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  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
  • More About:

  • Hospice Care
  • Clergy and Faith Communities
  • Additional Links
    Site Index
    Back to Module 13: Cultural Issues
    Tools for Diagnosing and Mediating Cultural Misunderstandings

    Touch and Gender
    Medical Subculture
    Traditional Medicine
    Body Language
    Bad News
    Meaning of Illness
    Alternative Medicine
    Pain Imminent Death


    Meanings Attributed to Pain

    • For most people in most of the world, pain and loss of function precipitate the search for care when home remedies fail
    • For patients with terminal diagnoses, pain is the reminder of imminent death
    • How they bear pain may be interpreted as a measure of character if stoicism is an important value
    • If pain represents impending incapacity, the patient may not admit it due to fear of death, fear of loss of status and respect, loss of power and authority, loss face (shame) and indignity. Patients may conceal pain for many reasons


    When a Patient Refuses Analgesics

    Patients may refuse analgesics for many reasons, including:

    • Fear of loss of mental capacity
    • Fear of addiction
    • A realistic desire not to have narcotics in the house if there are drug problems in the family

    It is important to emphasize that analgesics (and antidepressants) are medicines intended to improve function, that the doctors and nurses carefully monitor them. They are under the patient’s control


    A Language for Assessing Pain

    • In describing pain, think of a common kind of pain, like a toothache, like a pinch, like a stabbing knife, like a sticking needle
    • For women severity is relatively easy to grade. You can ask her to compare it to the pain of childbirth
    • For men, you might ask what was the worst pain they ever had. What caused that pain? How does this compare? Is it much worse, about the same, not as bad, not bad at all just there?
    • The pain analog scale with smiley faces, neutral faces and weeping faces may take some explanation since smiling face can represent embarrassment, neutral face anger and weeping face sorrow. These emotions do not scale
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