Utilization of Pain Management Tools Among Nurses Working In Acute care Units


Utilization of Pain Management Tools Among Nurses Working In Acute care Units in mater Misericordia hospital afikpo


Maintaining an optimal level of comfort is a universal goal  for physicians and nurses because pain is one of the major experiences that can minimize patients’ comfort. These patients experience pain from  preexisting  diseases, invasive procedures, or trauma Arif and Grap, (2009). Pain management is the first step in proper pain relief, an important goal in patients’ care Gelinas et al., (2006). According to the International Association for the Study of Pain (IASP) (2010), pain is a sensory and emotional experience associated with actual or potential damage or described in terms of such damage. It is a sensation that is strictly subjective in nature. McAffery (2010) defined pain as whatever the experiencing person says it is, existing whenever the experiencing person says it does. This exemplifies the importance of the patient’s perspective and input, which supports the individual’s self-report as the  single most reliable indicator of the existence and severity  of pain Pasero, (2009). Pain management is crucial if pain management is to be effective and nurses are in a unique position to assess pain as they have the most contact with the patient and their family in hospital. Failing to assess  pain may affect quality of life, and increase the length of  stay of hospitalized clients Zanolin et al., (2007). There are several validated assessment tools in the literature to assess the intensity of pain; for example, the Numeric  Rating Scale (NRS), Visual Analog Scale (VAS), Verbal Descriptor Scale (VDS), and Wong-Baker Faces Scale (WBFS) ACCN, (2013); Pasero and McCaffery, (2010). For critically ill adults who cannot communicate properly, there are also several validated tools including the, Behavioral Pain Scale (BPS), Critical-Care Pain Observation Tool (CCPO), and Face, Legs, Activity, Cry, and Consolability (FLACC) pain scale ACCN, (2013). Nurses play a pivotal role in pain management and management Suha et al., (2014). Untreated and undertreated pain has debilitating effects and significantly interferes with the patient’s  physical, emotional and spiritual well-being thus can alter  the patient’s quality of life Ho et al., (2013; Alexandrina de Jesus and Jacinta, 2013). Lui et al. (2008), reported that pain is a common symptom in patients in medical units and effective pain management using the right scale/tools is a senaquel to effective management strategies. It has been established that nurses assess patient pain using these  tools infrequently Rose, et al, (2011), and studies have shown that the reasons for the inadequacies in pain management, include inadequate knowledge on pain management tool/scale, lack of utilization, monitoring, and pharmacological treatment of pain especially frequently  used opioids Bernardi et al., (2007), Pediaditaki et al., (2010). In a cross sectional study conducted by Gregory  and Richard, (2014) on the use of pain management tools in clinical practice in school of Nursing Midwifery and Social Work, University of Manchester, UK using 132 healthcare professionals. The result shows that the numerical rating scales and the verbal descriptor scale were used by the majority of nurses. Behavioral pain management scale such as Abbey pain management scale were used by 42% of the respondents. It also indicates that verbal self-report pain management scales appear to be embedded into clinical practice, but the use of observational  pain  assessment tools for people with communication difficulties have not been adopted by the majority of organizations represented. Also a cross-sectional descriptive study conducted by  Ogwa, and Ndie, (2005), on the use of pain management tools among 450 nurses randomly selected at federal teaching hospital, Abakiliki. The result shows that majority  of the nurses use mainly patient’s verbal report of pain (87%) and simple descriptive pain intensity scale (57%) as their pain management tools. It revealed that  nurses  only use the subjective method to assess their patient’s  pain. In a descriptive study conducted by Ojong, Ojong-Alasia and Nlumanze (2014) on nurses on use of pain  assessment tools and management of pain among surgical patients in secondary health facility in Calabar Metropolis, Cross River State, Nigeria. The result shows methods of pain management tools recorded thus: patient self report of pain 72%, observation of behaviour 78.9% and assessment of pain site and location. Records of pain management tools used and management were deficient in the wards.

Similarly a participatory research conducted by Gregory (2012) on how to identify a pain management tools for  people with communication difficulty at University of Manchester, UK shows that several behavioral pain management tools available but are not used in everyday practice, but numerical pain management tool appeared  to be suitable for acute care but in practice and when compared to other tools it was not useful.

Furthermore, Niamh, (2011) in a study of  knowledge  and attitude regarding pain among surgical nurses, uses a descriptive cross-sectional design. It was find out that more than half (57.4%) of the sample always used a pain management tool (PAT), a further 38.3% used a pain management tool (PAT) frequently, with the remaining 4.3% of respondents rarely or occasionally using a pain management tool (PAT). Kizza and Muliira,  (2016)  in  a study aimed at describing the knowledge and practices related to pain management, and perceived barriers among nurses caring for critically ill – adult patients (CIAP) also reported that Nurses have poor pain management practices, including lack of use of pain management tools and guidelines, which were significantly associated  with workload and the low priority set to pain management and management. Similarly, Torvik et al., (2015), in a study to explore the use of pain management strategies (verbal, numeric, and observation rating scales and standardized questions) in home care and nursing homes. It was  revealed that pain management tools were not used frequently in nursing homes and home care. Verbal and numeric rating scales were used significantly more frequently in home care than in nursing homes. Registered nurses (RNs) in nursing homes used standardized  questions significantly more often than did RNs in home care. RNs and social educators in home care self-reported less competence in treating the patients’ total pain experience than did those in nursing homes..

Consequently, Taylor and Stanbury, (2009) shows that busy units, inadequate staffing, limited time, inappropriate attitude or focus on other imperatives, inadequate knowledge on assessment tools, poor communication, inadequate staff training were factors affecting utilization of pain management tools. Rose et al, (2011) relate factors like hemodynamic instability and inability to communicate have specifically influence pain management. Findings of a study showed that level of education qualification  and  the  number of topics covered during ongoing professional education did not influence reported perceptions on important of pain management tools Prose et al., (2011). Similar findings were reported by a study in Hong  Kong were educational level was how  significantly  associated with knowledge and utilization Lui et al., (2008).

Shurgarman and Colleague, (2010) also reported that educational level was not found to be associated with nursing staff utilization of pain management  tools  like Normal Rating Scale (NRS). Ashley, (2009), reported that social attitude and cultural beliefs of both  the  person  in pain and practitioners prevail and can limit effective utilization of pain management tools. Also absence of protocols and guidelines on pain management tools has  been cited to hinder effective utilization of pain management tools Kituyi et al., (2011).

It is on this plethora of background to the study that the work seeks to investigate the Utilization of Pain management tools among nurses working in acute care units in mater Misericordia hospital afikpo

Statement of problem

The cornerstone to adequate pain relief among patient is systematic and consistent use of pain management tool and documentation of right assessment tool used and this will enable the health care provider to know the accurate treatment for the patient in pain. Therefore it is imperative that health care provider assess pain accurately and document the right pain management tools used Arif-Rahu and Grap, (2010). The questions is did nurses use pain management tool in management of their patient pain? Research related to nurses knowledge and practices regarding utilization of pain management tools in clinical setting remain limited despite the increase  awareness  of the significance of pain among patients Shannon and Bucknall, as cited in Mohommed, (2010). Though study  exist that assess the nurses knowledge of pain management, there dearth of empirical study on nurse’s utilization of pain management tools especially in these part of the country. Hence this study is conducted to assess nurse’s use of pain management tool in university of Benin teaching hospital.