An Evaluation of Pain Assessment Knowledge and Management among Nurses in Selected Hospitals in Benin-City Edo State, Nigeria.

An Evaluation of Pain Assessment Knowledge and Management among Nurses in Selected Hospitals in Benin-City Edo State, Nigeria.

Ejovi AKPOJARO¹, Miracle Oghenerukevwe EJIROGHENE², Lucy Omonon CHUKWUKA³, Tessy Omoye EIGBE⁴, Ufuoma Roseline AGOGO⁵, Abieyuwa EWEKA⁶

¹Edo State College Of Nursing Sciences Department Of General Studies

²Benson Idahosa University

³Anchor University Lagos

⁴Edo State College of Nursing Science department of general studies

 ⁵Edo State College of Nursing Science

⁶College of Nursing Sciences UBTH Benin City

DOI: https://doi.org/10.51244/IJRSI.2024.1109025

Received: 04 September 2024; Accepted: 14 September 2024; Published: 30 September 2024

ABSTRACT

Pain a significant global health concern that affect all races, genders, ages, geographical locations, and socioeconomic classes. Previous studies have reported poor knowledge of pain assessment among nurses. Assessment of pain is the first and most important step in pain management. Inadequately managed pain has many consequences for the patient, family, health professionals, and society. This study aims to assess the knowledge of pain assessment and management among nurses in selected hospitals in Benin-city Edo State, Nigeria. This study was carried out among 140 nurses in two selected mission hospitals in Benin City. A descriptive cross-sectional study design was used and convenience sampling technique was used to select study participants until the sample size was gotten.  A self-administered questionnaire was used to collect information from the participants after undergoing pretesting for clarity in another secondary health facility. Data was analyzed using SPSS version 20.0 and statistical significance was set at p < 0.05 at 95% confidence interval. Ethical clearance was obtained from the Research Ethics Committee of Benson Idahosa University. Result shows that, Majority of the respondents in both hospitals had good knowledge of pain assessment with training and journals as the major source of information. While some got theirs from friends. The most common non pharmacologic intervention for pain used in both hospital is relaxation techniques while other techniques are not commonly used. Prescription pain medication is the common pharmacologic intervention in both hospitals. In conclusion proper pain management can lead to quick recovery and reduced complications and shorter hospital stay, foster nurse-patient communication effectively.

Keyword: Pain, Assessment, Nurses

INTRODUCTION

Pain a significant global health concern and it affects all races, genders, ages, geographical locations, and socioeconomic classes (Umuhoza et al., 2020). It is estimated that 50–80% of hospitalized patients suffer pain (Liyew et al., 2020). This is common among older adults, with a global prevalence ranging from 45% to 80% (Nguyen et al., 2021). Chronic pain affects approximately 20% of the adult population in developed countries, with higher rates observed in women, the elderly, and even children (Nguyen et al., 2021). In developing countries, the prevalence of chronic pain ranges from 13% to 51% (Sá et al., 2019). The International Association for the Study of Pain, described pain as an unpleasant sensory and emotional experience that may be linked to actual or potential tissue damage (Raja, 2020). Pain is regarded as the fifth vital sign and as important as the other vital signs (Imoro et al., 2019). Pain which presents as localized or generalized pain, if left untreated, can significantly impact a patient’s quality of life, affecting their physical, emotional, and spiritual well-being (Liyew et al., 2020). Assessment of pain is the first and most important step in pain management (Cox et al., 2018). Pain assessment practices must be considered during admission, after a change in medical status, prior to, during, and after procedures.  In recent decades, pain has become an important area of research and pain management a top priority in healthcare (Alkhatib et al., 2020). Assessment results must be documented and disseminated to all those involved in a patient’s care. Nociceptive and neuropathic are two types of pain patient tolerate during hospitalization (Kahsay et al., 2019).

Lack of training in skilled pain care for healthcare workers, has limited pain treatment in developing countries (IASP, 2018). Inadequately managed pain has many consequences for the patient, family, health professionals, and society. Patients may have emotional reactions related to pain such as anxiety, sleeplessness and hopelessness. These reactions can be followed by unusual behaviors expressed by the patient in response to the unpleasant life experience. Untreated pain has additional risks such as prolonged hospital stay, delayed recovery, and the development of chronic and persistent pain (Alabi et al., 2020). It is also known that poor analgesia leads to immobility and increase cardiovascular, respiratory, and gastrointestinal complications (Paladini et al., 2022).

