Ways of knowing cancer pain in a palliative care setting

Pain is a phenomenon that is complex and subjective. It implicates the physical, social, emotional, immunological, and spiritual aspects of being human. It has the power to reach the essence of human existence. Much research is focussed on the physiological, social, cultural, emotional and cognitive aspects of pain. However, very little work has been undertaken that explores pain as a part of human existence and the inherent knowing that accompanies it. This aspect of pain is fundamental to how a person-in-pain can exist with pain; it forms the ways a person knows their own pain. What pain means to people and how they know their own pain is the subject of this research study. The study sought to identify ways of knowing cancer pain of the six participants and the implications this holds for assessment of pain by nurses. Each of the six participants was receiving palliative care at the time of the study; a setting that provided a layer of complexity to the research process. Heideggarian hermeneutic phenomenology provided the framework for the study and the concept of knowing was explored within Heideggarian philosophy and applied to nursing assessment. An essential construct, the self as individual, which has formed the basis of much debate within nursing, was explored in relation to the universality of Being. Conversations and diaries provided data that informed thematic development of the shared meaning of Being, and contributed to assessment profiles formed within the construct of the self. The themes of, balancing conflict, living with threat, always there, and making sense are identified and examined to provide understanding of the ways these six people know their pain. The process of coming to know and themes from the study offer a stimulus to nurses to add another form of assessment to the range of assessment options available to them. A new model of pain assessment is offered that incorporates an ontological way of knowing, and the meaning that the findings have for nursing practice is explored. Implications for nursing practice and education that are derived from the study are offered. The rigour of the study is promoted through an audit process.