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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 2  |  Page : 97-101

A survey on the knowledge and attitude on pain management among nurses employed in the government hospitals


Department of Medical-Surgical, College of Nursing, University of Hail, Hail, Kingdom of Saudi Arabia

Date of Submission09-May-2020
Date of Decision05-Jun-2020
Date of Acceptance22-Jul-2020
Date of Web Publication19-Aug-2020

Correspondence Address:
Eddieson A Pasay-an
College of Nursing, University of Hail, Hail
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjhs.sjhs_100_20

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  Abstract 


Introduction: The literature has consistently shown common results on the knowledge and attitude of nurses toward pain; there is a dearth in exploring minute details like the demographics that serve as the key to address the problem which this study aims at. Aims: This study aims to determine the knowledge and attitude of the staff nurses and whether a difference exists when their demographic profiles are considered. Methods: This study employed quantitative-comparative design. The researchers employed a self-report questionnaire to gather the data from the 262 staff nurses working at three big hospitals located in Hail City. The researchers used the simple random sampling method to obtain the number of participants needed. Mann–Whitney U-test and Kruskal–Wallis test were used to test a comparison between the level of knowledge on pain assessment of the respondents across their profile. Meanwhile, Kendall Tau was used to determine the difference between the levels of knowledge on pain assessment of the respondents as to their age, years of experience, and number of trainings. Results: The mean knowledge and attitude of nurses is 20.39. When the demographic profile was compared to the level of knowledge, only area/unit of assignment (0.01) and number of training (0.01) showed significant results. The number of training (0.01) yielded positive relationship concerning the difference between the level of knowledge and attitude of nurses. Conclusion: Staff nurses have a low level of knowledge and attitude regarding pain management. The area/unit of assignment has shown to influence the knowledge and attitude, while the number of trainings has a positive effect on the knowledge and attitude.

Keywords: Attitude, knowledge, pain management


How to cite this article:
Panlican AS, Pasay-an EA, Gonzales FM, Alreshidi MS, Ibno NL, Alenzi SS. A survey on the knowledge and attitude on pain management among nurses employed in the government hospitals. Saudi J Health Sci 2020;9:97-101

How to cite this URL:
Panlican AS, Pasay-an EA, Gonzales FM, Alreshidi MS, Ibno NL, Alenzi SS. A survey on the knowledge and attitude on pain management among nurses employed in the government hospitals. Saudi J Health Sci [serial online] 2020 [cited 2020 Dec 4];9:97-101. Available from: https://www.saudijhealthsci.org/text.asp?2020/9/2/97/292640




  Introduction Top


Pain is considered as an essential measure as well as the germane outcome for every health-care agency.[1] This has been coined as the fifth vital signs[2] with the objective to increase the awareness and good outcomes of pain when properly assessed and managed.[3] As such, it is essential to recognize the cause of pain as it supports pain management before it becomes severe. To Koch,[4] pain is a personal, multifactorial experience which is influenced by certain factors such as culture, previous pain events, beliefs, moods, and ability to cope. Thus, if left untreated, it will result in devastating outcomes and impedes the psychical, emotional, and spiritual well-being of the patients, leading to compromised quality of life.[5],[6] It is in this context that nurses, being the health-care provider that stays with the patient longer than the other members of the health-care team, must possess the correct knowledge and appropriate attitude regarding pain management. This role of the nurse to alleviate patient from the unpleasant experience must include the entire nursing process.

Literature has shown that nurses have a lack of knowledge and have low attitude on pain management.[7],[8] Other studies such that the one reinforced the idea of nurses' lack of knowledge and possessed a negative attitude toward pain management.[9] Another study conducted in Italy has confirmed a parallel result;[10] the study in Jordan with the nurses as respondents has found out that they have a lower knowledge on pain management in comparison with the international standards.[11] Although factors have been considered by many researchers in investigating the lack of knowledge and negative attitude of nurses on pain management, it was difficult to generalize as it was conducted from one country to country. In the study of Lui et al.,[9] it was found out that work experience is a factor to knowledge and attitude, while Al Qadire and Al Khalaileh[11] alluded that nurses with previous pain education was a causal determinant to influence knowledge. On the other hand, a related study suggested that a lack of proper knowledge and attitude can affect pain management, specifically misconceptions regarding the use of opioids.[12] While literature consistently has shown common results on the knowledge and attitude of nurses toward pain, there is a dearth in exploring minute details like the demographics that serve as the key to address the problem which this study aims at.

