Evaluation of Nurses practices regarding postoperative pain management among Adult patient with abdominal surgery

Mohaisen, Sajad Kareem; Hassan, Hakima Shakir

doi:10.33899/mjn.2022.175387

Journals List

Evaluation of Nurses practices regarding postoperative pain management among Adult patient with abdominal surgery

Mosul Journal of Nursing (Print ISSN: 2311-8784 Online ISSN: 2663-0311)

Article 6, Volume 10, Issue 3, August 2022, Pages 46-50 PDF (1 M)

Document Type: Original Articles

DOI: 10.33899/mjn.2022.175387

Authors

Sajad Kareem Mohaisen¹; Hakima Shakir Hassan²

¹Ministry of Health/ Al-Diwaniya Health Directorate, Iraq.

²Assist. Prof, Adult Nursing/ College of Nursing University of Baghdad, Iraq

Abstract

The influence of pain on one's quality of life, social connections, physical capacity, and mental health was significant. A nurse's or other health care professional's lack of information about pain evaluation and treatment, worries of opioid usage, abuse, and diversion, and misunderstandings about the therapeutic dose of analgesia can all contribute to inadequate pain relief. The research aims to evaluate the nurses' practice in the management of postoperative pain for adult patients after abdominal surgery. A major barrier to properly managing pain was a lack of awareness and practices of pain management. A quantitative design (descriptive study) was carried out at Al-Diwaniya Teaching Hospital for the period from 15^thoctober, 2021 to 20^thMay, 2022. The present study aimed to evaluate of nursesꞌ practices about management of postoperative pain for adult patients after abdominal surgery. Purposive sample comprised of (30) nurses who have been actually working in the surgical wards. Through the use of practice checklist includes (21) items concerning management of postoperative pain. The results of the study revealed that the majority of participants were have a poor level about management of postoperative pain as show with mean of score and standard division (1.58 ∓ 0.359).The study concluded that the nurses working in surgical wards have a poor level of practice about management of postoperative pain for adult patients with abdominal surgery.

Keywords

practices; postoperative pain; abdominal surgery

Full Text

Evaluation of Nurses practices regarding postoperative pain management among Adult patient with abdominal surgery

Sajad Kareem Mohaisen¹, Hakima Shakir Hassan ² *

Ministry of Health/ Al-Diwaniya Health Directorate, Iraq.
Assist. Prof, Adult Nursing/ College of Nursing University of Baghdad, Iraq.

Corresponding author:Sajad Kareem Mohaisen

Email: Sajadam133@gmail.com

ORCID

ABSTRACT

Keywords: practices ,postoperative pain, abdominal surgery

INTRODUCTION

Pain, both acute and chronic, is frequent, particularly among surgical patients and inpatients in general medical facilities. More than half (>50%) of hospitalized patients were in excruciating pain (Line et al .,2015). Every year, more than 230 million individuals throughout the world had surgery. With this yearly rise, more than 80% of patients had acute pain after surgery, with more than 75% experiencing moderate or severe pain. This means that 80% of patients who have undergone surgery will experience acute pain (Arab et al.,2016). The numerous training courses and application tactics available, researches reveal that between 55 and 78.6% of inpatients experience moderate-to-severe pain (Liyew et al., 2020). Postoperative pain (POP) was shown to be prevalent in 47-100 percent of patients. According to research conducted over the previous three to four decades, 20 to 80 percent of individuals following surgery had inadequate pain management (Wurjine et al., 2018). The influence of pain on one's quality of life, social connections, physical capacity, and mental health was significant. Exhaustion, sleep disturbances, lack of appetite, and worry were some of the other symptoms. Untreated pain can have major repercussions, such as increased use of health services, duration of stay, and expenses. A nurse's or other health care professional's lack of information about pain evaluation and treatment, worries of opioid usage, abuse, and diversion, and misunderstandings about the therapeutic dose of analgesia can all contribute to inadequate pain relief. A lack of pain awareness and practices was a major obstacle to successful pain management (Salim et al., 2020). In reality, it can have a direct impact on the comfort and lifestyle of patients, producing nausea, vomiting, weariness, tension, loss of control, poor quality of life, and a lack of sexual activity and public relations, as well as poor work performance and everyday activities (Arab et al .,2016; Shakya et al .,2016). Pain is an unpleasant sensory and emotional experience that is associated with real or potential tissue damage (Jaleta et al., 2021). Furthermore, pain is a unique, dynamic, and subjective experience of the nociceptive data centers in the higher brain. It can be influenced by a variety of elements, including sensory, emotional, and cognitive experiences, as well as distraction, attitude, beliefs, and heredity (Misiołek et al.,2018).. Therefore, thus study concerns the interventional program and nurses’ practice toward management for postoperative pain for adult patients undergoing abdominal surgery in Al-Diwaniya Province/ Iraq.

