Gate Control Theory
The gate control theory (GCT) was proposed in 1965 to explain the relationship between pain and emotion. Melzack and Wall (1982) concluded that pain is not just a physiologic response but that psychological variables (i.e., behavioral and emotional responses) influence the perception of pain. According to the GCT, a gating mechanism occurs in the spinal cord. Pain impulses are transmitted from the periphery of the body by nerve fibers (A, delta, and C fibers). The impulses travel to the dorsal horns of the spinal cord, specifically to the area of the cord called the substantia gelatinosa. The cells of the substantia gelatinosa can inhibit or facilitate pain impulses that are conducted by the transmission cells. If the activity of the transmission cells is inhibited, the gate is closed and impulses are less likely to be conducted to the brain. When the gate is opened, pain impulses ascend to the brain. Similar gating mechanisms exist in the descending nerve fibers from the thalamus and cerebral cortex. A person’s thoughts and emotions can influence whether pain impulses reach the level of conscious awareness (Helms & Barone, 2008; Litwack, 2009). Gate Control Theory
The gate control model ( Figure 15-5 ) differentiates the excitatory (white circle) and inhibitory (black circle) links from the substantia gelatinosa to the transmission cells as well as descending inhibitory control from brain stem systems. The round knob at the end of the inhibitor link implies that its action may be presynaptic, postsynaptic, or both. All connections are excitatory, except the inhibitory link from substantia gelatinosa to the transmission cell (Melzack & Wall, 1982).
As mentioned in the case study, it is believed that pain medication has an effect on the gating mechanism. If pain medication is administered before the onset of pain (i.e., before the gate is opened), it will help keep the gate closed longer and fewer pain impulses will be allowed to pass through. The greater the degree of pain, the greater the number of pain impulses passing through the gate. If fewer pain impulses are allowed through the gate, the person will experience less pain. If the gate is allowed to open completely, a higher dosage of pain medication is required to close the gate. Therefore, in theory, prevention and management of pain are linked to keeping the gate closed. Gate Control Theory
Application to Nursing
The GCT has also been the model for several reports related to pain management. Lane and Latham (2009), for example, presented aspects of the GCT in use of heat and cold therapy as nonpharmacologic interventions to reduce pain in hospitalized children. Tansky and Lindberg (2010) performed a comprehensive literature review on the use of breastfeeding as a intervention to reduce pain caused by immunization using the GCT as a framework. They found that there is considerable evidence that it is an effective pain management technique.
In nursing research, one study (Ngamkham, Holdern, & Wilkie, 2011) used the GCT to examine pain pattern responses in location, intensity, and quality among outpatients with cancer. Friesner, Curry, and Moddeman (2006) used GCT as the framework in a research study to compare two strategies for removal of chest tubes. They determined that encouraging slow, deep-breathing relaxation helps manage pain during chest tube removal. Finally, another experimental study, Hatfield (2008) showed that administration of an oral sucrose solution prior to immunization is effective in helping relieve pain in infants receiving routine vaccinations. Gate Control Theory
Nurses continually use concepts and principles from multiple biomedical theories in practice and in research. Indeed, these concepts, principles, and theories are so integral to nursing that they are difficult to differentiate and set aside for detailed inspection.
The biomedical theories used by nurses include theories of disease and disease causation, as well as theories related to physiology and physical functioning. Nurses, particularly advanced practice nurses such as Maria from the case study, should study these theories. They should understand their relevance to nursing practice and recognize how they are used and supported in nursing research. Gate Control Theory
Because of length constraints, only a few concepts and theories were described in this chapter. But it is hoped that these discussions will lead the reader to recognize the importance of understanding theory and to apply theory to guide practice and research. Ultimately, this will improve the care of clients.
· Theories from the biomedical sciences have greatly influenced nursing since Nightingale’s time.
· Biomedical science theories used by nurses include theories from biology, medicine, public health, physiology, and pharmacology. Gate Control Theory
· Theories and models of disease causation commonly used by nurses include the “germ theory” (principles of infection) and public health theories, such as the epidemiologic triangle and the web of causation.
· The Natural History of Disease model outlines the concepts of health promotion as well as primary, secondary, and tertiary prevention; these principles are used by nurses in all areas of practice and research.
· Theories and principles of physiology and physical functioning include homeostasis and theories of stress and adaptation; both are commonly used by nurses in practice and research.
· Theories and principles related to immunity and immune function are widely used in nursing practice and are increasingly being studied in nursing research. Gate Control Theory
· Nursing knowledge regarding genetics, genetic principles, and genetic counseling is growing, and nurses are recognizing the importance of genetic factors on health.