This study is of significance as it aims to find out what demographics that can factor into the lack of knowledge and negative attitude of nurses toward pain management. As such, it will be the basis for policymaking. The findings of this study will serve to tailor-fit management such that targeting continuing professional development for nurses. This study aims to determine the knowledge and attitude of the staff nurses and whether a difference exists when their demographic profiles are considered.


  Methods Top


Research design

This study employed quantitative-comparative study to determine the knowledge and attitude of the staff nurses and whether a difference exists when their demographic profiles are considered.

Population and sampling

The staff nurses from the three big hospitals located in Hail City were the respondents of the study. These staff nurses are working at the unit where they are required to be competent on pain management. The researchers utilized a simple random sampling method. The required sample was determined using the Lynch Formula,[13] with a 95% confidence interval. Of the 812 staff nurses from the three hospitals, there were 262 who are eligible as respondents. These 262 staff nurses were drawn using a sample number generator.

The inclusion criteria were as follows: (a) those nurses who are working at the unit where a good background on pain management is required (e.g., postoperative unit, surgery unit, and anesthesia unit) and (b) those who are willing to participate in the study. The exclusion criteria were (a) those nurses who are new to the area (orientation program) and those (b) intern nurses who are caring for the patients in the unit.

Data gathering procedure

With the approval of the Ethics Review Committee of the H-2016-0550 together with the permission of the authorities of the three hospitals, the researchers had scheduled an orientation with the staff nurses. Two separate schedules of orientation were conducted with the participants. The first orientation was conducted exclusively for those nurses who were having a night shift duty and the second schedule was conducted to nurses who were having their day shift duty. The orientation includes what the study all about, aims of the study, the significance of the study, as well as their rights as a respondent. The researchers allotted time for the staff nurses to raise their concerns should there be. Thereafter, the researchers distributed the questionnaires to the staff nurse on duty. Data gathering was between October of 2018 and December 2018. The researchers distributed 262 questionnaires with a 100% response rate.

Instrument

This study utilized the questionnaire as the main tool to collect the data. The questionnaire has two parts. The first part is a question intended to gather the demographic information of participants. The second part is the “Knowledge and Attitudes Survey Regarding Pain (KASRP)” developed by Ferrel and McCaffery.[14] According to the developers, the tool is one of the mostly used tools since it was developed. The KASRP tool consisted of 37 items and two case studies. It has composed of 21 true or false with one point per correct answer and 16 items of multiple-choice types and two case studies with one point per correct answer. As a disclaimer, the original authors of the instrument allowed the free used of the tool with the condition to the users that proper citation should be made. The original author has established an internal consistency reliability (alpha r > 0.70) with items reflecting both knowledge and attitude domains.

In this present study, five panels of experts were invited to validate the tool. The panel of experts was doctoral degree holder in nursing. Three of them were from the tertiary hospitals and two from a research university. The panel of experts unanimously agreed that the tool is highly valid. The tool was pilot tested to 20 staff nurses who were no longer part of the actual participants. The tool yielded a high consistency for knowledge and attitude (r > 0.71).

Ethical considerations

This study has obtained ethical approval from the ethical review board of H-2016-0550. Anonymity, confidentiality, privacy, and the rights of the respondents were fully observed.

Data analysis

The data gathered were treated using the IBM Software Group, Chicago, IL, USA. Frequency and percentage were used to determine the demographic profile and the level of knowledge of the respondents in pain assessment. Mann–Whitney U-test and Kruskal–Wallis-test were used to test a comparison between the levels of knowledge on pain assessment of the respondents across their profile. Meanwhile, Kendall Tau was used to determine the difference between the levels of knowledge on pain assessment of the respondents as to their age, years of experience, and number of trainings.


