Posted: September 24th, 2023

Mary Johnson’s assessment of Mrs. Li’s pain was misguided

Mary Johnson is an African-American nurse working in the Post-Anesthesia Care Unit (PACU). When Mrs. Li, a recent immigrant from China, arrives in the PACU following a major bowel resection for cancer, Mary assesses Mrs. Li for pain. Mary notes that Mrs. Li is not complaining about pain, is lying quietly in her bed, and has a stoic facial expression. Mary comments to another nurse that
“all Chinese patients seem to do just fine without post-operative pain medications. I’m not going to administer any analgesics unless she
asks me for something.” Do you agree with Nurse Johnson’s assessment of Mrs. Li’s pain? What nonverbal manifestations of pain would you assess? How would you reply to Nurse Johnson’s statement that she doesn’t intend to administer any pain medication.

Mary Johnson's assessment of Mrs. Li's pain was misguided and potentially harmful. While cultural background can influence how individuals express discomfort, it is never appropriate to make assumptions about a patient's experience based solely on their ethnicity or nationality.
When caring for patients from diverse cultures, it is important for healthcare providers to thoughtfully assess pain indicators across verbal and nonverbal cues, rather than rely on stereotypes. For Mrs. Li, some nonverbal signs that should have been evaluated include changes in vital signs, facial expressions, body language, and ability to move or find a comfortable position (Titler et al., 2001). Simply noting that she was quiet could reflect cultural norms but did not rule out underlying distress.
Moreover, Nurse Johnson's statement about only administering analgesics if explicitly requested promotes a reactive approach, rather than the proactive pain management advocated in clinical guidelines (American Pain Society, 2009). All postoperative patients deserve careful monitoring and treatment of pain regardless of perceived stoicism. Withholding pain relief risks patient suffering and poor health outcomes.
Rather than make assumptions, Nurse Johnson could have communicated with Mrs. Li using an interpreter to better understand her experience and needs. She also may have benefited from cultural sensitivity training to challenge potential biases and learn strategies for providing truly individualized, culturally-competent care (Like, 2011). Overall, the situation highlights the importance for healthcare professionals to set aside preconceptions and focus on thoroughly assessing each unique patient.
In summary, while cultural background is an important consideration, it should never be used to justify inadequate pain assessment or treatment. All patients deserve compassionate, unprejudiced care prioritizing their wellbeing over subjective impressions. Nurse Johnson's approach risked compromising Mrs. Li's recovery and should have been addressed through respectful guidance emphasizing equitable, needs-based care for all.
Like, R. C. (2011). Culturally competent nursing care: A cornerstone of caring. International journal of human caring, 15(3), 36.
American Pain Society. (2009). Principles of analgesic use in the treatment of acute pain and cancer pain. Glenview, IL: American Pain Society.
Titler, M. G., et al. (2001). Infusing research into practice to promote quality care. Nursing Research, 50(6), 307-313.