Report suggests poor compliance among nurses in recording and reporting pain assessment findings in low-income countries (Grunauer et al., 2021). Nurses play a crucial role in pain management decisions, as they spend considerable time with patients. Nurses should use a consistent and methodical approach to pain exploration. Furthermore, nurses should consider pain assessment principles while using assessment techniques and instruments. Studies conducted in various countries, including Turkey, Saudi Arabia, and Ethiopia, have shown that nurses often lack adequate knowledge and possess unfavorable attitudes toward pain management (Andualem et al., 2018). Research suggests that inadequate knowledge and inappropriate attitudes of nurses regarding pain management have substantial effects on patient care and treatment (Menlah et al., 2018).

Findings from this study will be valuable to improve patient’s outcome via proper pain management which can lead to quick recovery and reduced complications and shorter hospital stay, foster nurse-patient communication effectively. This study will also provide adequate information to improve nurses’ knowledge towards pain assessment practices and management.  Through this study nurses would be able to improve patient with quality care and comfort with overall satisfaction with their health care experience. The aim of this study is to determine pain assessment knowledge and management among nurses in selected hospitals, Benin-City.

METHODOLOGY

This study was carried out among 140 nurses in two selected mission hospitals in Benin City for year. The hospitals a mission hospital offers secondary health care services. A descriptive cross-sectional study design was used and convenience sampling technique was used to select study participants based on their availability for the study from the study locations until the sample size was gotten.  A structured self-administered questionnaire was used to collect information from the participants after undergoing pretesting for clarity in another secondary health facility. The questionnaire was developed based on relevant literature and guidelines, and its content validity was ensured through expert review. Participants would be given enough time to complete the questionnaire, and their anonymity and confidentiality would be maintained throughout the study. Data was analyzed using SPSS version 20.0 and statistical significance was set at p < 0.05 at 95% confidence interval. Univariate analysis was used to summarise data. Bivariate analysis of variables was done. P was set P<0.05 at 95% confidence interval. Ethical clearance for this study was obtained from the Benson Idahosa University Ethics and Research committee. Approval was sought from the management of St Philomena hospital and Faith mediplex. Verbal informed consent was obtained from the participants before inclusion in the study.

RESULTS

The data from the table indicates that out of 140 participants, 42 (30%) were male and 98 (70%) were female. In terms of age distribution, 20 (14.3%) were in the 20-25 age group, 36 (25.7%) were in the 26-35 age group, 62 (44.3%) were in the 36-45 age group, and 22 (15.7%) were 46 and above. Moreover, 86 (61.4%) had an educational qualification of RN/RM, 42 (30%) had a B.SC, and 12 (8.6%) fell into the ‘Others’ category. Regarding years of nursing experience, 24 (17.1%) had less than 1 year, 72 (51.4%) had 1-5 years, 28 (20%) had 6-10 years, and 16 (11.4%) had 10 years or more. Additionally, for years of working with the health institution, 22 (15.7%) had less than 1 year, 32 (22.9%) had 1-3 years, 48 (34.3%) had 3-5 years, and 38 (27.1%) had 5 years or more. In terms of grade level, 38 (27.1%) were in the 7-9 range, 58 (41.4%) were in the 10-12 range, 30 (21.4%) were in the 13-15 range, and 14 (10%) were 15 and above. Lastly, across various units/departments, 22 (15.7%) were in A & E, 38 (27.1%) were in O & G, 30 (21.4%) were in the surgical ward, 32 (22.9%) were in the medical ward, and 18 (12.9%) were in other departments.

Majority of the respondents in faith mediplex [89 (63.6%)] and St philomena [23(16.4%)] had good knowledge of pain assessment while about 19(13.6%) and 7 (5%) respondents had poor knowledge of pain assessment. Training (19.3%), journals (24.3%) were the major source of information for commonly used tool for pain assessment for nurses in faith mediplex while training (7.9%), journals (10%) were also very common source of information for commonly used tool for pain assessment in St Philomena. Majority of the respondents in Faithmediplex [84(60%)] and St philomena [28(20%)] have been trained on pain assessment while about 15% and 5% of the respondents in Faithmediplex and St philomena has not been trained.

The most common non pharmacologic intervention for pain used in faith mediplex (20%) and St Philomena (19.3%) is relaxation techniques while other techniques are not commonly used. Prescription pain medication is the common pharmacologic intervention in faith mediplex (24.%) and St philomena (24.%).

DISCUSSION OF FINDINGS

The findings suggest that 60% of nurses in Faith Mediplex Hospital and 20% in St. Philomena Hospital use pain assessment tools. This finding aligns with previous research by Zhang et al. (2020) and a study conducted in Uganda which found adequate knowledge of pain assessment among nurses in 2018 (Iwanuka et al., 2018). This is different from a study that reported low knowledge among nurses in Ethiopia (Rathnayake et al.,2012). However, the disparity between the two hospitals could indicate differences in institutional protocols or training practices, highlighting the need for further investigation. Assessment of pain is the first and most important step in pain management (Cox et al., 2018). It is notable that assessing pain decreases overtreatment and treatment-related adverse effects. This study found that a significant proportion of nurses in both hospitals rely on journals and trainings as a source of information. This aligns with previous research by Chambers (2018), emphasizing the importance of evidence-based practices in pain management. However, the reliance on informal sources such as friends raises concerns about the potential impact on the quality of pain assessment.