METHOD

A quantitative design (descriptive study) has been conducted from (15^th October, 2021 to 20^th May, 2022). The researcher used a non- probability (purposive) sampling method on (30) nurses working at surgical ward in Al-Diwaniyah Teaching Hospital. The study instrument consists of two parts: the first part is demographic data for study sample which of age, gender, educational level, years of experience in nursing profession, years of experience in surgical wards. The second part is the observation checklist tool which consists of (21) items. The validity of the instrument and the interventional program were identified by presenting it to 13 experts. Descriptive and inferential statistics were used to analyse the results of the study using the Statistical Package of Social Sciences (SPSS) version 21 and Microsoft Excel (2010).Approval achieved from the Council of the Nursing College/ University of Baghdad and Ethical Researches Committee for the study. Then the researcher submitted a detailed description including the study objectives and methodology (questionnaire) in order to obtain officialpermission from the Ministry of Planning (Central Statistical Organization) and to Al-Diwaniyah Health Directorate to carry out the study. After that in order to ensure the agreement and cooperation, the researcher sent a permission to Al-Diwaniyah Teaching Hospital. Written informed consent has been obtained from each nurse.

RESULTS

Findings revealed in table (1), the Mean age for the study sample is (27.2 ± 1.066). Most of their age study sample within the age group (25-29 years) 14 (46.7%) of participants. The majority of gender were female presented 17 (56.7%) of participants. Concerning the level education, the more of the nurses in study sample were nursing institute graduate, 11 (36.7). Regarding the years of experience in nursing the nurses in the study sample with Mean ± SD 7.50 ± 6.600, while the years of experience in the surgical wards with Mean ± SD 4.16 ± 5.072. According to the training course, the most nurses attended a training course with percentage (23.3%) just one time inside the Iraq and for one week. The results of table (2) show that the majority of participants were have a poor practices level about management of postoperative pain for adult patients with abdominal surgery as show with mean and standard division (1.58 ∓ 0.359).

Table 1. Demographic characteristics related to participants.

Demographic Characteristics	Variables	Study Sample (n=30)
Demographic Characteristics	Variables	f.	%
Age Mean ± SD	20 – 24 years	5	16.7
	25 – 29 years	14	46.7
	30 – 34 years	8	26.7
	35 – 39 years	2	6.7
	40 – 44 years	0	0
	45 years and above	1	3.3
	Total	30	100.0
	Mean ± SD	27.2 ± 1.066
Gender	Male	13	43.3
Gender	Female	17	56.7
Education level	School of nursing	10	33.3
	Nursing institute	11	36.7
	College of nursing	9	30.0
	Total	30	100.0
Social Status	Single	12	40.0
	Married	16	53.3
	Widowed	0	0
	Divorced	2	6.7
	Separated	0	0
	Total	30	100.0
Years of experience in nursing	Mean ± SD	7.50 ± 6.600
Years of experience in surgery wards	Mean ± SD	4.16 ± 5.072
Training course	Not participate	23	76.7
	One	7	23.3
	Two	0	0
Place of training	Not participate	23	76.7
	Inside Iraq	7	23.3
	Outside Iraq	0	0
Duration of the course	Not participate	23	76.7
	One week	7	23.3
	More than one week	0	0

Table 2. Distribution of the Nurse’s practices about pain management items for the Study sample.

