CHAPTER ONE

INTRODUCTION

Background to the Study

Pain is an unpleasant sensory and emotional experience which is primarily associated with tissue damage or described in terms of such damage or both (Caffery & Ferrell, 2011). It is the most common symptom of any disease and the prompting factor for a health care consumer’s visit for consultation. The experience of pain negatively influences patient’s daily living (Caffery & Paseros, 2008). The relief of pain has been one of the primary reasons for development of health care. Despite the growing awareness of pain management, patients still suffer from unnecessary pains in many hospitals with the resultant negative effect on physical, emotional and spiritual health and quality of life (Lui, & Fong, 2008).

Pain management is considered an important part of care. It is referred to as the “fifth vital sign to emphasize its significance and increase the awareness among health professionals of effective pain management (American Pain Society, 2013). This suggests that the assessment of pain should be as automatic as taking a patient blood pressure and pulse.

Barett (2007) opined that pain is the way the peripheral nervous system warns the central nervous system of injury or potential injury to the body. The message is transmitted through nerve cell called nociceptors by neurotransmitters. The body also releases prostaglandins that may enhance the pain message. Stedman (2006) described

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pain as a variable unpleasant sensation associated with actual or potential tissue damage and mediated by specific nerve fibers to the brain where its conscious appreciation maybe modified by various factors.

Attitudes are the way a person views something and tends to behave towards it, often in an evaluative way. Pain management is an important aspect of patient care and nurses play a significant role in the acute care setting in providing pain assessment and treatment. In this regard, nurses who possess strong foundation in pain management and who can provide individual care to patients with the proper attitude can make an important impact in pain management (Courtenay & Carey, 2010). Misconceptions and biases can affect pain management. These may involve attitudes of the nurse or the client as well as knowledge deficits. However, pain is a multidimensional phenomenon and it is the role of nurses to identify the factors that may influence the patient’s way of perception and expression of pain (Maryland Board of Nursing, 2011).

Mann and Carr (2009) opined that pain management encompasses various types of pain experiences throughout an individual’s life cycle from birth to the end of life. Pain experiences may include acute and chronic pain, pain from a chronic deteriorating condition, or pain as one of many symptoms of the patient receiving palliative care. Pain is not exclusively physiological but also include spiritual, emotional and psychosocial dimensions. The goal of pain management throughout the life cycle is to address the dimensions of pain, and to provide maximum pain relief with minimal side effects (Mann & Carr, 2009). Birth and Willis (2011), indicated that adequate assessment in conjunction with opiod titration based on patient response can provide

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maximum pain relief without adversely affecting respiratory status. Therefore, it is wrong to under-utilize or withhold opiods from patient who is experiencing pain based on fear of causing respiratory depression.

Coll, Mead and Ameren (2011) asserted that inadequate pain relief in post operative care may result in immobility, prolonged recovery and many patients also develop increased cardiovascular, respiratory and gastro-intestinal complications as well as chronic pain conditions. Apart from its humanitarian utility, effective relief of post operative pain is a critical element of a patient’s post operative recovery.

Failure to manage pain effectively in the immediate post operative period can produce undesirable long term physical and psychological consequences that can disrupt an individual’s quality of life (Parvizi, 2009). Post operative pain constitutes a health care challenge requiring knowledge on how to prescribe and administer drugs, assess and reassess post operative patient and a broad understanding of cultural and ethical responses to pain and pain management (Classidy, 2011). Mackintosh (2012) suggested that treatments of post operative pain using the World Health Organization analgesic ladder, should be from top down, that is starting with strong opiod analgesic such as morphine and working down to mild analgesic (non - opiods) such as parecetamol or aspirin. The nurse should be fully aware of the use of pharmacological and non-pharmacological measures in pain management. The nurse should have the knowledge on the use of pharmacological measures, such as opiods, narcotics, analgesics and morphine and also the use of non-pharmacological approaches such as acupuncture, massage and breathing measures among others in pain management. In addition

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knowledge on the existing standards of pain management is considered to be vital. Nurses should learn to distinguish between physical and psychological reliance, withdrawal and pseudo addiction as a result of patient using or having used certain drugs (Maryland Board of Nursing, 2011). It is considered that these therapies will help the standard pharmacological treatment in pain management, while medical drugs are being used for treating the somatic (physiological and emotional) dimensions of the pain. Eidelson (2010) opined that non-pharmacological therapies aim to treat the affective, cognitive, behavioural and socio-cultural dimensions of the pain.

