Our definition of pain stipulates that the patient âsaysâ something to us about the pain. This term does not mean that the patient must verbalize. Many patients will not or cannot communicate verbally. What the patient says to us includes all voluntary and involuntary behaviors and all verbal and nonverbal behaviors.
(McCaffery, 1972, p. 9)
The nursing definition of pain has been stated as being whatever the experiencing person says it is, existing whenever he says it does. It has been stipulated that what the patient says about pain involves far more than his verbalisations. Therefore assessment will be based on a variety of observable behaviors.
(McCaffery, 1972, p. 11)
Expanding the concept of âsayingâ or testimony to include verbal and nonverbal dimensions is now broadly agreed (see, e.g., Sonneborn and Williams, 2020).3 Yet this nuance, and a great deal of the sophistication in McCafferyâs work, is lost when educators abbreviate the message presented to students and simply state that âpain is what the patient says it isâ. This reduced conception, at least in the academy, is close to being a nursing given. Carragher, MacLeod and Camargo-Plazas (2021) note the definition is âwidely used today and is embedded in nursing curricula teachingsâ (p. 4), and acceptance of McCaffery and McCaffery-esque like mantras tend to be demanded.4
Thus despite McCafferyâs (1972) own position being considerably more interesting (and sporadically more puzzling) than this abbreviation allows, and regardless of the existence of a critical or questioning literature (see, e.g., Arber, 2004; Miller, Eldredge and Dalton, 2017), McCaffery-lite propositions are frequently presented in an unproblematised manner, and assertions to the effect that âpain is what the patient says it isâ appear without qualification â or very little qualification â in numerous nursing and healthcare texts (see, e.g., Clarke and Iphofen, 2008; Copeland, 2020; Dubos, 2018; Jenerette et al., 2015; Jones, 2018; Malcolm, 2015; Melville and Grogan, 2019; Sonneborn and Williams, 2020; Swain et al., 2018).
Generalisation misleads and, indisputably, some educators do engage with the totality of McCafferyâs extended work. Nonetheless, in discussing McCaffery (1972), henceforth it is the bowdlerised version of her core message which is referenced. Explicitly, her assertion that âverification of pain by others is meaningless. [And] Pain can be verified only by the person experiencing itâ (p. 7) is, here, taken to signify âMcCafferyismâ.
Not, I hasten to add, that this condensed conception lacks merit. Asking those we care for how they feel is a sensible way of opening discussion into mood/affect and listening to patients requires no defence. However, without in any way suggesting that nurses ought not to heed patient verbal and nonverbal âstatementsâ (which would be foolish), let us ask â if we take McCafferyâs position to be encapsulated in the notion that pain can be verified only by the person experiencing it, might this proposal be introduced to students simply as a topic for discussion? That is, within the academy, can her idea be debated in a manner that allows students to query and possibly reject what is proposed? Or, given the normative weight that attaches to âlistening to patientsâ, a weight undergirded by mainstream interpretations of professional values, is this option inadmissible?
To disaggregate the issues thrown out by these questions, and to explore the idea that professional values/norms and specific forms of criticality can be in tension, the assertion that pain can only be verified by the person experiencing it, and the allied assumption that nurses must accept or believe patient reports, is problematised. Problematisation is intended to highlight the complexity of âvalue choicesâ confronting educators. I am not, to restate, suggesting we shouldnât listen to patients.