The nursing management of pain in the community: a theoretical framework

Abstract

This paper is based upon a research project designed to investigate the nursing management of pain in the community. A theoretical framework is described which has been designed to encompass the complexities of different types of pain, individual differences in reaction to pain, and to identify key differences between patients who cope with pain and those who do not. The framework is based on a model of stress, the concept of controllability, and contemporary learning theory. It identifies a unique role for the nurse in pain management and will be used to direct a study into strategies which nurses can use to enhance the coping abilities and resources of elderly patients in the community with pain.

The nursing management of elderly patients with pain in the community: study and recommendations

“…The stahshcal model identified m Figure 1 is remarkably consistent with the theorehcal model of conh'ol which was developed as a framework for this research (Walker et al 1989) This proposed copmg as an achve process, m which an individual's predichons of bemg able to control a situation IS influenced by percephons of all current events, and influenced by available information, past expenences and available controlling skills or actions The similanty between the theorehcal model and the stahstical model is encapsulated m Figure 2, m which the key elements of the theorehcal and the stahstical models are ldenhfied together…”

“…The theoretical model, whidi was developed as part: of tfus C^'spo^kme Dr JM Walker BHn SBB Et^iaxd be cured or duninated, the sutraer must leam to c(^ wtni, or gam control over it, with help if necessary Many elderly people do cope remarkably well, and manage to mamtam a good quality of life, m spite of the presence of severe arthnhs, or other chronic painful conditions However others are unable to cope These pahents may become anxious, depressed, resentful, complam a lot, or make demands upon medical services which often cannot be met The theorehcal model (Walker et al 1989) ldenhfies a distmd role for the nurse m helpmg pahents to adapt successfully to pain and other stressors The model is based upon the concept of control, and identifies mood state, notably the presence or absence of anxiety and depression, as the mdicator of the degree of control perceived by an mdividual at any particular time It identifies a range of factors likely to influence control, indudmg acute and chronic pam, other stressful life events, informahon, past expenences, leamed coping skills and locus of control This has paved the way for a study m which coping can be measured by assessmg mood state as the dependent vanable…”

Chronic pain and distress among elderly in the community: comparison of patients’ experiences with enrolled nurses’ assessments

“…1993 ; Simon 1996). A holistic approach is desirable for the treatment of patients with pain who have a diversity of physical, psychological and social needs ( Akinsanya 1985; Walker et al . 1989 ).…”

Predictors of psychological distress in chronic pain patients

“…Much of the research into pain has continued to focus new tool was to ensure that the measure was theoretically valid, brief enough to use as part of routine nursing assess-upon pain intensity as the dependent variable. However, Walker et al (1989) proposed a theoretical model in which ment, easily understood, and seen as acceptable and relevant to patients with chronic pain. As such, it is a pain was identified as just one of many potential stressors which could reduce the ability of the individual to gain primarily a nursing measure, rather than a psychological one.…”