· Cancer theories, particularly related to prevention and early detection, are very important to nurses and a source for study for nursing research and review for nursing practice.
· Pain management is a vital part of nursing practice; nurses are continually researching how to improve pain management.
· Abraham, S. (2011). Fall prevention conceptal framework. The Health Care Manager, 30(2), 179–184.
· Ardizzone, L. L., Smolowitz, J., Kline, N., Thom, B., & Larson, E. L. (2012). Patient hand hygiene practices in surgical patients. American Journal of Infection Control, 41(6), 487–491.
· Banasik, J. L. (2010a). Inflammation and immunity. In L. C. Copstead & J. L. Banasik (Eds.), Pathophysiology (4th ed., pp. 181–221). Philadelphia: Saunders/Elsevier. Gate Control Theory
· Banasik, J. L. (2010b). Genetics. In L. C. Copstead & J. L. Banasik (Eds.), Pathophysiology (4th ed., pp. 128–157). Philadelphia: Saunders/Elsevier.
· Banasik, J. L. (2010c). Neoplasia. In L. C. Copstead & J. L. Banasik (Eds.), Pathophysiology (4th ed., pp. 128–157). Philadelphia: Saunders/Elsevier.
· Beery, T. (2008). Genetics for advanced nursing practice. The Nurse Practitioner, 33(11), 10–18.
· Bellar, A., Kunkler, K., & Burkett, M. (2009). Understanding, recognizing and managing chronic critical illness syndrome. Journal of the American Academy of Nurse Practitioners, 21(11), 571–578.
· Black, J. M., & Hawks, J. H. (2009). Medical surgical nursing: Clinical management for positive outcomes(8th ed.). Philadelphia: Elsevier. Gate Control Theory
· Blattner, W. A. (2000). Etiology of malignant disease. In H. D. Humes (Ed.), Kelley’s textbook of internal medicine (4th ed., pp. 141–147). Philadelphia: Lippincott Williams & Wilkins.
· Buet, A., Cohen, B., Marine, M., Scully, F., Alper, P., Simpser, E., et al. (2013). Hand hygiene opportunities in pediatric extended care facilities. Journal of Pediatric Nursing, 28(1), 72–76.
· Calzone, K. I. A., Jenkins, J., Yates, J., Cusack, G., Wallen, G. R., Liewehr, D. J., et al. (2012). Survey of nursing integration of genomics into nursing practice. Journal of Nursing Scholarship, 44(4), 428–436.
· Causey, C., & Greenwald, B. (2011). Promoting community awareness of the need for colorectal cancer prevention and screening: A replication study. Gastroenterology Nursing, 34(1), 34–40.
· Cavence, W. K., & White, R. (1995). The genetic basis of cancer. Scientific American, 272, 72–79.
· Carroll, E. W. (2009). Genetic control of cell function and inheritance. In C. M. Porth & G. Matfin (Eds.), Pathophysiology: Concepts of altered health states (8th ed., pp. 112–132). Philadelphia: Lippincott Williams & Wilkins. Gate Control Theory
· Chan, Z. C. Y., Chan, T. S., Ng, K. K., & Wong, M. L. (2012). A systematic review of literature about women’s knowledge and attitudes toward human papillomavirus (HPV) vaccination. Public Health Nursing, 29(6), 481–489.
· Chen, Y. Y., Chi, M. M., Chen, Y. C., Chan, Y. U., Chou, S. S., & Wang, F. D. (2013). Using a criteria-based reminder to reduce use of indwelling urinary catheters and decrease urinary tract infections. American Journal of Critical Care, 22(2), 105–114.
· D’Alonzo, K. T., Johnson, S., & Fanfan, D. (2012). A biobehavioral approach to understanding obesity and the development of obesogenic illness among Latino immigrants in the United States. Biological Research for Nursing, 14(4), 364–374.
· DeLuca, J., Zanni, K. L., Bonhomme, N., & Kemper, A. R. (2013). Implications of newborn screening for nurses. Journal of Nursing Scholarship, 45(1), 25–33.
· Donahue, M. P. (2011). Nursing: The finest art (3rd ed.). St. Louis: Mosby.
· Emerson, R. J. (2010). Homeostasis and adaptive responses to stressors. In L. C. Copstead & J. L. Banasik (Eds.), Pathophysiology (4th ed., pp. 14–27). Philadelphia: Saunders/Elsevier.
