Theory of Adapting to Chronic Pain

Chronic pain is often a complex health issue, which is not easy to ease or cure, but is likely to be encountered in almost every area of nursing. With chronic pain comes lasting discomfort, especially in instances of chronic illnesses. Chronic pain develops through a gradual worsening of symptoms, which manifest in the joints, pelvis, back, or other parts of the body. The symptoms last anywhere from a period of one month to more than six months. Therefore, managing pain must be the priority of the nurse, whose role should strongly focus on the healthiest lifestyle possible for the patient with a chronic illness.

There are multiple theoretical frameworks nurses can apply to help alleviate suffering by the patient experiencing unrelenting chronic pain. Theories are a vital component of the foundations of nursing practice. Nurses are required to apply conceptual frameworks implemented to assist in describing and predicting behaviors and possible outcomes. The middle-range theory of unpleasant symptoms is a resource implemented to enhance self-care in patients with chronic pain.

Middle-Range Theory of Unpleasant Symptoms

According to Kolebaek and Snis (2018), the middle-range theory is more concrete and applicable as it relates to patients with chronic pain in comparison to other theories. This particular theory explains that similarities exist among unpleasant symptoms that describe a specific chronic illness. The presentation of these symptoms can be treated or managed by nursing interventions. The theory describes a chronic condition fulfilling three criteria: the symptom the patient is experiencing, contributing factors or illnesses to the extent of the symptoms, and outcomes of the symptoms (Nguyen, Haas, & Pugh, 2017). Additionally, the theory posits that symptoms usually occur simultaneously, ultimately resulting in a cluster phenomenon. For instance, pain and nausea, which commonly present together, may signify a certain illness. This combination often makes it more challenging to identify, which usually necessitates further assessment.

According to Fernandes, the middle-range theory is a qualitative paradigm approach developed within the primary healthcare realm. The theory can guide any given healthcare scenario by examining a patient's behavior, altering processes, explaining observations, and describing observed outcomes (Fernandez, 2015). The theory provides nurses with a comprehensible platform due to the model's explanatory nature.

It is necessary to demonstrate concepts linked to the patient, nursing objectives, expected results, and the integration of existing theories and nursing frameworks. The framework identifies both barriers and essential individuals in managing chronic illnesses like pain. A patient's beliefs, attitudes, autonomy, background, and independence are vital in identifying possible barriers. The degree of perceived vulnerability, support system, and level of self-sufficiency all significantly contribute to the patient's response to nurse-guided self-care to a certain degree. The framework also underscores the necessity for nurses to possess professional knowledge, counseling skills, a focus on patient advocacy, and the ability to recognize behavioral changes to lessen or relieve patient suffering. Such skills and knowledge would enable a nurse to communicate effectively, which in turn would necessitate the evaluation of management deficits, shared decision-making, and coping strategies. The ultimate desired outcome would be pain relief leading to a lifestyle change for chronic patients.

The use of Middle-Range Theory to Explain Chronic Pain

The middle-range theory explains how a health condition may alter the physiological, psychological, and situational condition of a patient. Certain health conditions manifest similar symptoms of timing, degree of discomfort, quality, and intensity. A patient's severity rating of a condition is representative of both the physical intensity and emotional aspect of discomfort, as well as disruptions in quality of life. The use of language to verbally express symptoms often reflects the patient's quality of life. Sometimes, albeit inadvertently, the patient provides clues to the nurse or provider, making it vital to engage active listening skills. There are three types of variables that affect the timing, intensity, extent of discomfort, and quality of the condition: situational, psychological, and physiological features (Nguyen, Haas, Pugh, 2017).