Practices about pain management items		Study sample
Practices about pain management items		Mean	SD.	Evaluation
First part	Hand washing
	a. Wash hands before starting any nursing work	1.56	.678	Poor practices
Second part	Measures and document vital signs
	a. Pulse	1.66	.802	Poor practices
	b. Blood pressure	1.60	.723	Poor practices
	c. Respiratory rate	1.43	.568	Poor practices
	d. Temperature	1.46	.571	Poor practices
Third part	Pain assessment
	a. The nurse locate pain	1.50	.629	Poor practices
	b. The nurse determine the prevalence of pain	1.50	.508	Poor practices
	c. The nurse determine the nature of pain	1.43	.504	Poor practices
	d. The nurse uses pain assessment tools, for example, numerical scale, face scale	1.46	.507	Poor practices
Fourth part	Drug administration
	a. Read the medical order and doctors notes	1.63	.668	Poor practices
	b. Give prescribed pain medication on a fixed schedule	1.66	.711	Poor practices
	c. Document dose	1.83	.791	Moderate practices
	d. document route	1.80	.664	Moderate practices
	e. document time of administration	1.86	.730	Moderate practices
	f. Monitor side effects of pain medications	1.50	.629	Poor practices
Fifth part	Non-pharmacological management to reduce pain
	a. Changes the position of the patient	1.76	.817	Moderate practices
	b. Instruct the patient to Perform deep breathing.	1.43	.626	Poor practices
	c. Teach patient how to support pain area when cough	1.43	.678	Poor practices
	d. Help patient to perform distracted activities	1.56	.626	Poor practices
	e. Document any non- pharmacological management with time	1.36	.490	Poor practices
	f. Remove gloves and wash hands an disinfected with each patients	1.83	.791	Moderate practices
Total mean of practices Items		1.58	.359	Poor practices

M = Mean, S.D=Standard Deviation, Eva=evaluation level, P = poor (1 – 1.66), IN= Intermediate (1.67 - 2.32), G = Good (2.33 - 3).

DISCUSSION

This study used a purposive clinical trial design to evaluate nurse’s practices about management of postoperative pain for adult patients undergoing abdominal surgery. The present study samples consists of 30 nurses. The mean age was 27.2 ± 1.066.

This result match with the result of Alreshidi (2016) who find in his study that The bulk of the research participants were between the ages of 26 and 30 years (Alreshidi,2016).. In their study on postoperative pain management among health care professionals in the ILE-IFE hospital,Famakinwa et al., (2014) claimed that the most of the sample in their study was between the ages of 21 and 30 years (Famakinwa et al., 2014). With somewhat more were female 17 (56.7 %) than male for the study sample. Rafati et al., (2016) performed a research in Iran to evaluate nursing reports on patients' pain severity and quality, concurrent symptoms, the use of scales in pain assessment, and compliance with the national guideline following surgery, that stated the mean age of the patients was 34.55 ±11.94 years, and 77.7% were female and mean of years of experience was 11.98 ± 9.04 (Rafati et al., 2016). Concerning to Levels of education, the study results showed that the majority of nurses 11 (36.7%) of nurses in the study sample were nursing institute. A study by Enlah et al., (2018) found that the majority of the nurses working in surgical ward were graduate from institute (Enlah et al., 2018). Concerning to years of experience in the surgical ward the study results showed that in the study sample with Mean ± SD 4.16 ± 5.072. According to a research done by (Nimer & Ghrayeb 2017), the study and control groups had a larger percentage of years of nursing experience (1-5) years (Nimer & Ghrayeb, 2017). Germossa et al., (2018) conducted a study to investigate the influence of an in-service training program on nurses' knowledge and attitudes about pain management in an Ethiopian university hospital where the majority of nurses (67.6%) had worked in the field for less than 10 years (Germossa et al.,2018). Quliti and Alamri (2015) concluded that there was a gap in pain evaluation and management prior to attending an educational course in their study "Assessment of pain Knowledge, Attitude, and Practice of Health Care Providers" (Al-Quliti & Alamri, 2015). Alzghoul and Abdullah (2016) found that nurses' understanding of postoperative pain management was low level prior to participating in the educational intervention in their study "Pain Management Practices by Nurses: An Application of the Understanding, Attitude, and Practices Model." (Alzghoul and Abdullah, 2016).

CONCLUSIONS

This study reveals that the level of nurses practices who working in the surgical wards about postoperative pain management were poor.

ETHICAL CONSIDERATIONSCOMPLIANCEWITHETHICALGUIDELINES

This study was completed following obtaining

consent from the University of Baghdad.

FUNDING
This research did not receive any grant from

funding agencies in the public, commercial, or non-profit sectors.

AUTHOR’SCONTRIBUTIONS

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

DISCLOSURESTATEMENT:

The authors report no conflict of interest.

ACKNOWLEDGEMENTS

We thank the anonymous referees for their useful suggestions.

REFERENCES

Al-Quliti, K. W., & Alamri, M. S. (2015). Assessment of pain: Knowledge, attitudes, and practices of health care providers in Almadinah Almunawwarah, Saudi Arabia. Neurosciences, 20(2), 131.

