ASSESSMENT OF KNOWLEDGE AND APPROACHES OF NURSES TOWARDS CANCER PAIN MANAGEMENT IN ELDERLY PATIENTS IN AHMADU BELLO UNIVERSITY TEACHING HOSPITAL, ZARIA KADUNA STATE

ASSESSMENT OF KNOWLEDGE AND APPROACHES OF NURSES TOWARDS CANCER PAIN MANAGEMENT IN ELDERLY PATIENTS IN AHMADU BELLO UNIVERSITY TEACHING HOSPITAL, ZARIA KADUNA STATE

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Abstract

Pain is the most disturbing and annoying symptom experienced by cancer patients, yet it is poorly managed. About 60-70% of cancer cases in Nigeria present in advance stage; at least 30% of such cases experience one or more types of pain, which is almost pathognomic of the disease state. As a result, the study aimed at assessing nurses‟ knowledge, approaches rendered to elderly patient with pain and the challenges they encounter during cancer pain assessment and managementat Ahmadu Bello University Teaching Hospital, Zaria. A cross sectional descriptive research design was used where both questionnaire and observation were used to obtain information from 73 nurses. The data obtained were analysed using descriptive and inferential statistics with the aid of SPSS version 22.0 as a tool for analysis. Findings on level of knowledge revealed that only 24 (32.8%) of the nurses have knowledge on cancer pain in elderlywhich is below average.The challenges nurses encountered during pain assessment includetoo many patients to assess (mean 4.1); absence of time for assessing patients with pain (mean 4.0); inconsistency of pain report by cognitive impaired patients(mean 3.8);lack of institutional policies for accountability for pain assessment(mean 3.6); and communication barrier between nurses and patients(mean 3.5). The challenges they encountered during cancer pain                    management            include;             none          availability/inadequatemedications(mean                  3.5) andinadequate trained nurses on cancer pain management(mean 4.0). Based on the result of the observation, the approaches nurses rendered includereassuring patient (that pain is real and will assist him or her in dealing with it)(mean 2.95);administering balanced analgesic agents as prescribed to promote optimal pain relief(mean 3.0); anddocumenting severity of patient‟s pain on chart(mean 2.14). It can therefore be concluded that, nurses‟ knowledge on cancer pain is below optimal. This was found to be hindered by certain factors during assessment and in the course of rendering their care to elderly patients with cancer. It is therefore recommended that there should be frequent formal training of nurses on cancer pain management. This could be at the local level such as in both pre service and in service trainings. Pain assessment tools should be available to nurses and adequate staff nurses should be postedto all wards with oncology cases.

Key words: Approaches, Cancer, Elderly, Knowledge, Nurses, Pain

CHAPTER ONE 1.0            INTRODUCTION

1.1       Background to the Study

Cancer is a term for diseases in which abnormal cells divide without control and can

invade nearby tissues(National Cancer Institute, 2015). One defining feature of cancer is

the rapid creation of abnormal cells that grow beyond their usual boundaries, and which

can then invade adjoining parts of the body and spread to other organs, the latter process

is referred to as metastasis(National Cancer Institute, 2015). Metastases are a major cause

of death from cancer (World Health Organisation, 2017). Cancer is the second leading

cause of death globally, and was responsible for 8.8 million deaths in 2015. Globally,

nearly 1 in 6 deaths is due to cancer (World Health Organisation, 2017). Ageing is a

fundamental factor for the development of cancer because the incidence of cancer rises

dramatically with age, most likely due to a build-up of risks for specific cancers that

increase with age (World Health Organisation, 2017).The incidence of malignancies after

the age of 65 years has increased 11-fold compared to younger adults (Marosi & Köller,

2016). Nearly 80% of all cancers are diagnosed in persons beyond the age of 55 years

(Palli, Fortpied, & Wedding, 2010). The median age of diagnosis in many tumours lies

beyond the age of 60 years, for example, hormone-sensitive breast cancer, multiple

myeloma, renal, prostate and colon cancer(Arnold, Karim-Kos, & Coebergh, 2015).

The prevalence of cancer pain is estimated in 25 to 50% for recently diagnosed patients,

in 33 to 80% for patients under treatment, and in approximately 75 to 100% for those in

advanced and terminal states (Oliveira, Sobrinho, & Cunha, 2016). Research suggests

that 70-90% of people with advanced cancer experience persistent pain (Kapoor, Kalwar,

1


Singhal, Nirban, & Kumar, 2015). Further statistics indicate that the over-60s are likely

to stay more than twice as long in hospital for conditions associated with persistent pain

than those aged 59 and below. While pain management has advanced significantly in

recent decades, older people remain less likely than younger people to receive good pain

management, with older women and being more at risk of under-treatment than older

men(McLachlan, Bath, Naganathan, & Hilmer, 2011).As the number of individuals older

than 65 years continues to rise, frailty and chronic diseases associated with pain will

likely increase (Cavalieri, 2005). Reports from the developed world have shown that in

general, the prevalence of pain at the time of cancer diagnosis and early in the course of

disease is estimated to be approximately 50%, increasing to 75% at advanced stages

(International Association for the Study of Pain, 2009).

Persistent pain experienc


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