This study found that 60% of nurses in Faith Mediplex Hospital and 20% in St. Philomena Hospital have received training on pain assessment and management. This echoes the findings of Mirlashari et al. (2020), emphasizing the significance of continuous education for enhancing nursing practices. However, the lower training percentage in St. Philomena Hospital suggests potential disparities in resource allocation or institutional priorities, indicating the need for standardization of training programs to ensure uniform quality of care. Lack of training in skilled pain care for healthcare workers, has limited pain treatment in developing countries (IASP, 2018). If left untreated, pain can significantly impact a patient’s quality of life, affecting their physical, emotional, and spiritual well-being (Liyew et al., 2020).

This study found that relaxation technique was the most common non pharmacologic intervention for pain management used in both hospitals. These findings align with the research by Chou et al. (2017). The study indicate that prescription pain medication is the primary pharmacological interventions used. These findings resonate with the study by Ballantyne and Sullivan (2022).

Inadequately managed pain has many consequences for the patient, family, health professionals, and society. Patients may have emotional reactions related to pain such as anxiety, sleeplessness and hopelessness. These reactions can be followed by unusual behaviours expressed by the patient in response to the unpleasant life experience. Untreated pain has additional risks such as prolonged hospital stay, delayed recovery, and the development of chronic and persistent pain (Alabi et al., 2020). This study did not delve into how nursing management of pain

CONCLUSION

Nurse’s knowledge of pain assessment and management will lead to quick recovery and reduced complications and shorter hospital stay, foster nurse-patient communication effectively.

REFERENCE

1. Alabi, A., Balogun, O., Habeebu, M., Joseph, A. O., & Salako, A. (2021). Cancer pain control in a Nigerian oncology clinic: Treating the disease and not the patient. Pan Africa Medical Journal, 40, 104.
2. Alkhatib, G. S., Al Qadire, M., & Alshraideh, J. (2020). Pain Management Knowledge and Attitudes of Healthcare Professionals in Primary Medical Centers. Pain Management Nursing, 21, 265-270. https://doi.org/10.1016/j.pmn.2019.11.003
3. Andualem, A. A., Lema, G. F., Nigatu, Y. A., & Ahmed, S. A. (2018). Assessment of acute pain management and associated factors among emergency surgical patients in Gondar University Specialized Hospital Emergency Department, Northwest Ethiopia. Pain Research and Treatment. https://doi.org/10.1155/2018/5636039
4. Cox, F. (2018). Advances in the pharmacological management of acute and chronic pain. Nursing Standard (Royal College of Nursing (Great Britain): 1987), 33(3), 37–42.
5. Grunauer, M., Mikesell, C., Bustamante, G., Cobo, G., Sánchez, S., Román, A. M., et al. (2021). Pain assessment and management in pediatric intensive care units around the world, an international, multicenter study. Frontiers in Pediatrics, 9, 746489.
6. Imoro, M. A. (2019). Practice of pain assessment in critically ill patients among nurses at the Tamale Teaching Hospital. Diverse Journal of Multidisciplinary Research, 1(1), 1–6.
7. Kahsay, D. T., & Pitkajarvi, M. (2019). Emergency nurses’ knowledge, attitude, and perceived barriers regarding pain management in resource-limited settings: A cross-sectional study. BMC Nursing, 18(6), 56-59. https://doi.org/10.1186/s12912-019-0382-9.
8. Liyew, B., Tilahun, A. D., Bayu, N. Ju H., & Kassew, T. (2020). Knowledge and attitude towards pain management among nurses working at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Pain Research and Management, https://doi.org/10.1155/2020/6036575 Manwere, A., Chipfuwa, T., Mukwamba, M. M., & Chironda, G. (2015).
9. Menlah, A., Garti, I., Amoo, S. A., Atakro, C. A., Amponsah, C., & Agyare, D. F. (2018). Knowledge, Attitudes, and Practices of Postoperative Pain Management by Nurses in Selected District Hospitals in Ghana. SAGE open nursing, 4, 2377960818790383. https://doi.org/10.1177/2377960818790383
10. Nguyen, N. P., Kim, S. Y., Daheim, J., & Neduvelil, A. (2021). Prescription pain medication use among midlife and older adults with chronic pain: The roles of generativity and perceived family support. Families, Systems, & Health, 39(2), 248–258. https://doi.org/10.1037/fsh0000579
11. Paladini, A., Rekatsino, M., Saltelli, G., & Varrassi, G. (2022). The Neurobiology, Physiology, and Psychology of Pain. Academic Press, 4, 275-286.
12. Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., Keefe, F. J., Mogil, J. S., Ringkamp, M., Sluka, K. A., Song, X. J., Stevens, B., Sullivan, M. D., Tutelman, P. R., Ushida, T., & Vader, K. (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain, 161(9), 1976–1982. https://doi.org/10.1097/j.pain.0000000000001939
13. Sá, K. N., Moreira, L., Baptista, A. F., Yeng, L. T., Teixeira, M. J., Galhardoni, R., & de Andrade, D. C. (2019). Prevalence of chronic pain in developing countries: systematic review and meta-analysis. Pain reports, 4(6), e779. https://doi.org/10.1097/PR9.0000000000000779
14. Umuhoza, O., Chironda, G., Katende, G., & Mukeshimana, M. (2019). Perceived knowledge and practices of nurses regarding immediate post-operative pain management in surgical wards in Rwanda: A descriptive cross-sectional study. International Journal of African Nursing Sciences, 10, 145-151. https://doi.org/10.1016/j.ijans.2019.07.005

