be culturally sensitive.

Feuerbach theory, provides another reason why health care professionals need to be culturally sensitive. In his theory Feuerbach prosed that people show pain differently because of how their culture will judge them (Giddens, 1971, p.5). This has now been confirmed by the study conducted by Edwards, Doleys, Fillingim & Lowery (2001). Feuerbach theory on its own isn’t enough to explain why it is important for health care professionals to be culturally sensitive. When combined with globalization theory it is obvious that health care professionals need to be culturally sensitive when dealing with patients who are experiencing some form of pain. Because with the number of cultures in Australia growing due to globalization and according to Feuerbach theory everyone expresses their pain differently, because of their perception on how their culture will view them. So emergency healthcare professionals need to be culturally sensitive so they can help.

Because of the theory of globalization and Feuerbach theory in Australia today it is important for all health professionals to be culturally sensitive when dealing with patients who are experiencing pain.

The reason some healthcare professionals may struggle with knowing how much pain a person from another culture is in can be explained using social and sociological theories. Cognitive social theory, is the theory that a persons knowledge and experiences can be related to people they are observing. As already shown everyone experiences and expresses pain differently, so when a healthcare worked applies cognitive social theory to a situation they could be making the situation worse not better which is against their intentions.

It Is important for all people working in pubic health to be culturally sensitive for a few reasons. Firstly globalization, this refers to the growth of the word, both technologically and socially (Princeton). This relates to the issue because it is reason that this even is an issue. Because if there wasn’t globalization people wouldn’t be willing and able to migrate to another country, and bring with them a rich culture that is different to what some people are use to. Feuerbach theory, that people show pain differently because of how their culture will judge them (Giddens, 1971, p.5), is another cause of this issue. Because of everyone showed their pain the exact same way then everyone would know how much pain everyone else is in. Because of the theory of globalization and Feuerbach theory in Australia today it is important for all health professionals to be culturally sensitive when dealing with patients who are experiencing pain.

__**Artifact analysis, and learning reflection:**__

The 1893 painting by Norwegian Edvard Munch “The Scream”, is an expressionist painting of someone screaming. Being an expressionist painting Munch painted his expressions and feelings when he imagines someone screaming. As with all famous paintings people try to do their own expression of this masterpiece, each adding their own personal touch, some are similar and some are different. One thing is common it is their own expression of the emotions that they think of when they think of the title “The Scream”. These emotions that they try to capture in their paintings are based on their own culture and life experiences.

When someone is in pain the way they express this is based on their culture and life experiences. As when they are doing their own recreation of the painting some people express their pain in similar ways, and some in different ways. Researching this article has reinforced in my mind the importance of communicating with a patient as an emergency healthcare worker.

Currently I am studying Paramedics. Realising that the way everyone expresses their pain may not be the way you expect the to, is easier said then done. In some of the research articles that I studied showed that even experienced doctors and nurses struggle with this. So it is important to go to every new patient with a blank slate and not assume anything.

__**Reference list:**__ Australian Bureau of Statistics. (2011). //Australian Standard Classification of Cultural and Ethnic Groups (ASCCEG)////.// Canberra, ACT: Australian Government Publishing Service.

Bonham, V.L. (2008). Race, Ethnicity, and Pain Treatment: Striving to Understand the Causes and Solutions to the Disparities in Pain Treatment. The journal of Law, Medicine and Ethics. 28 (s4) 52-68. DOI: 10.1111/j.1748-720X.2001.tb00039.x retrieved from: __[|http://web.ebscohost.com.ezp01.library.qut.edu.au/ehost/detail?sid=68439428-c37b-468a-aa63-aa36ff1278fa%40sessionmgr104&vid=1&hid=113&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#]__

Doleys, D.M., Edwards, R.R., Fillingim, R.B., & Lowery, D. (2001). Ethnic Differences in Pain Tolerance: Clinical Implications in a Chronic Pain Population. Psychosomatic Medicine. 63, 316-323. DOI:0033-3174/01/6302-0316 retrieved from: []

Giddens A, (1971). //Capitalism and modern social theory: an analysis of the writings of Marx, Durkheim and Max Webber//. Cambridge, UK: Press syndicate of the university of Cambridge

Kellner, U. (2011, September, 22) Migrants suffer pain more intensely. European Hospital retrieved from: [|__http://www.european-hospital.com/en/article/9018-Migrants_suffer_pain_more_intensely.html__]

Mossey, J.M. (2011) Defining Racial and Ethnic Disparities in Pain Management. Clinical Orthopaedics and Related Research. 469 1859-1870. DOI 10.1007/s11999-011-1770-9 retrieved from: [|__http://www.springerlink.com.ezp01.library.qut.edu.au/content/mt475822t15wt606/fulltext.pdf__]