Information for Research Papers, Reports, Essays, Presentations, and Speeches

Research has become a valued part of many nursing school programs with nursing students needing to present a variety of presentations and research papers on a variety of topics. Another somewhat recent development is more demand on students to find a special type of credible information called evidence-based practice information/articles. There are different levels of evidence-based practice information. A variety of sources are listed on the "Nursing and Allied Health Topics" web page to help Nursing and Allied Health students find credible peer-reviewed journal articles, including articles based on evidence-based practice. It seems that a majority of Nursing and Allied Health classes ask the students to cite according the APA Manual SIXTH EDITION, so the articles listed on the various Nursing and Allied Health Topics web pages will be presented according to the the American Psychological Association Manual.

Pain Assessment for the Nonverbal Patient

The introduction to the "Assessing Pain in Nonverbal Older Adults" article may say it best by saying "Because pain is a subjective experience, pain assessment relies heavily on verbal self-report. However, self-report may be difficult or impossible in nonverbal critically ill older adults who are intubated, sedated, or unconscious; or older adults with communication and cognitive impairments, such as aphasia/dysphasia, language barriers, dementia, delirium, intellectual disabilities, traumatic brain injury, and/or deaf or severe hearing impairment. As a result, they are unable to verbally convey and describe pain, placing them at greater risk for non- and under-assessment."

However, it is not just older adults for various reasons who may be nonverbal. There are plenty of reasons why many patients, young and old, are not able to communicate their condition to the healthcare professional. The following scholarly journal articles provide a variety of information about pain assessment for the nonverbal patient.

The following articles are cited according to APA Manual 6th edition.

The authors wrote a two-part article about assessing pain in older adults. The part one article covered assessment in verbal older adults. However, part two covers assessing pain in NONVERBAL older adults
This appears to be a very good article providing “behaviors suggestive of pain” for the older nonverbal adult. The older adult is part of the diverse population that healthcare professionals will serve.

"Because pain is a subjective experience, pain assessment relies heavily on verbal self-report. However, self-report may be difficult or impossible in nonverbal critically ill older adults who are intubated, sedated, or unconscious; or older adults with communication and cognitive impairments, such as aphasia/dysphasia, language barriers, dementia, delirium, intellectual disabilities, traumatic brain injury, and/or deaf or severe hearing impairment. As a result, they are unable to verbally convey and describe pain, placing them at greater risk for non- and under-assessment. To prevent under-assessment in this vulnerable population, a multi-component and interdisciplinary approach to determine pain is needed."

This entire part two article can be found in PubMed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991889/ .

IF the definition of diversity includes nonverbal patients that are nonverbal for diverse reasons then here is an article about children who are nonverbal because of cognitive impairment. How does the nurse recognize pain with this part of the population? The article is not about newborns who have not developed speech, yet. This article is about children who could self-report, but cannot because of their cognitive impairment. 

"The aims of this review were to examine pain measures for hospitalized children with cognitive impairment who are unable to self-report and to describe the best available evidence for their clinical utility in acute care settings."

The entire article can be accessed through PubMed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4100776/

I am guessing that this might be one of the better articles featuring diversity when talking about pain assessment and the nonverbal patient.
This article is listed in CINAHL, but the entire article can be found at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4815256/

Page two of this PDF states that:

“Ethnic Differences in Pain Expression
Mark Zborowski’s work in the early 1950’s was one of the first to report that pain is not only a neurological and physiological experience, but also a cultural one as well. Zborowski (1952) demonstrated that cultures vary in how they pattern pain attitudes as well as emotional, linguistic, and behavioral responses to pain.”

“Although few studies have explored ethnic differences in the expression of nonverbal pain behaviors, researchers have examined ethnic differences in the expression of emotions, which may provide additional detail regarding potential differences in the outward expression of pain behaviors (Marsh, Elfenbein, & Ambady, 2003; Mesquita & Walker, 2003; Stepanikova, Zhang, Wieland, Eleazer, & Stewart, 2012). Marsh et al. (2003) found subtle cultural variations in basic nonverbal facial expressions, suggesting that some differences do exist in the nonverbal expression of emotions (i.e. fear, disgust, sadness, surprise, happiness, and anger).”

"Palliative care patients who have pain are often unable to self-report their pain, placing them at increased risk for underrecognized and undertreated pain. Use of appropriate pain assessment tools significantly enhances the likelihood of effective pain management and improved pain-related outcomes. This paper reviews selected tools and provides palliative care clinicians with a practical approach to selecting a pain assessment tool for noncommunicative adult patients."

The entire article is located at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978178/

This is a 2010 scholarly journal article. The entire article can be found at the following location. If it does not open up by clicking on the link, then please cut and paste the URL into your browser.
http://www.lacrosseconsortium.org/uploads/content_files/Culture_Effects_on_Pain_Assessment_.pdf

Here are only a couple of excerpts that I cut and pasted. There is much more information within the article that may help. These two excerpts give you an idea about the article:

“Culture also influences beliefs about how to prevent and treat illness and what constitutes good care. More specifically, it influences how each person experiences and responds to pain, including when and how to ask for treatment.
By virtue of belonging to multiple cultural groups, each of us has a unique cultural perspective. Nurses must embrace this crucial point in order to provide patients with culturally acceptable pain management. Nurses should also be aware of the cultural patterns (beliefs, values, and behaviors) that influence their own and their patients’ responses to pain."

"Nonverbal communication problems. Nurses use many cues besides direct communication to assess a patient’s pain, such as facial expression, body posture, and activity level. However, nonverbal communica­tion patterns are just as likely as is language to vary across cultures and therefore to be subject to misinterpretation."

Neonatal patients are part of the diverse population. This provides a variety of information on how healthcare professionals attempt to assess neonatal pain. A variety of “tools” are used OR NOT used. The entire text is within CINAHL, but the entire article can be located for free at: http://www.objnursing.uff.br/index.php/nursing/article/view/5413/html_1