Educational Program for Nurses about Pain-Related Management for Children with Burns Injuries

Burn injury occurs to the skin or other organic tissue primarily result in from exposure or direct contact to any type of chemical, thermal, electrical, or radiation (WHO, 2021).

RESULTS

The table (1) shows the demographic characteristics of the nurses sample in the study, that 40.0% (12) of the sample at age (21-30) years with mean (1.90) and standard deviation (0.845), the sample gender was equal in number between male and female with mean (1.50) and standard deviation (0.509), 63.3% (19) of them was nursing institute of educational level with mean (1.63) and standard deviation (0.490), 40.0% (12) of the sample at (1-5) years of experience in nursing with mean (2.27) and standard deviation (1.258), 50.0% (15) of the sample at (1-5) years of experience in nursing with mean (1.67) and standard deviation (0.758), 93.3% (28) of the sample not having training courses with mean (2.87) and standard deviation (0.507), also 93.3% (28) of the sample not having number of training courses with mean (0.07) and standard deviation (0.254), finally 40.0% (12) of the sample not reading sources with mean (1.53) and standard deviation (0.507).

The table (2) shows the statistical differences result for nurses' knowledge regarding types and management for children with burn injuries, that the types of burn pain was 60.0% (18) of the sample at unacceptable level of knowledge in pretest, but 43.3% (13) of the sample at acceptable level of knowledge in posttest 1, also 46.7% (14) of the sample at acceptable level of knowledge in posttest 2, for that the  paired samples t-test at Pretest- Posttest 1 was (-6.656) with P. value (0.000) high significance, the t-test at Pretest- Posttest 2 was (-6.176) with P. value (0.000) high significance, but the t-test at Posttest1- Posttest 2 was (1.795) with P. value (0.083) non-significance. The general management of burns was 43.3% (13) of the sample at unacceptable level of knowledge in pretest, but 66.7% (20) of the sample at good level of knowledge in posttest 1, also 60.0% (18)  of the sample at good level of knowledge in posttest 2, for that the  paired samples t-test at Pretest- Posttest 1 was (-7.225) with P. value (0.000) high significance, the t-test at Pretest- Posttest 2 was (-7.109) with P. value (0.000) high significance, but the t-test at Posttest1- Posttest 2 was (1.439) with P. value (0.161) non-significance. The surgical management was 43.3% (13) of the sample at unacceptable level of knowledge in pretest, but 56.7% (17) of the sample at good level of knowledge in posttest 1, also 53.3% (16)  of the sample at good level of knowledge in posttest 2, for that the  paired samples t-test at Pretest- Posttest 1 was (-4.892) with P. value (0.000) high significance, the t-test at Pretest- Posttest 2 was (-4.626) with P. value (0.000) high significance, but the t-test at Posttest1- Posttest 2 was (1.000) with P. value (0.326) non-significance.

The table (3) presents the statistical differences result for nurses' knowledge regarding pain management for children with burn injuries, that the assessment of pain was 53.3% (16) of the sample at unacceptable level of knowledge in pretest, but 30.0% (9) of the sample at excellent level of knowledge in posttest 1, also 26.7% (8) of the sample at excellent level of knowledge in posttest 2, for that the  paired samples t-test at Pretest- Posttest 1 was (-7.737) with P. value (0.000) high significance, the t-test at Pretest- Posttest 2 was (-6.620) with P. value (0.000) high significance, but the t-test at Posttest1- Posttest 2 was (1.682) with P. value (0.103) non-significance. The management of pain-pharmacological approaches was 33.3% (10) of the sample at unacceptable level of knowledge in pretest, but 40.0% (12) of the sample at excellent level of knowledge in posttest 1, also posttest 2, for that the  paired samples t-test at Pretest- Posttest 1 was (-6.746) with P. value (0.000) high significance, the t-test at Pretest- Posttest 2 was (-6.746) with P. value (0.000) high significance. The management of pain- non-pharmacological techniques was 50.0% (15) of the sample at fail level of knowledge in pretest, but 36.7% (11)  of the sample at very good level of knowledge in posttest 1and posttest 2, for that the  paired samples t-test at Pretest- Posttest 1 was (-6.934) with P. value (0.000) high significance, the t-test at Pretest- Posttest 2 was (-6.934) with P. value (0.000) high significance.

The table (5) presents the statistical correlations between effect of an intervention program for nurses’ knowledge results with the demographic variables, there was significant correlations between the most demographic variables with most parts of nurses knowledge at p. value ≤  0.05 at pretest and posttest, and also non- significant correlations between the some demographic variables with some parts of nurses knowledge at p. value ≤  0.05 at pretest and posttest.

