EVALUATION OF NURSES' ATITUDE AND PROFICIENCY IN PAIN MANAGEMENT

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Hospitalised patients experience significant distress due to pain (Ramira, Instone, & Clark, 2019). As per the definition provided by the Pain Research Organisation, it is "the unpleasant sensory and emotional experience accompanied by tissue damage, either present or potential, or that can be associated with such damage," and it is also referred to as a "pain protection mechanism." Therefore, when assessing pain, it is essential to consider both physical and non-physical factors simultaneously (Babacan, 2020). The American Pain Association and the Health Care Organisation Accreditation Committee (JCAHO) recognised pain as the "fifth vital finding" and emphasised the importance of ongoing pain assessment (elik, 2018). 

When the pain persists and hinders an individual's ability to carry out routine tasks, the individual may encounter the following consequences: diminished libido, psychomotor slowdown, social withdrawal, loss of productivity, diminished self-confidence, irritability, sleep disturbances, exhaustion, excessive bodily handling, diminished libido, passivation of assistance, or aggressive behaviour. Furthermore, the individual may experience emotional changes and become isolated from others. Sleep disturbances and a decline in quality of life result from pain. Presently, it is widely acknowledged that pain management requires a multidisciplinary team approach; patients, nurses, and physicians are the three essential team members; of these team members, only the patient experiences pain and strives to alleviate it (Samarkandi 2020). The knowledge, conduct, disposition, and clinical decision-making abilities of healthcare team members who administer pain management are critical to its success. The nurse plays an essential and indispensable role in pain management within this team (elik, 2018). The nurse is entrusted with a variety of pain management responsibilities, including defining, assessing, and monitoring pain, administering analgesics at the request of the physician, monitoring the patient's response to the effects of the medications administered, preventing the development of complications, and implementing nonpharmacological treatment approaches (elik, 2018). The nurse's role in pain control is characterised by several key elements that set it apart from other team members. Primarily, due to the nurse's extended presence with the patient and other team members, the patient acquires knowledge of prior pain experiences and coping mechanisms, which the nurse then implements when necessary. Additionally, the nurse instructs the patient on effective coping strategies, administers the prescribed analgesic treatment, monitors outcomes, and offers an empathetic approach (Babacan, 2020). 

According to the studies conducted, nurses exhibited a predilection for drug administration management in pain management and refrained from utilising nonpharmacological applications, an area in which they could readily demonstrate their autonomy. Their knowledge and experience regarding these methods have been deemed insufficient. It has been demonstrated that these deficiencies result in ineffective pain management (Morgan, 2019). The assessment of nurses' pain knowledge and dispositions significantly influences their approach towards patients experiencing pain. According to a study by Ozer and Bolükbaş (Samarkandi, 2020), 96.23 percent of nurses do not consistently believe patients who communicate their pain, and 47.62 percent fail to observe the pain-indicative behaviours exhibited by patients who are unable to express their discomfort. 

Pain management influences not only the knowledge but also the cultural infrastructures and personal experiences of nurses. As opposed to defining their current state, research indicates that nurses' decisions regarding pain management and pain are influenced by their own attitudes and misconceptions regarding pain. Understanding the attitudes, knowledge levels, and behaviour patterns of nurses regarding pain management is, therefore, the foundational step in promoting positive behaviour change.

1.2 Statement of the Problem

The persistent challenge lies in the insufficient evaluation and management of pain within the healthcare infrastructure of Nigeria. An essential individual capable of enhancing pain management and delivering nursing care that adequately attends to the patient's requirements is the nurse (Babacan, 2020). Greater knowledge and attitude on the part of nurses result in enhanced pain management, improved patient outcomes, and increased patient satisfaction. Clinical environments rely heavily on nurses for pain assessment and management; therefore, they must be well-versed in the most effective methods of pain assessment and management (Oztunc, 2022). 

Nevertheless, insufficiency in pain management is apparent at every stage of life; prior studies have discovered that children are administered comparatively fewer analgesics than adults in similar circumstances, and a considerable proportion of children who are hospitalised endure intolerable levels of pain due to healthcare providers' ignorance of pain management practice and the misconception that infants and children do not experience pain (or endure less of it than adults). 

Research has shown that substandard pain management can negatively impact patient outcomes through potential prolongation of hospitalisation and recuperation delays; therefore, pain management has significant ramifications for the nursing profession (elik, 2018). This may compromise the physiological and health safety of patients. This investigation bridges the knowledge divide regarding the attitudes and competencies of nurses in the region regarding pain management. This serves as the foundation for the present investigation.

1.3 Objectives of the study

Broadly, the objective of this study is to evaluate nurses attitude and proficiency towards pain management. Precisely, other aims of this study are:

Assess nurses knowledge on pain management practices and competences.

Assess the attitude of nurses towards pain management in Kwuba General Hospital.

Determine whether the level of nurses proficiency influences their attitude towards pain management in Kwuba General Hospital.

Find out the factors influencing effective pain management among nurses working in Kwuba General Hospital.

1.4  Research Questions

The study will be guided by the following questions;

What are the pain management practices and competences required of nurses in Kwuba General Hospital?

What is the attitude of nurses towards pain management in Kwuba General Hospital?

Does the level of nurses proficiency influences their attitude towards pain management in Kwuba General Hospital?

Find out the factors influencing effective pain management among nurses working in Kwuba General Hospital?

1.5   Research Hypothesis

Ho: The level of nurses proficiency does not influence their attitude towards pain management in Kwuba General Hospital.

Ha: The level of nurses proficiency influences their attitude towards pain management in Kwuba General Hospital.

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 evaluate nurses attitude and proficiency towards pain management. The respondents of this study will comprise of nurses in Kwuba General Hospital.

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.

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.

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