ABSTRACT
Pain
is one of the most frequently encountered symptoms in the hospital environment
making it the 5th vital sign yet pain is often untreated and
patients continue to suffer the ill effect of pain. The nature of pain being
complex, medications alone may not be sufficient to pain relief and therefore
multiple strategies must be used of which alternative pain relief strategy is
one. There is need therefore to investigate the knowledge and effective use of
these strategies. The purpose of this study was to determine the alternative
pain relief measures used by nurses in the management of orthopaedic patients’
pain in federal medical centre, Ebute-Metta. The research design was a
descriptive survey method. The subjects of study were all the target population
comprising of 72 nurses working in orthopaedic in FMC. Data were collected
using researchers constructed and validated questionnaire. Descriptive
statistical method of analysis was used in the analysis and chi –square cross
tabulation used to test for hypothesis of data obtained. The major endings of
the study showed that nurses have good knowledge of some of the physical,
psychological and cognitive behavioural methods of alternative pain relief and
their benefits. However the nurses’ reasons for not using these Alternative
Pain Relief methods were: lack of time, excessive workload for the nurses, lack
of equipments, lack of knowledge of some of the various alternative measures. A
fair implementation of these measures was found among nurses in this tertiary
institution. However, there was a statistically significant difference among
nurse educational level and their use of these alternative pain relief
measures. There was also statistically significant difference found between
nurses’ years of experience and their uses of these alternative pain relief
measures. It is recommended that nurses need training and education on the
implementation of non-pharmacological pain relief methods, particularly on
methods that have been shown to be effective which is less often used by nurses
in the management of orthopaedic patients’ pain.
TABLE OF CONTENT
Title
page - - - - - - - i
Certification
page - - - - - - ii
Dedication - - - - - - - iii
Acknowledgement - - - - - - iv
Table
of content - - - - - - v
List
of tables - - - - - - vi
Abstract - - - - - - vii
CHAPTER ONE: INTRODUCTION
Background
of the study - - - - - 1
Statement
of the problem - - - - - 5
Purpose
of the study - - - - - 7
Objectives
of the study - - - - - 7
Research
questions - - - - - - 7
Hypotheses - - - - - - 8
Significance
of the study - - - - - 8
Scope
of the study - - - - - 9
Operational
Definition of Terms - - - - 10
CHAPTER TWO: LITERATURE
Concept of pain - - - - - 13
Types of pain - - - - - - 15
Pathophysiology of pain - - - - - 17
Factors influencing pain response - - - - 20
Pain assessment - - - - - 22
Pharmacological
approaches to pain management - 23
Concept of
non-pharmacological (alternative) pain management - 24
Theoretical review - - - - - 40
Empirical review - - - - - - 41
Summary of literature
review - - - - 50
CHAPTER THREE: RESEARCH METHODOLOGY
Research Design - - - - - 51
Research method - - - - - 51
Area of study - - - - - - 52
Population - - - - - - 52
Sample and sampling technique - - - - 52
Research Instrument - - - - - 52
Validity of Research Instrument - - - - 53
Reliability of Research
Instrument - - - 53
Procedure for Data Collection - - - - 54
Procedure for Data Analysis - - - - 54
CHAPTER FOUR: PRESENTATION AND ANALYSIS OF DATA
Summary of major findings - - - - 55-71
CHAPTER FIVE: DISCUSSION OF RESEARCH FINDINGS
Implication
for nursing - - - - 72
Limitation
of study - - - - - 79
Suggestion
for further study - - - - 79
Summary - - - - - - 80
Conclusion - - - - - - 81
Recommendation - - - - - 81
References - - - - - - - 83
Appendices - - - - - - - 86
CHAPTER ONE
INTRODUCTION
Background to the study
Pain is a distressing feeling often caused by intense or
damaging stimuli, such as stubbing a toe, burning a finger, putting alcohol on
a cut, or bumping the "funny bone. Because it is a complex, subjective
phenomenon, defining pain has been a challenge. The International Association
for the Study of Pain (2015), widely used definition states
that pain is an unpleasant sensory and emotional experience associated with
actual or potential tissue damage, or described in terms of such damage. In
medical diagnosis, pain is regarded as a symptom
of an underlying condition.