· Fletcher, B. J., Himmelfarb, C. D., Lira, M. T., Meininger, J. C., Pradhan, S. R., & Sikkema, J. (2011). Global cardiovascular disease prevention: A call to action for nursing; community-based and public health prevention initiatives. Journal of Cardiovascular Nursing, 26(45), S35–S45. Gate Control Theory
· Frazier, L., Johnson, R. L., & Sparks, E. (2005). Genomics and cardiovascular disease. Journal of Nursing Scholarship, 37(4), 315–321.
· Friesner, S. T., Curry, D. M., & Moddeman, G. R. (2006). Comparison of two pain-management strategies during chest tube removal: Relaxation exercise with opioids and opioids alone. Heart & Lung, 35(4), 269–276.
· Ganz, F. D. (2012). Tend and befriend in the intensive care unit. Critical Care Nurse, 32(3), 25–33.
· Garcia, S. P. Q., Greco, K. E., & Loescher, L. J. (2011). Teaching strategies to incorporate genomics education into academic nursing curricula. Journal of Nursing Education, 50(11), 612–629.
· Gonzalez, S. A., Ziebarth, T. H., Wang, J., Noor, A. B., & Springer, D. L. (2012). Interventions promoting colorectal cancer screening in the Hispanic population: A review of the literature. Journal of Nursing Scholarship, 44(4), 332–340.
· Guvenc, G., Akyuz, A., & Yenen, M. C. (2013). Effectiveness of nursing interventions to increase pap smear test screening. Research in Nursing & Health, 36(2), 146–157. Gate Control Theory
· Hatfield, L. A. (2008). Sucrose decreases infant biobehavioral pain response to immunizations: A randomized controlled trial. Journal of Nursing Scholarship, 40(3), 219–225.
· Helms, J. E., & Barone, C. P. (2008). Physiology and treatment of pain. Critical Care Nurse, 28(6), 38–47.
· Holmes, T., & Rahe, E. (1967). The social readjustment rating scale. Journal of Psychosomatic Research, 11,213.
· Hughes, D., Ladas, E. L., Rooney, D., & Kelly, K. (2008). Massage therapy as a supportive care intervention for children with cancer. Oncology Nursing Forum, 35(3), 431–436.
· Jablonski, K., & Duke, G. (2012). Pain management in persons who are terminally ill in rural acute care: Barriers and facilitators. Journal of Hospice & Palliative Nursing, 14(8), 533–540.
· Jacobson, J. (2013). Navigating the PSA screening dilemma. AJN, 113(1), 19–21.
· Johnson, N. L., Giarelli, E., Lewis, C., & Rice, C. E. (2013). Genomics and autism spectrum disorder. Journal of Nursing Scholarship, 45(1), 69–78. Gate Control Theory
· Jones-Parker, H. (2012). Primary, secondary, and tertiary prevention of cardiovascular disease in patients with HIV disease: A guide for nurse practitioners. Journal of the Association of Nurses in AIDS Care, 23(2), 124–133.
· Kalisch, P. A., & Kalisch, B. J. (2004). American nursing: A history (4th ed.). Philadelphia: Lippincott Williams & Wilkins.
· Kang, D. H., McArdle, T., Weaver, M. T., Smith, B., & Carpenter, J. (2011). Dose effects of relaxation practice on immune responses in women newly diagnosed with breast cancer: An exploratory study. Oncology Nursing Forum, 38(3), E240–E252.
· Keene, A., McMenamin, E. M., & Polomano, R. C. (2002). Pain. In D. D. Ignatavicius & M. L. Workman (Eds.), Medical-surgical nursing: Critical thinking for collaborative care (4th ed., pp. 61–94). Philadelphia: Saunders.
· Kirk, M., Lea, D., & Skirton, H. (2008). Genomic health care: Is the future now? Nursing and Health Sciences, 10(2), 85–92.
· Kisiel, M., & Marsons, L. (2009). Recognizing and responding to hyperglycaemic emergencies. British Journal of Nursing, 18(8), 1094–1098. Gate Control Theory
· KuKanich, K. S., Kaur, R., Freeman, L. C., & Powell, D. A. (2013). Evaluation of a hand hygiene campaign in outpatient health care clinics. AJN, 113(3), 36–43.
· Kunert, M. P. (2009). Stress and adaptation. In C. M. Porth & G. Matfin (Eds). Pathophysiology: Concepts of altered health states (8th ed., pp. 198–212), Philadelphia: Lippincott Williams & Wilkins.