Non-pharmacological methods used in pain management can be classified in different ways. In general, they are classified as physical, cognitive, behavioural and other complementary methods or as invasive or non-invasive methods. Meditation, rhythmic respiration, biofeedback, therapeutic touching, transcutancous electrical nerve stimulation (TENS), musical therapy, acupressure and cold-hot treatment are non-invasive methods (Eidelson, 2010). Bjordal, Johnson and Junggreen (2011) noted that there are many benefits to using non-pharmacological methods in relieving pain, therefore, the barriers keeping patients, nurses and physicians from using them need to be explored. Nurses attitude and use of non-pharmacological pain management therapies need to be assessed, and any deficits identified need to be rectified so that patients could experience satisfaction in pain management.

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Statement of Problem

Pain treatment is directed toward relieving pain with minimal adverse treatment effects, allowing the patient a good quality of life and level of function and a relatively painless death. Though, 80-90% of patient with pain can be eliminated or well controlled, nearly half of all patients with pain including those in developed countries receive less than optimal care (Induru & Lagman, 2011).

Notwithstanding the availability of effective analgesic approaches, many patients continue to experience pain after surgery (Bostrom, 2012). This makes them prone to some post-surgical complications like tissue damage, trauma, necrosis and others and its is also a key factor to their disturbed body comfort. Judging from the negative impacts of pain on health, with its unpleasant sensation, it is necessary to treat pain.

Bostrom (2012) asserted that negative and mistaken beliefs about pain and its treatment are common in the health care system. It has been observed that many health care professionals do not have adequate knowledge, attitude and skills to manage pain effectively. Nurses attitudes towards pain influence the way they perceive and interact with clients in pain. Without adequate assessment skills or knowledge of pain and analgesic therapy, nurses may not be able to understand their client’s pain and confidently participate with other health care providers in its treatment.

Following surgical intervention, patients are placed on analgesic agents. In an effort to obtain adequate pain relief, the patient may respond with demanding behaviour, escalating demands for more or different medications, and repeated requests before the

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prescribed interval between doses has elapsed. The nurses are usually faced with dilemma to administer more analgesic or not because of the implications of such actions. McCaffery and Ferell, (2011) asserted that the use of evidence based information alone by nurses is inadequate to effect change on post-operative pain management. This is because a variety of other nurse characteristics and conduct affect the pain management process in different ways. They include, educational background of the nurse, misconception and lack of skill about pain management among physicians and nurses.

Similar observations were made by the researcher in surgical ward during her clinical experience in IMSUTH. Based on the above, the researcher decided to ascertain the nurses’ attitude to and management of pain in post-operative patients in Imo State University Teaching Hospital Orlu.

Purpose of the Study

The purpose of this study was to assess nurses’ attitude to and management of pain in post operative patients in surgical wards of Imo State University Teaching Hospital, Orlu.

The specific objectives were to;

1)               Determine the nurses attitude towards management of pain in post operative

patients in Imo State University Teaching Hospital, Orlu.

2.                Assess the nurses attitude in the use of pharmacological management of pain in post operative patient in Imo State University Teaching Hospital, Orlu.

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3.                Ascertain the nurses attitude in the use of non-pharmacological management of pain in post operative patients in Imo State University Teaching Hospital, Orlu.

4.                Determine influence of socio-demographic characteristics on nurse’s attitude towards management of pain in post operative patients.

Researcher Questions

1.                What are the attitudes of nurses in surgical wards towards management of pain in post operative patients in Imo State University Teaching Hospital, Orlu?

2.                To what extent do nurses use pharmacological measures in management of pain in post operative patients in Imo State University Teaching Hospital, Orlu?

3.                To what extent do nurses utilize the non-pharmacological measures in management of pain in post operative patient in Imo State University Teaching Hospital, Orlu?

4.                How do socio-demographic characteristics influence nurse’s attitude towards management of pain in post operative patients?

Hypotheses

Ho1: Educational level of nurses has no significant influence on nurse’s attitude towards the management of pain in post operative patient.

Ho2: Nurses years of experience have no significant influence on nurse’s attitude towards management of pain in post operative patient.