Pain is an unpleasant
sensation ranging from mild discomfort to agonized distress associated with
real or potential tissue damage (Oxford Medical Dictionary, 2003). It could
also be defined as an unpleasant sensory and emotional experience associated
actual or potential tissue damage or described in terms of such damage
(American pain society (APS), 2003; Gordon, 2002).
Pain is a universal human
experience which is as old as the universe itself and most common reason people
seek medical care. The presence of pain is an indicator that something is wrong
in the structure and function of the body related to injury or damage to the
structure and function of the body. Thus the need to carry out the intervention
to alleviate suffering and improve comfort especially in orthopaedic patients’
who experience pain resulting from several degrees of fractures, trauma,
accidents and burns, medical and surgical procedures becomes important (Innis,
Bikaunicks, Retryshen, Zellermeyer & Ciccarelli, 2004).
The need to alleviate
pain stems from the fact that pain alters the quality of life more than any
other health related problem. It interferes with sleep, mobility, nutrition, thought,
sexual activity, emotional well-being, creativity and self actualization,
increases the heart rate and blood pressure. It may also result in patiens’ not
reporting pain accurately because of its interference with the quality of life
(peter and watt Watson, 2002). Pain may get worse or intense when patients’ is
in anxiety, stress or sad.
Pain cannot be
objectively measured in the same way as blood pressure, pulse rate and
temperature, thereby making pain a subjective individual phenomenon which only the
person (patient) experiencing it could say whenever it is existing (Mc Caffery
& Pasero, 2002). Thus patients self reporting (expression) of their pain is
regarded as the gold standard of pain assessment measurement as it provides the
most valid measurement of pain (Arnstein, 2002). The American pain society
(2005), therefore stated that it is the responsibility of the clients to inform
the nurses about their pain and also the nurses responsibility to accept the
clients report of pain during pain assessment. This pain if not well reported
by the patients’ to the nurses could affect its thorough management and
control, thus increasing the intensity of pain.
As pain is one of the
most frequently encountered symptoms in hospital environment making it the 5th
(fifth) vital signs, every nurse must develop the skill to assess and manage
patients’ pain properly. Most of the time, drugs are prescribed to relieve the
pain including narcotics’ and non-steroidal anti-inflammatories. However, pain
is often under-treated and patients continue to suffer from the ill effects of
pain and lack of management (Yales et al. 2001). The medications also have
their adverse effects which often result from the long use of these pain
killers caused by prolonged nature of the health problems of these patients.
Such side effects like stomach irritation, gastrointestinal bleeding,
respiratory depression, nausea, pruritis, vomiting, urinary retention e.t.c,
have been reported (Helmrich et al 2001).
Nature of pain being
complex, therefore, medications alone may be insufficient for relief and
multiple strategies must be utilized (Nadler, 2004) of which alternative
(non-pharmacologic) pain management strategies are used. Thus both
pharmacological and alternative (non-pharmacologic) methods of pain relief have
been used by health professionals to alternative the various categories of pain
experienced by patients.
Alternative pain relief
measures have been advocated for by many healths professional to augment the
effects of drugs and to reduce the various degrees of side effects caused by
the use of medications in pain management in orthopaedic patients (Helmrich,
Yales, Nash, Hobman, Pouton & Berggren 2001). Alternative or
non-pharmacological pain reliefs are therefore orthodox medicine to alleviate
pain, such measures could be physical, psychological, or cognitive behavioural
interventions.
Physical interventions or
methods are concerned with the use of massage, heat and cold application,
position change, transcutaneous electrical nerve stimulation (TENS) to reduce
pain. Psychological method includes relaxation or rest and music, while
cognitive behavioural method include distraction techniques by the use of
music, playing cards, games or watching television to divert patients mind from
the pain he is feeling at that moment thus focusing his mind on something else
different from the pain. Many of these alternative approaches are non-invasive,
low risk, inexpensive, easily performed at the clinical settings. They achieve
their effects in numerous ways, not only in reducing the pain but also by
reducing the emotional components, thus reducing anxiety, facilitating coping
skills, providing a sense of control, enhancing comfort, promoting sleep,
reducing fatigue and improving quality of life (Mc Caffery & Pasero, 2002).