· Kuo, E. S., Stoep, A. V., Herting, J. R., Grupp, K., & McCauley, E. (2013). How to identify students for school-based depression intervention: Can school record review be substituted for universal depression screening? Journal of Child and Adolescent Psychiatric Nursing, 26(1), 42–52.
· Kushi, L. H., Doyle, C., McCullough, M., Rock, C. L., Demark-Wahnefried, W., Bandera, E. V., et al. (2012). American Cancer Society guidelines on nutrition and physical activity for cancer prevention: Reducing the risk of cancer with healthy food choices and physical activity. CA: A Cancer Journal for Clinicians, 62(1), 30–67.
· Lane, E., & Latham, T. (2009). Managing pain using heat and cold therapy. Paediatric Nursing, 21(6), 14–18.
· Leavell, H. R., & Clark, E. G. (1965). Preventive medicine for the doctor in his community: An epidemiologic approach (2nd ed.). New York: McGraw-Hill. Gate Control Theory
· Li, J., & Zhou, L. (2011). Statins for the primary prevention of cardiovascular disease. Journal of Cardiovascular Nursing, 26(4), 288–289.
· Lipsitz, L. A. (2001). Clinical physiology of aging. In H. D. Humes (Ed.), Kelley’s textbook of internal medicine (4th ed., pp. 118–127). Philadelphia: Lippincott Williams & Wilkins.
· Litwack, K. (2009). Somatosensory function, pain, and headache. In C. M. Porth & G. Matfin (Eds.), Pathophysiology: Concepts of altered health states (8th ed., pp. 1225–1259). Philadelphia: Lippincott Williams & Wilkins.
· MacMahon, B., & Pugh, T. F. (1970). Epidemiologic principles and methods. Boston: Little, Brown.
· Mahon, S. M. (2005). Tertiary prevention: Implications for improving the quality of life of long-term survivors of cancer. Seminars in Oncology Nursing, 21(4), 260–270.
· Matthews, R., & Moore, A. (2013). Babies are still dying of SIDS: A safe sleep environment in child-care settings reduces risks. AJN, 113(2), 59–65.
· McEwen, M., & Pullis, B. (2009). Community-based nursing (3rd ed.). Philadelphia: Saunders/Elsevier.
· Meadows-Oliver, M. (2012). Screening for postpartum depression at pediatric visits. Journal of Psychosocial Nursing, 50(9), 4–5. Gate Control Theory
· Melzack, R., & Wall, P. D. (1982). The challenge of pain. New York: Penguin Books.
· Merkle, C. J. (2009). Neoplasia. In C. M. Porth & G. Matfin (Eds.), Pathophysiology: Concepts of altered health states (8th ed., pp. 156–196). Philadelphia: Lippincott Williams & Wilkins.
· Millar, B. C., Loughrey, A., Bill, R., & Moore, J. E. (2011). Community-associated MRSA in primary care. Practice Nursing, 22(12), 662–664.
· Morinec, J., Icaboni, J., & McNett, M. (2012). Risk factors and interventions for ventilator-associated pneumonia in pediatric patients. Journal of Pediatric Nursing, 27(5), 435–442.
· Mulvihill, D. (2005). The health impact of childhood trauma: An interdisciplinary review, 1997–2003. Issues in Comprehensive Pediatric Nursing, 28(2), 115–136.
· Murphy, R. J. (2012). Preventing multidrug-resistant gram-negative organisms in surgical patients. AORN Journal, 96(3), 315–329.
· Ngamkham, S., Holden, J. E., & Wilkie, D. J. (2011). Differences in pain location, intensity, and quality by pain pattern in outpatients with cancer. Cancer Nursing, 34(3), 228–237.
· Nguyen-Truong, C. K. Y., Lee-Lin, F., & Gedaly-Duff, V. (2013). Contributing factors to colorectal cancer and hepatitis B screening among Vietnamese Americans. Oncology Nursing Forum, 40(3), 238–251.
· Nonnemacher, M., Stusberg, J., Bartoszek, G., Lottko, B., Neuhaeuser, M., & Maier, I. (2008). Predicting pressure ulcer risk: A multifactorial approach to assess risk factors in a large university hospital population. Journal of Clinical Nursing, 18, 99–107. Gate Control Theory
· Okonta, N. R. (2012). Does yoga therapy reduce blood pressure in patient with hypertension? An integrative review. Holistic Nursing Practice, 26(3), 137–141.
· Outland, L. (2010) Intuitive eating: A holistic approach to weight control. Holistic Nursing Practice, 24(1), 35–43.
