Physiologic and Behavioral Responses to Acute Myocardial Ischemic Pain in Mexican Male Patients
Review TypeNone: Degree-based Submission
Repository Posting Date2019-08-30T16:56:23Z
Author(s)Douglas, Marilyn K.
Author DetailsDr. Marilyn K. Douglas, PhD, RN, FAAN
Lead Author Sigma AffliationAlpha Eta
Level of EvidenceCross-Sectional
Research ApproachMixed/Multi Method Research
CINAHL HeadingsBehavior; Pain Measurement; Hispanics; Chest Pain; Nursing Assessment; Nonverbal Communication; Behavior--Evaluation; Coronary Disease
The verbal, non-verbal and physiologic responses of Mexican male patients to the pain of acute myocardial ischemia were studied as a basis for subsequent comparison with other cultural groups. A sample of 57 patients was studied in the Emergency Department (ED) of a federal, tertiary health care facility in urban central Mexico. Inclusion criteria were: chief complaint of non-traumatic chest pain and subsequent admission to the Coronary Care Unit with a suspected acute myocardial infarction (AMI); Mexican birth and residence; male gender; 35 years or older; and, 12 or less years education. At the time of ED admission, a 12-Lead electrocardiogram, vital signs and serum creatine phosphokinase (CPK) levels were measured. Subjects were asked to describe the pain and give a numerical rating on a vertical, Spanish-language verbal descriptor pain scale. Non-verbal pain behaviors were assessed by two nurses and a negotiated score was given to each of seven categories and then totaled. The categories were: attention to pain, amount of restlessness, tenseness, anxiety, diaphoresis, facial grimacing, and vocalization, such as crying. Higher pain scores were associated with greater amounts of non-verbal behavior ($p <$.0001), more ST segment elevation ($p <$.001), higher CPK levels ($p <$.01), and greater elevation in pressure-rate product ($p <$.05) and systolic blood pressure ($p <$.05). Patients with the discharge diagnosis of AMI had higher pain scores than those in which an AMI was ruled out ($p <$.005). However, multiple regression analysis determined that non-verbal behavior explained 42.4% of the variance in the pain score ($p <$.0001), while the physiologic variables were not significant in predicting the patient's pain intensity score. These results indicate that nursing assessment of pain should include a behavioral assessment, which in turn requires validation with the patient and family members because of wide cultural variation in these behaviors.
DescriptionThis dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 9008978; ProQuest document ID: 303672214. The author still retains copyright.
Degree GrantorUniversity of California, San Francisco
NotesThis item has not gone through this repository's peer-review process, but has been accepted by the indicated university or college in partial fulfillment of the requirements for the specified degree.
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