Pain as a mutual experience for patients, nurses and families: a perspective from Valencia, Spain.

Abstract: The Spanish data collection was consistent with the overall study design and drew from three groups: laboring women, children and elderly patients. The Valencia data was amongst the most detailed, specific and complete in this international study. This is most likely due to the experienced nature of the Spanish research team. The study results revealed more commonalities than differences in all age groups with regard to pain identification and pain alleviation. Across age groups, pain was identified by study participants through observation and listening. Key Words: Pain; Perspective from Spain Valencia is the capital city of the Valencia Au- tonomous Community, a region located in Eastern Spain along the Mediterranean coast. With long stretches of beautiful beaches, it has become in the last few decades one of the favorite summer places for the people from all over Europe. With a population of 750,000, its major industries are fishing, agriculture and the manufacture of furniture. Autonomy has brought major achievements in the areas of health, education, management and control of all health services. Over 95% of the population are covered either by the state or local social security. For the last 20 years, local/regional health reform has focused on primary health care, specialized care and health education. The Spanish data collection was consistent with the overall study design and drew from three groups: laboring women, children and elderly patients. Quantitative data from the three patient groups will be presented first followed by qualitative data reflecting commonalities and differences across groups. QUANTITATIVE FINDINGS Laboring Women Ten subjects participated in this aspect of the study. Their average age was 29 years. In each case they were accompanied by their husbands, whose average age was 31 years. In each birthing situation, the women were attended by a nurse midwife whose average age was 49. These midwives had an average clinical experience of 22 years. It is of interest that professional nursing preparation in Spain entails three years of study at the university. Two additional years of specialization is required to practice as a midwife. The Pain Intensity Scale (PIS) was administered to the laboring woman. In addition, it was administered to the family member and to the nurse to quantify and compare their perceptions to that of the laboring woman's pain. The results of the PIS comparisons are as follows. In 50% of the cases, nurses accurately assessed the woman's pain. Underestimation of pain occurred 30% of the times and over-estimation 20%. It is worth noting that the difference was only one point deviation above or below the patient's reported score. The PIS scores of the spouses were also analyzed. In 33% of the cases the husbands' score matched those of their wives. Underestimation of their wives pain occurred 22% of the time and overestimation occurred in 45% of the cases. In all, husbands expressed personal distress with their wives' pain, impatience and frustration in their attempts to bring about relief. Children Ten children and their mothers participated in this aspect of the study. The average age of the child was 22 months with the mothers averaging 29 years. The nurses' ages averaged 39 years with 17 years of clinical experience. The PIS was administered to the mothers to determine their estimation of their child's pain and also to the nurses to compare their perception to the mothers'. Nurses' estimate of the child's pain equaled that of the mother in only 25% of the cases. Nurses overestimated pain in 12% of cases and underestimated the pain in 63%. It is important to note that this underestimation of pain was by three points on the PIS. Elders Ten elderly females (n=6) and males (n=4) whose mean age was 76 years, participated in this component of the study These elders were interviewed with either a spouse/companion (average age 74 years), or with their children (average age 50 years). …