 

Table 1: Socio demographic information of respondent from both hospitals

Variable	Categories	Frequency N=140	Percentage (%)
Gender	Male Female	42 98	30 70
Age group	20 – 25 years 26 – 35 years 36 – 45 years 46 and above	20 36 62 22	14.3 25.7 44.3 15.7
Educational qualification	RN/RM B.SC Others	86 42 12	61.4 30 8.6
Years of nursing experience	Less than 1 year 1 – 5 years 6 – 10 years 10 years and above	24 72 28 16	17.1 51.4 20.0 11.4
Years of working with that health institution	Less than 1 year 1 – 3 years 3 – 5 years 5 years and above	22 32 48 38	15.7 22.9 34.3 27.1
Grade level	7 – 9 10 – 12 13 – 15 15 and above	38 58 30 14	27.1 41.4 21.4 10.0
Unit/ department	A & E O & G Surgical ward Medical ward Others	22 38 30 32 18	15.7 27.1 21.4 22.9 12.9

Table 2. Nurse’s knowledge of pain assessment

Knowledge of pain assessment	Frequency	Percentage (%)
Faith Mediplex Good Poor	89 19	63.6 13.6
St Philomena Good Poor	23 7	16.4 5

Table 3: Source of information for commonly used tool for pain assessment in Faith Mediplex Hospital

Source of Information	Frequency	Percent
Friends	22	15.7
Training	27	19.3
Journals	34	24.3
Others	17	12.1

Table 4: Source of information for commonly used tool for pain assessment In St. Philomena Hospital

Source of Information	Frequency	Percent
Friends	9	6.4
Training	11	7.9
Journals	14	10.0
Others	6	4.3

Table 5: Training on pain assessment and management in the last 1year

Trained on Pain Assessment	Frequency	Percent
Faith Mediplex Yes	84	60.0
No	21	15.0
St Philomena Yes No	28 7	20 5

Non-Pharmacological Intervention for Pain

Table 6: Faith Mediplex hospital

Non-Pharmacological Intervention	Frequency	Percent
Positioning and comfort measures	15	10.7
Relaxation techniques	28	20.0
Distraction therapy	5	3.6
Physical therapy	13	9.3
Other	9	6.4

Table 7: Non-Pharmacological Intervention in St. Philomena hospital

Non-Pharmacological Intervention	Frequency	Percent
Positioning and comfort measures	16	11.4
Relaxation techniques	27	19.3
Distraction therapy	4	2.9
Physical therapy	8	5.7
Other	9	6.4

Table 8: Pharmacological intervention for pain Faith mediplex hospital

Pharmacological Intervention	Frequency	Percent
Prescription pain medication	34	24.3
Intravenous (IV) analgesics	16	11.4
Epidural analgesia	8	5.7
Others	14	10.0

Table 9: Pharmacological intervention for pain in St. Philomena hospital

Pharmacological Intervention	Frequency	Percent
Prescription pain medication	34	24.3
Intravenous (IV) analgesics	16	11.4
Epidural analgesia	7	5.0
Others	11	7.9

Table 4.1.5: Appropriate assessment of pain

Faith mediplex hospital

Appropriate Assessment of Pain	Frequency	Percent	Valid Percent
Yes	106	75.7	78.2
No	11	7.9	8.1
Missing	2	1.4	0
Total	119	85.0	86.3

St. Philomena hospital

Appropriate Assessment of Pain	Frequency	Percent	Valid Percent
Yes	17	12.1	12.5
No	2	1.4	1.5
Missing	2	1.4	0
Total	21	15.0	14.0

Mean = 1.10

S.D = .295