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Transforming Acute Pain Experience Into a Pain Score: The Challenges

  • Author / Creator
    Slomp, Florence
  • BackgroundThe assessment of acute pain due to trauma (APT) in adults is pivotal to clinical decision-making for optimal pain management. Clinicians are expected to employ validated measurement tools, such as the Numerical Rating Scale (NRS), to examine the complex and unique phenomenon of pain of each patient they encounter in practice. Although we currently know much more about the lived experience of pain, we need to continue to refine and broaden our collective understanding of pain assessment. Ensuring that pain assessment accurately and effectively reflect the patient’s experience is an important component of pain assessment. By exploring how the experience of pain is transferred into a pain score, this exploratory study may provide clinicians with a deeper and richer understanding of the patient’s experience. In so doing, this exploration could possibly reveal clinical insights for clinicians to consider for pain management. Specifically, a preliminary exploration and analysis would provide a better conceptual understanding of how patients take their complex, lived experiences and reduce them to a single data point for the NRS. Closely related to a person’s experience of pain is the meaning they attribute to their pain. Exploring how meaning interacts with lived experience of pain and the subsequent scoring of it in a pain assessment could also extend our understanding of the pain experience. Therefore, the research questions are How do people with acute traumatic injuries determine their NRS pain score? and what meanings do people with acute traumatic injuries associate with their pain experiences?Methods and ResultsInterpretive description (ID) was the approach employed for this qualitative study. Individualized one-on-one interviews of a semi-structured format were completed with 13 adult participants in the Edmonton, Alberta area. Each adult had sustained acute traumatic injuries accompanied with pain sustained in an accident for which they were hospitalized for a minimum of one day. The digital recordings and their transcribed data were analyzed using latent content analysis to organize the raw data into contextual derived meaningful categories. Three experiential themes known in ID as conceptual descriptions, were identified for how some patients may reduce their complex, unique lived pain experience into a single data point: (a) receiving the injury, (b) sensing the imminent loss of consciousness, and (c) grasping the immediate context. Regarding the determinants of meaning of APT three themes were also identified including: (a) permanence of injuries, (b) incongruent care, and (c) personal responses. The conceptual descriptions of the first research question are published in the Journal of Pain Management (2018) while the dissertation contains these findings in Chapter Four entitled “The underlying framework of how an acute pain score is determined: An interpretive description.” It provides an exploratory but detailed account of how people use pertinent referents in their lived pain experience to provide clinicians with a numeric rating of their pain. Chapter Five contains the conceptual descriptions of how people attribute meaning to their pain and is entitled “The determinants of meaning of an acute traumatic injury.” This paper provides the contextual characteristics of participants values and beliefs regarding their expectations of care given their injuries. It was published in the Scandinavian Journal of Caring Sciences (2017). An application of the above exploratory conceptual descriptions to practice settings forms Chapter Six. This paper, entitled “A biopsychosocial approach to pain assessment using the NRS” is currently being prepared for submission for publication.ConclusionThese exploratory conceptual descriptions provide important insights into how we might understand the reduction of APT experiences into an NRS score for some people. Likewise, these findings have the potential to enhance the clinical utility of the NRS tool employed for pain assessment in certain contexts. The phrase meaning of pain loses some of its vagueness by providing some conceptual descriptions for how personal meaning is formed in these circumstances. Additionally, three higher-level themes that are intertwined through the dissertation are highlighted: (a) context plays a significant role in clinical practice, (b) clinicians control the administrative process of the pain assessment, and (c) clinicians can only work within the limitations of the NRS tool. Collectively, the conceptual descriptions and themes, although from an exploratory study, potentially offers insights that may provide further insights into understanding of the challenges of assessing a complex phenomenon: APT.

  • Subjects / Keywords
  • Graduation date
    Spring 2019
  • Type of Item
    Thesis
  • Degree
    Doctor of Philosophy
  • DOI
    https://doi.org/10.7939/r3-pp1y-wp34
  • License
    Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.