Considering these advantages, there is no need not only to educate the patients
about the various non-pharmacological interventions and how to implement these
interventions, but the health professionals themselves need to embark on its
use.
In spite of the
popularity of these alternative pain relief therapies, nurses are reported to
have poor knowledge in the application of these alternative pain relief
measures (Brolinson, Prince, Ditmyer & Reis 2001). Health professionals
especially nurses’ level of knowledge and attitude about these
non-pharmacologic pain relief management greatly affect whether a patient s
given these options. Researchers (Polkki, Laukkala, Vehilainen, Julkunen &
Pietila, 2003) found that the factors that promoted the use of
non-pharmacologic interventions included the nurses’ knowledge of the
techniques, the nurse’s desire to promote non-pharmacologic pain relief
techniques and the nurse having a small enough workload and enough time to
devote to implementing the techniques. According to King, Pettigrew and Reed
(2000), nurses’ need to be able to assess patient’s use of these alternative
and complementary therapies. But before suggesting or instructing patients in
the use of non-drug techniques, nurses need to be aware of the methods used
effectively and preferred by the patient and be able to implement it themselves
(nurses).
Since observation and
research (Brolinson, Price, Ditmyer & Reis 2001) show that there is poor
knowledge in the applications of these alternative pain reliefs and since it
still remains an important aspect of pain relief management in orthopaedic
patients, it becomes necessary to investigate the extent to which nurses
implement these measures. This is aimed at providing information for possible
solutions. Thus the study on alternative pain relief measures uses by nurses in
the management of orthopaedic patients’ pain.
Statement of the problem
Patients in orthopaedic
hospitals usually present with symptoms of shoulder, knee, hip, joint, rib,
neck, low back pain and headache for over a period of days, months or years.
This pain arises from fractures, inflammatory reactions trauma, accident,
diseases of the bones and nerve compression. The pain ranges from mild,
moderate to severe. The pain as the researcher observed leads to discomfort,
disturbed sleep pattern, altering the quality of life of patients and patients
normal daily activities, anxiety, depression loss of interest and immobility.
This excruciating pain
encountered by these patients and its consequencies were also noticed by the
researcher to be worsened by the numerous side effects of the medications
patients were placed on. These side effects include bleeding, stomach
irritation, chest pain, nausea and vomiting. These medications also offered
temporary pain relief thus making the patients dependent on them, which could
lead to drug lasting dependency thus there is need for the combination of the
non-pharmacologic and pharmacologic methods to give a lasting pain relief.
However, alternative or
non-pharmacologic pain relief measures which have been found to be effective
and with less side effects were mostly done by the physiotherapist
periodically. There does not seem to be much being done by nurses who are in
continous daily contact with these patients and who could administer these
alternative methods of pain relief alongside with other nursing intervention.
To what extent do these nurses use them in relieving patient’s pain? It is
assumed that a more frequent use of these non-pharmacological methods by nurses
could augment the use of medications, thus reduce patients hospital stay, cost
of health care services and medications, drug addiction and dependence and
patience numerous complaints of the adverse effects caused by pain medications.
The researcher thus aroused, decided to empirically ascertain the nurse’s knowledge
and use of alternative pain relief measures in managing orthopaedic patients,.
Purpose of the study
The purpose of the
study is to determine the alternative pain relief measures used by nurses in
the pain management of orthopaedic patients in Federal Medical Centre
Ebute-Metta, Lagos State.
Objective of the study
The specific
objectives of the study are to:
i. Determine the nurses’
knowledge of non-pharmacological methods of pain relief measures in the pain
management of orthopaedic patients.
ii. Determine the
nurses’ use of physical non-pharmacological methods of pain relief measures in
the pain management of orthopaedic patients.
iii. Assess the nurses’
use of psychological non-pharmacological methods of pain relief measures in the
pain management of orthopaedic patients.
iv. Assess the nurses’
use of cognitive behavioural non-pharmacological methods of pain relief measures
in the pain management of orthopaedic patients.
v. Assess if the
alternative pain relief measures used by nurses are determined by their
demographic characteristics.