AlReshidi, N. M. (2016). The impact of an interactive educational programme on children’s nurses’ knowledge, attitudes, beliefs and perceptions of children’s pain, self-efficacy, and perceptions of barriers to optimal post-operative pain management in children (Doctoral dissertation, University of Salford).

Alzghoul, B. I., & Abdullah, N. A. C. (2016). Pain management practices by nurses: an application of the knowledge, attitude and practices (KAP) model. Global journal of health science, 8(6), 154.

Arab, M., Shirzadi, F., Sabzvari, S., Jahani, Y., Rostami, M., Ebrahimi, M., ... & Balouchi, A. (2016). Effects of training programs on knowledge and attitudes of nurses about postoperative pain. Der Pharmacia Lettre, 8(4), 108-111.

Enlah, A., Garti, I., Amoo, S. A., Atakro, C. A., Amponsah, C., & Agyare, D. F. (2018). Knowledge, Attitudes, and Practices of Postoperative Pain Management by Nurses in Selected District Hospitals in Ghana. SAGE Open Nursing, 4, 2377960818790383.

Famakinwa, T. T., Oyeniran, Y. A., & Bello, B. D. (2014). Post-operative pain assessment and management among nurses in a teaching hospital in ILE-IFE. International Journal of Basic, Applied and Innovative Research, 3(4), 100-105.

Germossa, G. N., Sjetne, I. S., & Hellesø, R. (2018). The impact of an in-service educational program on nurses' knowledge and attitudes regarding pain management in an Ethiopian university hospital. Frontiers in public health, 6, 229.

Jaleta, D. T., Tuji, T. S., & Wake, A. D. (2021). Knowledge and associated factors towards post-operative pain management among nurses working at referral hospitals, Ethiopia. Open Journal of Pain Medicine, 5(1), 001-007.‏

Lin, R. J., Reid, M. C., Liu, L. L., Chused, A. E., & Evans, A. T. (2015). The barriers to high-quality inpatient pain management: a qualitative study. American Journal of Hospice and Palliative Medicine®, 32(6), 594-599.

Liyew, B., Dejen Tilahun, A., & Habtie Bayu, N. (2020). Knowledge and Attitude towards Pain Management among Nurses Working at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Pain Research and Management, 2020.

Misiołek, H., Zajączkowska, R., Daszkiewicz, A., Woroń, J., Dobrogowski, J., Wordliczek, J., & Owczuk, R. (2018). Postoperative pain management—2018 consensus statement. Anaesthesiology intensive therapy, 50(3), 173-199.

Nimer, A., & Ghrayeb, F. A. (2017). Palestinian Nurses Knowledge and Attitudes Regarding Pain Management.

Rafati, F., Soltaninejad, M., Aflatoonian, M., Mashayekhi, F. (2016) Postoperative pain: Management and documentation by Iranian nurses. Materia Socio Medica 28(1): 36–40. doi: 10.5455/msm.2016.28.36-40.

Salim, N. A., Tuffah, M. G., & Brant, J. M. (2020). Impact a pain management program on nurses' knowledge and attitude toward pain in United Arab Emirates: Experimental-four Solomon group design. Applied Nursing Research, 151314.

Shakya, B. M., & Shakya, S. (2016). Knowledge and Attitude of Nurses on Pain Management in a Tertiary Hospital of Nepal. Age (in years), 20(24), 21.

Wurjine, T. H., & Nigussie, B. G. (2018). Knowledge, attitudes and practices of nurses regarding to post-operative pain management at hospitals of Arsi zone, Southeast Ethiopia, 2018. MOJ Womens Health, 7(5), 130-135.

References

Al-Quliti, K. W., & Alamri, M. S. (2015). Assessment of pain: Knowledge, attitudes, and practices of health care providers in Almadinah Almunawwarah, Saudi Arabia. Neurosciences, 20(2), 131.

Alzghoul, B. I., & Abdullah, N. A. C. (2016). Pain management practices by nurses: an application of the knowledge, attitude and practices (KAP) model. Global journal of health science, 8(6), 154.

Nimer, A., & Ghrayeb, F. A. (2017). Palestinian Nurses Knowledge and Attitudes Regarding Pain Management.

Shakya, B. M., & Shakya, S. (2016). Knowledge and Attitude of Nurses on Pain Management in a Tertiary Hospital of Nepal. Age (in years), 20(24), 21.

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