Cultural diversity a factor in pain management at Scarborough Hospital

When Pain Specialist Angela Harrinanan is called to manage a patient’s pain, she undertakes a complete assessment, reviews medications, asks questions and speaks with family. It is important that she look at the patient as a whole.

At The Scarborough Hospital, situated in the most diverse community in Canada, Angela believes understanding a patient’s cultural background is also key in determining the best course of care.

“Different cultures express and perceive pain differently, and we want to deliver culturally competent patient care,” explains Angela, a Registered Nurse, Nurse Practitioner and The Scarborough Hospital’s only Nurse Pain Specialist. “I see patients as a central part of their care. I want them to be fully informed and participate in the decisions about their care. This is their body, their care, and I will advocate for them.”

In a community where more than half the population speaks a primary language other than English or French, The Scarborough Hospital’s vision is to be recognized as Canada’s leader in providing the best healthcare for a global community.

For Angela, that means having materials in multiple languages. “Having a tool that addresses pain in a patient’s first language allows for better communication and a better understanding of the patient’s pain level,” explains Angela, who sees anywhere from 20 to 40 patients a day.

Angela enhanced the pain assessment tool commonly used in hospitals by adding other languages. The series of facial expressions that sit on a scale of 1 to 10 to help healthcare professionals and patients communicate now includes text in Chinese and Tamil – in addition to English – covering the community’s most commonly spoken languages. She also had the tool made into posters for patient rooms, and badges for nurses to carry and use at the bedside.

“Too often, patients who have a lot of pain are misunderstood because of the language barrier. I want to ensure all pain is managed properly regardless of language or culture,” says Angela.

The hospital also has full-time interpreters onsite who speak Tamil, Cantonese and Mandarin, in addition to a diverse staff who speak over 48 languages and can be called upon to assist with translation.

In an effort to better manage pain in all units in the hospital, Angela recently recruited “pain champions,” nurses with an interest in pain management and the ability to interact and lead change in their areas of practice. The pain champions attended a workshop led by Angela, who covered topics like attitudes toward pain, ways to overcome negative attitudes, non-pharmacological approaches to pain management, physiology of pain, and the role of pain champions in promoting and developing pain management strategies in their areas of practice.

With Angela’s expertise and knowledge and the multi-language pain tool, the pain champions are now able to lead appropriate pain assessment to help minimize a patient’s pain and keep it from elevating.

As a pain specialist, she can make some modifications to medications and makes recommendations to physicians about medication changes. Angela plays a key role in educating patients, nurses and doctors.

“I can bring research to the bedside. I’m constantly learning, gaining more knowledge and insight so that I can make sure we are doing the best we can for our patients,” says Angela, who recently finished two Masters Degrees at the University of Toronto, one in Nursing, the other in Nursing Practitioner.

Angela also works closely with the department of anaesthesiology, where she is a valued member of the team.

“Angela performs a critical role in the hospital, both for the Acute Pain Service and as co-chair of the Pain Committee that looks at pain throughout the hospital,” says Dr. Winston Wong, Chief of Anesthesiology. “For surgical patients, fear of post-operative pain is a recurring issue and good post-operative pain control, as provided by Angela, improves patient satisfaction as well as contributes to better patient outcomes.”