How to assess your own beliefs about pain

Questions uncover biases

Understanding your own cultural beliefs and biases about pain is an important first step in accurately assessing a hospice patient's pain levels, says Mary Curry Narayan, MSN, RN, HHCNS-BC, a clinical education and transcultural nurse specialist and owner, Narayan Associates in Vienna, VA and author of "Culture's Effects on Pain Assessment and Management."1

Narayan suggests that hospice staff use the following self-assessment questions to determine their own cultural norms concerning pain:

1. When you were a child, how did those who cared for you react when you were in pain?

• How did they expect you to behave when you had a minor injury?

• How did they encourage you to cope when you had severe pain?

• How did they encourage you to behave during an injection or procedure?

2. When those who cared for you as a child were in pain, how did they react?

• What words did they use to describe the pain?

• How did they cope with their pain?

• Do you tend to follow their example?

3. Consider a painful experience you've had as an adult (for example, childbirth, a fracture, a procedure).

• How did you express (or not express) your pain?

• Did the pain cause you fear? What were you afraid of?

• How did you cope with the pain?

• How did you want others to react while you were in pain?

4. Have you ever felt "uncomfortable" with the way a patient was reacting (or not reacting) to pain?

• What did the patient do that concerned you?

• Why did you feel that way?

5. Do you have "feelings" (make value judgments) about patients in pain who:

• behave more stoically or expressively than you would in a similar situation?

• ask for pain medicine frequently or not often enough?

• choose treatments you don't believe are effective or with which you are unfamiliar?

• belong to a cultural group (ethnic, linguistic, religious, socioeconomic) different from your own?

6. Do you tend to feel certain reactions to pain are "right" or "wrong"? Why? What about these reactions makes them seem right or wrong?

• Are some expressions or verbalizations of pain "right" or "wrong"?

• Are some descriptions of pain "right" or "wrong"?

• Are some treatments for pain "right" or "wrong"?


1. Narayan MC. Culture's effects on pain assessment and management. AJN 2010;110:38-47.