Pain Assessment Practice And Its Associated Factors Among Nurses

Project and Seminar Material for Nursing (Science)

Pain Assessment Practice And Its Associated Factors Among Nurses


Abstract


This study was carried out to examine pain assessment practice and its associated factors among nurses in General Hospital in Ogoja Local Government Area of Cross River State. The study was specifically carried out to ascertain the pain assessment practices among nurses in General Hospital in Ogoja Local Government Area of Cross River State, ascertain the attitude of nurses towards pain assessment practices in General Hospital in Ogoja Local Government Area of Cross River State, and find out the factors affecting effective pain assessment among nurses working in General Hospital in Ogoja Local Government Area of Cross River State. The survey design was adopted and the simple random sampling techniques were employed in this study. The population size comprise of nurses in General Hospital in Ogoja Local Government Area, Cross River State. In determining the sample size, the researcher conveniently selected 57 respondents and 50 were validated. Self-constructed and validated questionnaire was used for data collection. The collected and validated questionnaires were analyzed using frequency tables, and mean scores. While the hypotheses were tested using Chi-square statistical tool. The result of the findings reveals that the pain assessment practices among nurses in General Hospital in Ogoja Local Government Area of Cross River State includes: use pain assessment scales/tools, assess patients’ pain before and after a procedure, discuss pain scores during a nurse-to-nurse report, document pain assessment scores, use observation(patient’s behaviors and gestures) in pain assessment, and use vital signs as extra indicators of the intensity of a patient’s pain/as a cue for pain assessment. The study also revealed that nurses have a negative attitude towards pain assessment practices in General Hospital in Ogoja Local Government Area of Cross River State. Therefore, it is recommended that the hospital should provide all types of pain assessment tools to the health care providers so that different types of pain are easily assessed without relying on only one single tool. To mention but a few.


Table of Content


  • Title Page
  • Certification
  • Dedication
  • Acknowledgement
  • Table of Content
  • List of Tables
  • Abstract

Chapter One:

Introduction

  • 1.1 Background of the Study
  • 1.2 Statement of the Problem
  • 1.3 Objective of the Study
  • 1.4 Research Questions
  • 1.5 Research Hypothesis
  • 1.6 Significance of the Study
  • 1.7 Scope of the Study
  • 1.8 Limitation of the Study
  • 1.9 Definition of Terms
  • 1.10 Organisations of the Study

Chapter Two:

Review of Literature

  • 2.1 Conceptual Framework
  • 2.2 Theoretical Framework
  • 2.3 Empirical Review

Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Population of the Study
  • 3.3 Sample Size Determination
  • 3.4 Sample Size Selection Technique and Procedure
  • 3.5 Research Instrument and Administration
  • 3.6 Method of Data Collection
  • 3.7 Method of Data Analysis
  • 3.8 Validity of the Study
  • 3.9 Reliability of the Study
  • 3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation
  • 4.2 Analysis of Data
  • 4.3 Answering Research Questions
  • 4.4 Test of Hypotheses

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • APPENDIX
  • QUESTIONNAIRE

Chapter One


Introduction

1.1 Background to the Study

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage(Rathnayake, 2012). The evidence shows that pain is one of the main reasons patients seek medical care(Oldewage-Theron, & Kruger, 2008). Untreated pain has an impact on patients’ clinical and psychological well-being, as well as hastens their risk of mortality and has a slew of other negative repercussions, such as raising treatment expenses, lengthening hospital stays, and lowering their quality of life(Khawaja, 2020).

Pain is regarded as the fifth vital sign and as important as the other vital signs(Imoro, 2019). Assessment of pain is the first and most important step in pain management(Schroeder, Hoffman, Fioravanti, & Medley, 2016). It is notable that assessing pain decreases over-treatment and treatment-related adverse effects(Hoffman et al. 2016). Pain assessment must be considered on admission, after a change in medical status, prior to, during, and after procedures(Hoffman et al. 2016). A comprehensive assessment of pain requires subjective and objective data, self-reports, and assessment tools(Hoffman et al. 2016). Actually, a patient’s self-report of pain is the most valid method of assessing pain in a patient who can communicate(Dudgeon, King, Howell, Green, Gilbert, and Hughes, 2012). Moreover, patients’ vital signs are part of a comprehensive pain assessment(Gilbert et al. 2012). Because the vital signs cannot distinguish pain from other types of suffering, they are utilized as a complement in pain assessment(Herr, et al. 2011). Additionally, during pain assessment, health care providers should also pay attention to patients’ behavior, such as facial expressions and gestures(Kizza, 2012). Furthermore, assessment results must be documented and disseminated to all those involved in a patient’s care(Kruger et al. 2008).