Research Questions
i.
What do nurses’
know about the non-pharmacological methods of pain relief measures used in the
pain management of orthopaedic patients?
ii.
What physical
non-pharmacological methods of pain relief measures do nurses use in the pain
management of orthopaedic patients?
iii.
What psychological
non-pharmacological methods of pain relief measures do nurses use in the pain
management of orthopaedic patients?
iv.
What cognitive
behavioural non-pharmacological methods of pain relief measures do nurses use
in the pain management of orthopaedic patients?
v.
How is the
relationship between the nurse’s demographic characteristics and their use of
alternative pain relief measures?
Hypotheses
i. There is no
significant relationship between educational level and the alternative pain
relief measures used by nurses in pain management of orthopaedic patients.
ii. There is no significant
relationship between the number of years of practice and the alternative pain
relief measures used by nurses in pain management of orthopaedic patients
Significance of the study
i. The study will
provide information on the non-pharmacological methods of relieving pain in the
pain management of orthopaedic patients. This information will be significant
because if the nurses use of alternative pain relief is found to be deficient,
it will serve as a pointer to the need for nurse educators to include these
important measures for alleviating pain in orthopaedic patients in the
curriculum for training orthopaedic nurses or nursing education in general.
ii. It could also be
used by nurse administrators and clinicians to plan continuing education
programmes in form of workshops, conferences, seminars e.t.c, for nurses so as
to improve their knowledge and skills in the use of these methods. It is
expected that when these measures are taken and the knowledge and skill are
acquired or improved, nurses will engage more in the use of the methods, this
is significant as it will help in reducing the excessive use of drugs and their
consequent side effects ranging from gastrointestinal bleeding, respiratory
depression, pruritis and urinary retention e.t.c, reduce the cost of
medications and where medications are used will augment its effect. These on
the long run will help in the effective management of pain in orthopaedic
patients.
iii. The findings may
also provide useful information for other researchers who would wish to work in
this field.
Scope of the study
The study is
delimited to nurses working in orthopaedic units of Federal Medical Centre,
Ebute-Metta irrespective of gender or professional cadre. It is also delimited to
the use of alternative pain relief measures in the management of orthopaedic
patients. Specifically, it is delimited to nurses knowledge of
non-pharmacological methods of pain relief; physical, psychological and
cognitive behavioural methods of non-pharmacological methods of pain relief.
Operational definition of terms
i. Pain relief measures: In this study, is the management of pain measures
used to reduce or control pain using such interventions like medications (
pharmacological: analgesics, non steroidal anti-inflammatory drugs (NSAID)
and/or non-pharmacological or alternative measures to relief pain.
ii. Knowledge of non-pharmacological methods of pain
relief: In this study, it means
what the nurses know about the types and the uses of these various non-pharmacological
methods of pain relief and their benefits.
iii. Alternative pain relief measures: In this study are those measures that are used in
combination with conventional or orthodox medicines to alleviate pain. It could
also be used interchangeably in this work as non-pharmacological methods of
pain relief and they are physical methods, psychological methods and cognitive
behavioural methods.
iv. Physical methods of non-pharmacological pain relief: In this study, it means manipulation or methods that
help in controlling or in relieving pain, inflammation and stiffness. These
measures include massage, heat and cold application, position change and Trans
cutaneous electrical nerve stimulation (TENS).
v. Psychological methods of non-pharmacological of pain
relief: methods that reduce or
control pain through manipulation of emotions aimed at diverting patient’s
attention from the pain he is experiencing. Examples are: relaxation/rest,
music e.t.c.
vi. Cognitive behavioural methods of non-pharmacological
pain relief: Methods that help to
reduce or control pain by managing
patients thoughts and feelings and the body’s physical response to such
feeling. Examples are distraction, guided imagery, breathing techniques,
meditation and exercise e.t.c.
vii. Demographic characteristics: the demographic characteristics used in this study
are educational level and years of professional experience.
Click “DOWNLOAD NOW” below to get the complete Projects
FOR QUICK HELP CHAT WITH US NOW!
+(234) 0814 780 1594
Login To Comment