DISCUSSION

Findings show the participants age, most of the volunteers (nurses) in the study were their age 21-30 years as being young adult nurses. This results come due to the increasing number of graduates from medical institutes and colleges in Iraq and their enrolment in the directly job more than before. These findings agreed with study conducted Tripura deals with hospital acquired infection knowledge. Findings depicts majority of the study participants were from 18 to 25 years’ age group (70.7%) (Datta et al., 2018). Also this finding is consistent with Rasha (2021), A quasi experimental design was conducted in Minia general hospital, this study shows that half (50%) of the studied nurses had 20 to

Regards to the participant’s gender, the study included 50% were male nurses and 50 % were female nurses, due to the nurses those who are male and female more responses and cooperative to participants in the study. In fact, pediatric hospitals mostly need nurses from female. According to Kilpatrick et al (2021), the majority of nurses in pediatric wards are female.

Education level related findings, (63.3%) of nurses who work in pediatric hospitals were hold (diploma) nursing institute. This finding come because the presence of institutes in most of the governorates and the graduation of batches of morning and evening study in large numbers in addition to the presence of several departments and various specialties. Many previous studies were in agreement with this result, Okwii (2017), found diploma health care workers constituted 48.9% as a majority. In Middle-East Hospital found that majority of respondents depicts to have diploma which indicate of 63.6% (n = 42) (Mohd-Nor & Bit-Lian, 2019). A study of Gawad (2017), found that respondents with diploma degree and bachelor's degree made up the highest proportions, (61.7 %) and (34.7%) respectively. The higher proportion (47%) of the respondents was diploma in study of Desta et al. (2018). Also these results are supported by Mona (2021), A quasi - experimental research design was conducted in Egypt, this study show their educational level revealed that around half of them had nursing technical institute degree (41.8%, 78.2% respectively). Studies above, all hospitals rely on diploma graduates as this educational degree works in all hospital units, in addition to the many institutions that graduate this degree.

Half of studied sample were had less than 5 years of experience, this is one of the factors affecting their knowledge and skills related to pain management in children. This finding come in line with Lulie et al. (2022), who find that the majority of nurses deals with importance pediatric areas were low years of experience, nurses with higher years of experience were better than those who are less years. Also this result agrees with study done by Mukhlif & Mansour, (2021), at teaching hospitals selected in Mosul city, among experience years in nursing and experience in burns were (1-5) years represent the highest percentage (56.7 %).

The majority of nurses in the study (93.3%) did not have any formal training on paediatric pain management. This is in line with a study in Rwanda by Ufashingabire et al. (2016) and Zeb et al. (2019) in Pakistan where most of the nurses 59.4% and 83.3%, respectively, had no formal training on paediatric pain management. Having a large number of nurses not having formal training on pain management mostly tends to influence their practice.

In current study findings, sexily percentage of nurses were unaware the type of burn pain, (43.3%) of them were unacceptable level in terms of general pain management, (43.3%) were unacceptable level associated surgical management, (53.3%) of nurses unable to assess pain, (33.3%) unaware pharmacological pain management and (50%) give a fail answer in terms of non-pharmacological pain management. In general, (33.3%) of nurses expressed unsatisfactory knowledge about pain management related burn injuries. These are worrisome consequences for the management of pain received by burns leading to infections and child care.

Similar findings have also been reported in other studies (Rampanjato et al., 2007; Albertyn et al., 2009; Latimer et al., 2009). Inability to assess pain therefore, meant nurses may not have been giving appropriate treatment according to pain severity. Consequently, children were likely to endure untreated pain and its effects such as prolonged hospital stay, and long term psychological manifestations (Alotaibi et al., 2019). The study in addition revealed inadequate knowledge of the WHO analgesic ladder and drugs to use at each step of the ladder. Lack of knowledge of pharmacological and non-pharmacological pain interventions has similarly been documented (Vagnoli et al., 2019).

The finding of this study was lower than a study conducted in Australia (77.56%) moderate level of knowledge (Peirc et al., 2018). The possible justification for this difference might be due to the differences in the study setting. The study conducted in Australia included only those nurses who were working in pediatric surgical wards, which might increase their knowledge of the subject matter because of the recent exposure to pain management in children. In addition, the study done in Australia included nurses who were working only in a tertiary pediatric hospital, and did not include other nurses, which might escalate their knowledge level.