Nurses are in a unique position to support patients who are experiencing pain(Cox et al. 2018). Nurses play a vital role in providing pain assessment and management. Besides, in order to effectively manage pain, a nurse must accurately measure the patient’s experience of pain. In addition, nurses should use a consistent and methodical approach to pain exploration(Herr, et al. 2011). Furthermore, nurses should consider pain assessment principles while using assessment techniques and instruments(Rathnayake et al. 2012).

In many clinical contexts, pain is not assessed in a standardized manner. Implementing the principles of pain assessment remains a challenge for many nurses. Several studies from developed countries pointed out that nurses’ pain assessments vary across regions, with some reports suggesting poor compliance among nurses in recording and reporting pain assessment findings(Fioravanti et al. 2016). On the other hand, problems of applying the standard of pain assessment were shown to be more prominent in low-income countries. Moreover, African patients are less likely to verbalize their pain because expressing pain is seen as an act of weakness(Herr, et al. 2011). Thus, African regions suffer from a double burden of pain assessment from nurses’ and patients’ sides. Furthermore, similar results were reported from studies of African countries indicating poor adherence to the principles of pain assessment. Besides, the previous few and inconsistent studies in Ethiopia showed that pain assessment practice among nurses was from 24.4% to 55.9% (Oldewage-Theron, & Kruger, 2008).

Being a male nurse, having low work experience, a lower educational level, lack of training on pain management, lack of organizational support, and absence of pain management guidelines were associated with nurses’ poor pain assessment practice.

Previous studies in Nigeria have mainly focused on pain management, other than pain assessment practice. Thus, there is very limited and inconsistent evidence on pain assessment practice among nurses in Nigeria. Therefore, this study aimed to examine pain assessment practice and its associated factors among nurses in general hospital Ogoja Local Government Area Cross River State.


1.2 Statement of the Problem

Key principles recommended for effective pain management are routine pain assessment and assessment of interventions, (Watt-Watson et al, 2009). A comprehensive clinical process of describing pain and its effects on patient function in detail is recommended, to assist in diagnosis, selection of appropriate medication and anticipating the severity or extent of disease or injury, (Brown, 2006). This requires use of standardized pain assessment tools like the PQRSTU, the numerical rating scale among others. This promotes consistency among the care providers, enhances communication between patients and practitioners by making a subjective experience measurable and facilitating evaluation of pain management decisions according to the WHO analgesic ladder, (Herr, et al, 2006).

A number of serious consequences occur to patients when pain is inappropriately assessed, it leads to its poor management, this is because, without assessing the intensity of pain, one cannot administer an appropriate analgesic and so patients may be at risk of being under dosed or over dosed with analgesia, addiction to analgesic agents, poor pain management, poor health outcomes for patients (chronic pain) and economic costs to the patient as a result of decreased productivity.

Factors affecting management of pain practices include: lack of nurse-physician collaboration, nurse related factors, organizational factors and nurse pain management domain. Nurses’ pain management practices concerns how nurses manage pain. There was increased focus on pain management programs and the development of new standards for pain assessment and management. Ward nurses have a central role in pain management practices. It is ward nurses who spend more time with patients and have the responsibility for assessing patient’s pain intensity, administering prescribed analgesic treatments and monitoring side effect of drugs(Khawaja, 2020).


1.3 Objectives of the Study

The main study objective is to examine pain assessment practice and its associated factors among nurses in General Hospital in Ogoja Local Government Area of Cross River State. while the specific objectives of the study include;

  1. Ascertain the pain assessment practices among nurses in General Hospital in Ogoja Local Government Area of Cross River State.
  2. Ascertain the attitude of nurses towards pain assessment practices in General Hospital in Ogoja Local Government Area of Cross River State.
  3. Find out the factors affecting effective pain assessment among nurses working in General Hospital in Ogoja Local Government Area of Cross River State.

1.4 Research Questions

The study will be guided by the following questions;

  1. What are the pain assessment practices among nurses in General Hospital in Ogoja Local Government Area of Cross River State?
  2. What is the attitude of nurses towards pain assessment practices in General Hospital in Ogoja Local Government Area of Cross River State?
  3. What are the factors affecting effective pain assessment among nurses working in General Hospital in Ogoja Local Government Area of Cross River State?

1.5 Research Hypothesis

  • Ho: The attitude of nurses towards pain assessment practices in General Hospital in Ogoja Local Government Area is not positive.
  • Ha: The attitude of nurses towards pain assessment practices in General Hospital in Ogoja Local Government Area is positive.

1.6 Significance of the Study

The findings of this study will improve nurses knowledge on pain assessment and management through continuous Nursing Education and use it accurately. Identify nurses strength and weaknesses in pain assessment and management, and then improve on their weaknesses.

