Editorial This month’s important CE article, Identi- and reliable method of objectively quantifying an individual’s 8 9 fying Pain and Effects on Quality of Life from experience of pain. Kleinman uses an explanatory model to Chronic Wounds Secondary to Lower-Extremity reconstruct the patient’s ‘‘illness narrative.’’ This ethnographic Vascular Disease: An Integrative Review, un- approach involves a series of questions to understand the derscores the need for highly organized meaning of illness or the pain based on the patient’s learned and active listening skills on the part of the experiences. The following is a list of qualitative interrogatives practitioner when taking and documenting clinicians can use to discover the patient’s lived experience, a pain history from individuals with chronic while expanding knowledge about the patient and the illness : wounds. The pain history is interdependent on the assessment 1. What do you call this problem? 2. What do you believe is the cause of this problem? of the ‘‘whole person’’ as promulgated by Siebens ; this holistic concept pulls us back from our professional purviews (spe- 3. What course do you expect it to take? How serious is it? cialties), reminding us to perform as an interprofessional team 4. Why do you think it started when it did? centering the patient. The Siebens Domain Model expands 5. What do you think this problem does inside your body? beyond the evaluation of a single wound, to encompass (1) 6. How does it affect your body and your mind? medical/surgical issues, (2) mental status/emotions/coping, 7. What do you most fear about this condition? (3) physical function, and (4) living environment. 8. What do you most fear about the treatment? For lower-extremity vascular disease, the Siebens Domain Getting an accurate pain history involves active listening Model may add a multidimensional aspect to the patient skills, a ‘‘whole person’’ approach, promoting self-efficacy, evaluation. Venous ulcers (VUs) are a relevant public health and a combination of qualitative communication methods. issue, with high cost, excess morbidity, and reduced quality of With careful attention, providers can help patients effectively life. The natural history of VUs exemplifies issues of chronicity, self-report pain. the complexity of care, and recurrence. Moreover, patients with 2Y4 this disease are susceptible to impairment. In a systematic review related to the quality of life of people with VU, the most frequently patient-reported symptom is pain, giving the patient a constant awareness of the disease. From this perspective, it is Richard ‘‘Sal’’ Salcido, MD, EdD clear that providers must evaluate self-efficacy and augment it 2Y6 through teaching and learning strategies. References Self-efficacy describes a set of beliefs about oneself, spe- 1. Siebens H. Applying the domain management model in treating patients with chronic cifically about one’s ability to perform specific behaviors within diseases. Jt Comm J Qual Improv 2001;27(6):302-14. 5,6 2. Oliveira RA, de Oliviera e Araujo R, Gomes da Costa V, et al. Self-efficacy, self-esteem and a particular environment. Self-efficacy in those suffering from adherence to treatment in people with venous ulcer in primary health care. Bioscience J pain involves feelings about one’s ability to control the pain, the 2017;33(6). nihilistic emotions associated with exacerbations of pain while 3. Green J, Jester R. Health-related quality of life and chronic venous leg ulceration: part 1. Br J Community Nurs 2009;14(12):S12, S14, S16-7. preforming activities of daily living, communicating their needs 4. Green J, Jester R. Health-related quality of life and chronic venous leg ulceration: part 2. to health providers, and implementing advice about their pain. Br J Community Nurs 2010;15(3):S4-6, S8, S10. There is some evidence that higher self-efficacy brings more 5. Miles CL, Pincus T, Carnes D, Taylor SJ, Underwood M. Measuring pain self-efficacy. Clin J Pain 2011;27(5):461-70. favorable outcomes, higher return-to-work rates, better treat- 6. Baldwin KM, Baldwin JR, Ewald T. The relationship among shame, guilt, and self-efficacy. ment adherence, more effective pain control, and a better Am J Psychother 2006;60(1):1-21. 5,6 prognosis. 7. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs 2005;14(7):798-804. Although many commonly used pain scales have been 8. Younger J, McCue R, Mackey S. Pain outcomes: a brief review of instruments and found to be reliable and valid, most rely on subjective patient techniques. Curr Pain Headache Rep 2009;13(1):39-43. communication, which may skew clinicians’ patient percep- 9. Kleinman A. Supplementary Module 1: Explanatory Model. DSM-5 Handbook on the tion and pain interpretation. Currently, there exists no valid Cultural Formulation Interview. Arlington, VA: American Psychiatric Association; 2015. Richard ‘‘Sal’’ Salcido, MD, EdD, is the Editor-in-Chief of Advances in Skin & Wound Care; the William Erdman Professor, Department of Physical Medicine and Rehabilitation; Senior Fellow, Institute on Aging; and Associate, Institute of Medicine and Bioengineering, at the University of Pennsylvania Health System, Philadelphia, Pennsylvania. WWW.WOUNDCAREJOURNAL.COM 101 ADVANCES IN SKIN & WOUND CARE & MARCH 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Advances in Skin & Wound Care – Wolters Kluwer Health
Published: Jan 1, 2018
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