Also, the result of this study also showed that nurses’ knowledge toward pain management was lower than the studies done in Mekelle city (58.6%) (Miftah et al., 2017), Nigeria Calabar Metropolis health center (60%) (Ojong et al., 2014), and Uganda Mulago Hospital (41%) (Kizza, 2012).

The reason behind this inconsistent finding between these studies might be due to the differences in the study setting, educational level of nurses, and the data collection tool. A study done in Mekelle city includes three public hospitals which is a multicenter study and the participants were diploma and bachelor holders, whereas this study was done in a single referral hospital and includes also MSc degree holders. In addition, studies performed in Nigeria and Uganda used a comprehensive tool to assess the knowledge of pain management for all patients regardless of age category, whereas this study focused on pediatric pain management.

In Ghanaian tertiary hospital, the results of the study were that the nurses had good knowledge regarding pain management in children associated burns, as justified by the nurses had more years of experience (Tetteh et al., 2021).

Another, nurses expressed a satisfactory knowledge related pan management in Blantyre, Malawi due to higher academic qualification (Kholowa et al., 2017).

In another directory, nurses in Turkey exhibited poor knowledge related pain management of pediatric as being the majority were low level of education (diploma) (Ekim & Ocakcı, 2013).

The unsatisfactory pain-management knowledge in University of Gondar Comprehensive Specialized Hospital due to lack of training (Lulie et al., 2022).

In current study findings, nurses expressed a good level of knowledge with regard pain management at the post-test period of measurement (M± SD= 4.27±0.720) after application of intervention program as compared pre-test period of measurement (M± SD= 2.57± 0.568) were unsatisfactory knowledge. With respect to the statistical mean, the study results indicate that there is an improvement in the knowledge scores in post test I after the application of the intervention program compared with the pre-test before application of intervention program (effectiveness of an intervention program).

There is accepted hypothesis that states (There were significant differences in nurse’s knowledge between pre-test and post-test) (p=0.000), nurses participated in the study achieved considerable benefit from intervention program concerning pain management related burns injuries.

After a month has been passed, there were no significant differences in knowledge scores between post-test I (M± SD= 4.27±0.720) and post-test II (M± SD= 4.20±0.714), this means that nurses' knowledge is not affected by the passage of time (p > 0.05).

This finding is supported by findings from Practices in China, experimental group nurses had an improvement in pain assessment. The percentage of nurses who correctly used the Chinghai Pain Scale to assess patients’ pain intensity increased significantly after the PEP, and the increased usage of the assessment tool between experimental and control groups also shows a statistical difference in trend (χ2=93.281, P < 0.001). The PEP has been demonstrated to be effective in improving nurses’ pain knowledge assessment (Zhang et al., 2008).

Sujatha et al. (2015), showed that the Pre-test and Post–test knowledge scores found statistically significant ‘t’ = 1.671, p

Findings presents the statistical correlations between effect of an educational program for nurses’ knowledge results with the nurse’s demographic variables such as (age, gender, education level and years of experience). This correlation and the moral differences are considered as factors affecting their knowledge. Further studies need to be under taken to assess in more details the influencing factors of pain management among pediatric nurses.

Olsson (2011), confirmed that the nurses experience is significantly (positive) correlated with their knowledge regards pediatric pain management, that is, more years of experience is significantly increased nurse’s knowledge.

A study by Mohammed (2016) is consistent with the current study through revealed a significant correlation between knowledge with their age at pre-test and post-test assessment of (P= 0.462) and (P= 0.315) at p. value equal or less than (0.05).

Also, the result of this study is consistency with a study by ALSudani & Ali, (2014), that finding of the study show there was a significant association with level education and nurses' knowlege.

Heo et al. (2016), find that there were significant differences in nurse’s knowledge concerning pediatric pain management with regards different education level and stated that the education level considered factors inflecting pain management. The differences in favor those who are higher education, that is, nurses with low level of education is significantly associated with nurse’s knowledge (positive correlation).

CONCLUSIONS

An educational training program is effective in improving nurses' knowledge and practices about pain-related management for children with burns injuries. Findings from this study showed that after the training, nurses' knowledge and practice toward pain management were enhanced and not affected by time.

ETHICAL CONSIDERATIONS COMPLIANCE WITH ETHICAL GUIDELINES

This study was completed following obtaining consent from the University of Baghdad and ministry of health.

FUNDING

This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

AUTHOR’S CONTRIBUTIONS

Study concept, Writing, Reviewing the final edition by all authors.

DISCLOSURE STATEMENT:

The authors report no conflict of interest.

ACKNOWLEDGEMENTS

We thank the research supervisor and the anonymous judges for their usefulness suggestions.

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