By creating awareness to health facility authorities about the knowledge of nurses in pain assessment and management, the study will help hospitals to identify ways of improving the knowledge of their nurses on pain assessment and management for example through training.


1.7 Scope of the Study

This study is structured to generally examine pain assessment practice and its associated factors among nurses in General Hospital in Ogoja Local Government Area of Cross River State. The respondents of this study will comprise of nurses in General Hospital in Ogoja Local Government Area.


1.8 Limitation of the Study

Like in every human endeavour, the researcher encountered slight constraints while carrying out the study. Insufficient funds tend to impede the efficiency of the researcher in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. More so, the researcher simultaneously engaged in this study with other academic work. As a result, the amount of time spent on research will be reduced.


1.9 Definition of Terms

Pain:

An unpleasant sensory and emotional experience associated with tissue damage or treatment, which can be determined by raised blood pressure, raised pulse rate, pupil dilatation and facial grimacing in critically ill unconscious patients.

Assessment:

This refers to the critical analysis of physiological and behavioural parameters in unconscious patients to determine their level of pain. It involves gathering, analysis and synthesis of relevant parameters upon which the Intensive Care nurse will base her decision of whether a critically ill patient is in pain.

Pain management:

It involves the administration of analgesia or non-pharmacological interventions to relieve pain after assessment, according to the unit protocol or prescription, documentation of the procedure and follow-up to determine if the patient’s pain is relieved


1.10 Organization of the Study

This research work is organized in five chapters, for easy understanding, as follows.

  • Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study.
  • Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature.
  • Chapter three deals on the research design and methodology adopted in the study.
  • Chapter four concentrate on the data collection and analysis and presentation of finding.
  • Chapter five gives summary, conclusion, and recommendations made of the study.

Chapter Five


Summary, Conclusions and Recommendations:

5.1 Introduction

This chapter summarizes the findings on pain assessment practice and its associated factors among nurses in General Hospital in Ogoja Local Government Area of Cross River State. The chapter consists of summary of the study, conclusions, and recommendations.


5.2 Summary of the Study

In this study, our focus was to examine pain assessment practice and its associated factors among nurses in General Hospital in Ogoja Local Government Area of Cross River State. The study was specifically carried out to ascertain the pain assessment practices among nurses in General Hospital in Ogoja Local Government Area of Cross River State, ascertain the attitude of nurses towards pain assessment practices in General Hospital in Ogoja Local Government Area of Cross River State, and find out the factors affecting effective pain assessment among nurses working in General Hospital in Ogoja Local Government Area of Cross River State.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 50 responses were validated from the enrolled participants where all respondent were nurses in General Hospital in Ogoja Local Government Area, Cross River State.


5.3 Conclusions

Based on the findings of this study, the researcher concluded that;

  1. The pain assessment practices among nurses in General Hospital in Ogoja Local Government Area of Cross River State includes: use pain assessment scales/tools, assess patients’ pain before and after a procedure, discuss pain scores during a nurse-to-nurse report, document pain assessment scores, use observation(patient’s behaviors and gestures) in pain assessment, and use vital signs as extra indicators of the intensity of a patient’s pain/as a cue for pain assessment.
  2. Nurses have a negative attitude towards pain assessment practices in General Hospital in Ogoja Local Government Area of Cross River State.
  3. The factors affecting effective pain assessment among nurses working in General Hospital in Ogoja Local Government Area of Cross River State includes: nursing workload, lack of adequate availability of pain assessment tools, lack of familiarity with assessment tools, patient inability to communicate, and lack of protocol /guidelines for pain management.

5.4 Recommendations

Based on the findings of the study, the following recommendations are proffered.

  1. Pain education should begin from the training level where the nurse educators and clinical facilitators should work hand in hand to initiate a clinical and theory pain curriculum for students during their training in the university and college. All the topics should be covered and on employment to pain assessment and management training done at the beginning and on a regular basis. The patient who cannot self-report pain must be a point of focus and not generalizing the two groups of patients since they have different needs.
  2. The hospital should provide all types of pain assessment tools to the health care providers so that different types of pain are easily assessed without relying on only one single tool.
  3. The hospital should ensure that all nurses are trained continuously about pain assessment and management through internally organized trainings, and supervisory and monitoring bodies must be appointed to ensure compliancy by nurses.
  4. The hospital should provide guidelines to the nurses and others health care professionals in the hospital regarding pain assessment and management.
  5. The hospital should provide facilitators and monitor the training of the workers of pain and related topics.
  6. The hospital should ensure that there are always adequate pain relief medications in all classes according to the analgesic ladder.

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