One of my favourite moments of the semester was our visit from Dr. Margot Latimer and Julie Francis. Dr. Latimer is a Registered Nurse out of the IWK in Halifax, NS as well as a professor of nursing at Dalhousie University. Julie Francis is a Registered Nurse out of Eskasoni, Cape Breton. They came to Cape Breton University to present to us their research on pain perception in aboriginal children.
Dr. Latimer explained that her idea for researching this phenomena grew from the low number of first nations children being referred to the IWKs paediatric pain clinic. She contacted the Eskasoni Health Clinic here in Cape Breton to inquire whether or not they’ve noticed a similar trend and their research partnership began.
Through numerous interviews they discovered that there is an actual difference in the way aboriginal and non-aboriginal children express pain. There were a few points that have stuck with me since their visit. I felt they were worth reflecting on and could offer some insight into pain assessments within the aboriginal population.
1) There is no word for “pain” in the Mi’kmaq language.
As someone who does not speak Mi’kmaq, I did not know this. This small piece of knowledge is extremely important for those of us working in health care. We ask our patients numerous times throughout the day “are you experiencing any pain”, “where is your pain”, “on a scale of 1-10 how bad is your pain?” Before this presentation pain to me was a universal concept. I was taught that pain is something experiences across genders, cultures, races, etc. But how can pain be assessed if we aren’t communicating with our patients the best we can? Dr. Latimer found that rather than “pain”, the word “hurt” was used within the Mi’kmaq community. Something as simple as changing our wording from “pain” to “hurt” can make our assessments more accurate, and our treatment more effective.
2) Aboriginal children are “stoic”, even when experiencing acute and chronic pain.
This is another important detail to keep in mind while assessing aboriginal children for pain. When we think of children in pain we think of crying, frowning, sadness, irritable, etc. This is however not how all aboriginal children will present when experiencing sometimes very severe pain. This can make the assessment process rather difficult. We currently use the Faces Scale tool, and ask the child to point to the face that best describes how they are feeling. Clearly if the child does not personally display pain through facial grimacing, this tool will not be helpful.
Dr. Latimer is currently exploring new methods of assessing pain to help improve clinical practice. Some of these new ideas include story telling and expressing pain through art. They are also in the process of developing a new pain scale tool that moves away from the use of facial expressions as a rating.
3) This phenomena extends from childhood into adulthood.
As we watched some of the interviews, we saw that the outward expression of pain is also limited in aboriginal adults. Some of the interviewees explained that growing up they were taught to be strong when facing hardship and have always done so. I should emphasize that this does not mean they do not experience pain or hardship, it is just the outward expression of these emotions that we are so used to seeing that are absent.
As a nursing student practicing in Cape Breton I found this reasearch absolutely fascinanting. Dr. Latimer and Julie Francis’ visit has definitely made a difference in how I will perform pain assessments from here on out. I hope these tips can be of some help to other health care professionals.
Be sure to keep an eye out for Dr. Margot Latimer’s ongoing research in this exciting field! Here are a few link’s to read more about the great work this team is doing:
http://pediatric-pain.ca/faculty/latimer/current-research/
http://globalnews.ca/news/1664031/aboriginal-children-express-pain-differently-iwk-research/
Two-Eyed Seeing for Health 