Content area
Full Text
Summary
Pain is a complex and individual experience, and those involved in caring for patients in pain often need creative approaches to identify possible causes, meaning and management. This case study explores the unique pain experience of a patient with cancer being cared for in a hospice at the end of her life.
Keywords
Pain dimensions; Symptom control; Total pain
These keywords are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review. For author and research article guidelines visit the Nursing Standard home page at nursingstandard.rcnpublishing.co.uk. For related articles visit our online archive and search using the keywords.
THE CONCEPT OF TOTAL PAIN was first described by Dame Cicely Saunders in the late 1960s, following her extensive work with terminally ill patients at St Christopher's hospice in Sydenham, London (Saunders etal 1995). Total pain incorporates physical, social, spiritual and psychological aspects, which interact through complex mechanisms to construct each person's unique pain experience (Clark 1999). Pain has been defined as: 'an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage' (International Association for the Study of Pain 2008).
The recent End of Life Care Strategy emphasises that the notion of a 'good death' depends on controlling difficult symptoms such as pain, and notes that in many cases pain remains a problem for the dying person (Department of Health 2008). This article explores the concept of total pain by describing and analysing the care of a woman with terminal pancreatic cancer admitted to a hospice. All names and identifying features have been altered to maintain anonymity (Nursing and Midwifery Council 2008).
Background
Evelyn was a 58-year-old retired textile worker, married to Jim. She was diagnosed with metastatic pancreatic cancer after visiting the GP with symptoms of pain and jaundice. She was admitted to a specialist palliative care hospice with uncontrolled pain, nausea and vomiting. Her daughter, Chloe, who was in her early twenties, lived and worked some distance away. Until then, Chloe had been unaware of the seriousness of her mother's illness, as Evelyn had not wanted to cause her any distress. She was taking oral slow-release morphine sulphate for pain, but nausea affected her...