Physiological features include the patient’s energy levels, while psychological features encompass response to the illness, understanding of symptoms, and mental status. Conversely, situational features, which are shaped by the physical environment, affect how a patient experiences or interprets the symptoms. The middle-range theory discusses the impact of the symptoms encountered. It demonstrates how the symptoms from a chronic illness shift the situational, physiological, and psychological state. For instance, it explains how chronic pain and its ensuing symptoms negatively impact social relationships and the patient's societal role. Chronic pain may also affect eating habits, a physiological aspect, or increase depression/anxiety, a psychological aspect. Moreover, chronic pain has the potential to cause changes in significant areas of life, such as employment. The demonstration of the relationship among the overlapping symptoms of chronic pain and their ultimate impact on the functioning of an individual enables nurses to develop vital interventions to alleviate chronic pain.

Nursing Interventions for Chronic Pain

The middle-range theory demonstrates the importance of the culmination of experience, skill, and knowledge in the decision-making and implementation of self-care plans for chronic pain patients (Jaarsma, Cameron, Riegel, 2017). Nurses should be trained to ensure patients gain skills and proficiency in self-care. Nurses are advised to verify that patients understand all aspects of self-care, which can easily be achieved by observation.

Intrinsic or extrinsic motivations are also factors that have proven to help in adaptation to chronic pain. Intrinsic motivation is the engagement in an activity because of the recommendation from an external force (Jaarsma, Cameron, Reigel, Stromberg 2017). When patients perceive participating in a certain activity yields benefits, they are more likely to be motivated. For instance, performing self-care may be accompanied by benefits such as the reduction in pain symptoms and overall improvement in patients' health. Factors that may motivate a person to adapt to chronic pain include lifestyle changes, such as maintaining a healthy lifestyle, deliberate focus on positive feelings, and partaking in activities that provide pleasure (Jaarsma, Cameron, Riegel, 2017). Support from family and close friends is a significant aspect that the middle-range theory highlights for enabling patients to implement self-care plans for chronic pain (Jaarsma, Cameron, Riegel, 2017). Caregivers provide immeasurable contributions to self-care, as patients often depend on their families and social circles as contributors in the pursuit of pain relief. Caregivers are strategically placed to provide a form of motivation alongside practical support that can influence self-care behaviors and manage possible depressive symptoms (Jaarsma, Cameron, Riegel, 2017).

Conclusion

Chronic pain is a condition that is hard to manage and ultimately cure. Nurses are required to develop individualized interventions for patients suffering from chronic pain. The middle-range theory explains the procedure of evaluating the health and mental condition before developing nursing interventions for self-care. Nurses must encompass the physiological, psychological, and spiritual aspects of a patient experiencing chronic pain to evaluate the extent of possible planning and implementation needed. These efforts enable the nurse to individualize interventions to achieve the best possible outcome for the patient. The potential weakest link in these theories is the nurse. The position we hold and how we utilize our knowledge have the ability to make dealing with chronic pain tolerable. The theory of adapting to chronic pain highlights a number of vital pieces of information a nurse must gather before developing a self-care plan. These include the patient's level of independence, and knowledge about management of their individual symptoms. Factors such as support from caregivers, self-sufficiency, attitudes, culture, beliefs, and level of motivation are all equally important to effectively manage chronic pain.
As mentioned in my introduction, I am not currently practicing. However, with the prominence of pain reported by patients, I felt this topic was one that will be applicable in my future endeavors. Adequately controlled chronic pain could potentially alleviate dependence on pain medications. Avoiding dependence on even one individual would be a great achievement.

Reference list

1. Drevenhorn, Eva. "A Proposed Middle-range Theory of Nursing in Hypertension Care." International Journal of Hypertension, April 26, 2018: 1-11.
2. Fernandes, M. J. "Grounded Theory: Building a Middle-range Theory in Nursing." Biomed Biopharm Res, 12.1(2015): 11-20.
3. Kolbaek, Ditte, and Snis, U. L. "Proactive Review: Toward an Emerging Middle-range Theory of Learning from Experience in the Context of Work." N.d. Web. Accessed August 26, 2018.
4. Nguyen, J. Haas, R. E., Pugh, L. "The Application of the Theory of Unpleasant Symptoms to the Educators and Practice of Nurse Anesthetists." Nursing and Healthcare Journal, 11.4(2017): 1-8.

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