· Porth, C. M. (2009). Genetic and congenital disorders. In C. M. Porth & G. Matfin (Eds.), Pathophysiology: Concepts of altered health states (8th ed., pp. 133–155). Philadelphia: Lippincott Williams & Wilkins.
· Prows, C. A., Hopkin, R. J., Barnoy, S., & Van Riper, M. (2013). An update of childhood genetic disorders. Journal of Nursing Scholarship, 45(1), 34–42.
· Rentz, C. (2008). Nursing care of the person with sporadic Creutzfeldt–Jakob disease. Journal of Hospice and Palliative Nursing, 10(5), 272–284.
· Riker, G. I., & Setter, S. M. (2012). Polypharmacy in older adults at home: What it is and what to do about it—Implications for home healthcare and hospice. Home Healthcare Nurse, 30(8), 474–485.
· Rosenberg, S. (2013). Cell phones and children: Follow the precautionary road. Pediatric Nursing, 39(2), 65–70.
· Ruiz, R. J., & Avant, K. C. (2005). Effects of maternal prenatal stress on infant outcomes: A synthesis of the literature. Advances in Nursing Science, 28(4), 345–355. Gate Control Theory
· Santos, E. M. M., Edwards, Q. I., Floria-Santos, M., Rogatto, S. R., Achatz, M. I. W., & MacDonald, D. J. (2013). Integration of genomics in cancer care. Journal of Nursing Scholarship, 45(1), 43–51.
· Scott, L. K, & Hall, L. M. (2012). Reliability and validity of the acanthosis nigricans screening tool for use in elementary school-age children by school nurses. Journal of School Nursing, 28(6), 442–447.
· Seckel, M. A. (2013). Maintaining urinary catheters: What does the evidence say? Nursing, 43(2), 63–65.
· Secker, T., Hervé, R., & Keevil, C. (2011). Adsorption of prion and tissue proteins to surgical stainless steel surfaces and the efficacy of decontamination following dry and wet storage conditions. Journal of Hospital Infection Control, 78(4), 251–255.
· Selye, H. (1976). Stress in health and disease. Boston: Butterworths.
· Shi, L., & Singh, D. A. (2012). Delivering health care in American: A systems approach. Burlington, MA: Jones & Bartlett.
· Siegel, J. H. (2007). Predictors of overweight in children in grades six through eight. Doctoral dissertation, University of Miami.
· Skirton, H., O’Connor, A., & Humphreys, A. (2012). Nurses’ competence in genetics: A mixed method systematic review. Journal of Advanced Nursing, 68(11), 2387–2398. Gate Control Theory
· Snow, D., & Lu, J. H. (2012). Genetics and genomics: Unraveling new opportunities for addiction treatment and education. Journal of Addictions Nursing, 23, 93–96.
· Starkweather, A. (2013). Psychologic and biologic factors associated with fatigue in patients with persistent radiculopathy. Pain Management Nursing, 14(1), 41–49.
· Starkweather, A., Witek-Janusek, L., & Mathews, H. L. (2005). Applying the psychoneuroimmunology framework to nursing research. Journal of Neuroscience Nursing, 37(1), 56–62.
· Staniute, M., Brozaitiene, J., & Bunevicius, R. (2013). Effects of social support and stressful life events on health-related quality of life in coronary artery disease patients. Journal of Cardiovascular Nursing, 28(1), 83–89.
· Stark, S. (2012). Elder abuse: Screening, intervention, and prevention. Nursing 2012, 42(10), 24–20.
· Stride, P., Hunter, J., & Bailey, M. (2009). Nursing patients with Creutzfeldt-Jakob disease. Are you at risk? Australian Nursing Journal, 17(1), 30–32.
· Tansky, C., & Lindberg, C. E.(2010). Breastfeeding as a pain intervention when immunizing infants. The Journal for Nurse Practitioners–JNP, 6(4), 287–295. Gate Control Theory
· Upshaw-Owens, M., & Bailey, C. A. (2012). Preventing hospital-associated infection: MRSA. MedSurg Nursing, 21(2), 77–81.
· Van Dyke, N. F. (2005). Domestic violence: Differences among rural, urban and suburban women. Doctoral dissertation, State University of New York at Binghamton.
· Walker, D. K. (2012). Skin protection for (SPF) kids program. Journal of Pediatric Nursing, 27(3), 233–242.
· Welsh, D. (2009). Predictors of depressive symptoms in female medical-su Gate Control Theory
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