  Results Top


In this study, almost all (96.90%) of the respondents are female. The vast majority (63.00%) of the respondents have 1 year of experience. The vast majority (62.60%) of the respondents are assigned to the special area unit. Most (66.80%) of the respondents have no training attended [Table 1].
Table 1: Demographic profile of the respondents (n=262)

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The level of knowledge of the respondents in pain assessment and the mean (standard deviation) score is 20.39 (7.67), which indicates a low level of knowledge and attitude of nurses toward pain as seen in 52.29% correct answers out of a maximum score of 39 [Table 2].
Table 2: Level of knowledge of the respondents in pain assessment (n=262)

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The result revealed that sex has no statistically significant difference between both sexes (U = 1272.00, P = 0.22). There is also no statistically significant difference between the level of knowledge on pain assessment of the respondents when group according to their age and years of experience with a score of H = 27.15 and P = 0.40 and H = 2.40 and P = 0.66, respectively. Meanwhile, regarding area/unit assigned Kruskal–Wallis scored H = 42.35 and P = 0.01, which means that there is a statistically significant difference between the level of knowledge on pain assessment of the respondents. Finally, Kruskal–Wallis yielded a significant score of H = 17.14 and P = 0.01 on the difference between the level of knowledge on pain assessment of the respondents and their number of training [Table 3].
Table 3: Comparison between the level of knowledge on pain assessment of the respondents across their profile (n=262)

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[Table 4] shows the relationship between the level of knowledge on pain assessment of the respondents and their age, years of experience, and the number of training. Regarding age and years of experience, Kendall Tau scored Tb = 0.04 and P = 0.37 and Tb = 0.18 and P = 0.71, respectively, which means that there is no statistically significant relationship between the level of knowledge on pain assessment of the respondents and their age and years of experience. Meanwhile, on the relationship between the level of knowledge on pain assessment of the respondents and their number of training, it showed that there is a significant weak positive relationship with a score of Tb = 0.13 and P = 0.01.
Table 4: Differences between the level of knowledge on pain assessment of the respondents and their age, years of experience, and number of training (n=262)

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  Discussion Top


This study aims to determine the knowledge and attitude of the staff nurses and whether a difference exists when their demographic profiles are considered. In this present study, it has revealed that nurses scored lower than the standard which is 39. This indicates a low level of knowledge and attitude of nurses. The mean score in this study is consistent with less than the recommended minimum standard of 80%.[15] Using the same KASRP instrument, the mean scores of the past studies range from% 35 to 72%. For instance, in 2007, a study in Taiwan had 49%,[16] while in the following year (2008), the findings of Lui et al.[9] and Yildirim et al.[17] were 47.72% and 35%, respectively. Surprisingly, better results were noticed with the recent researches, such as the studies done by Stanley and Pollard[15] with 66%, Moceri and Drevdahl[18] with 76%, and Gretarsdottir et al.[19] with 68.8%. This finding contributes to the drastic need of educating nurses and strengthens their knowledge toward pain. Nurses and hospital administrators must keep in mind that one of the core competencies that a nurse should possess is safety. Hence, adequate knowledge is vital in the provision of quality pain management to patients. Hospitals should have a policy on giving an initial assessment of nurses on pain as part of their orientation which will be monitored up by the nursing education department.

In the present study, the mean score was closely comparable with the recent ones having higher than the passing 50% (52.28%). Although it is still far to be considered adequate, based on the minimum threshold of 80%, an upright trend is seen compared to the results of the study conducted by Albaqawi et al.[20] The mean score of the said study was 41.76%, with a 10.52% increase in this study. This same trend was evident in the studies in Jordan, wherein a minimal development was also noticed from the study of Abdalrahim et al.[21] (45.7%) to those findings of Al Qadire and Al Khalaileh[11] (48.25%). While in Italy, a 5.83% difference was also noted from the studies performed by Bernardi et al.[10] (50%) and Latina et al.[22] (55.83%).

The low level of knowledge and attitude regarding pain is identified as the biggest obstacle in providing optimal pain management to the patients (Latina et al., 2015; Stanley and Pollard, 2013). One of the reasons why nurses continue to demonstrate an inadequate knowledge and poor attitude toward pain management is the lack of adequate pain education and training in the curriculum worldwide.[11],[23],[24] This is evident in the previous studies, where despite students present progression in terms of pain knowledge based on their mean scores throughout the nursing program, still, it did not reach the minimum standard to be considered adequate. In the case of the faculty, although they appeared to have a baseline knowledge regarding pain management skills, they are inconsistent in integrating pain content to the curriculum.[24],[25]

The area or unit where the staff nurses were deployed found to be significant. Indeed, frequent exposure to patients with pain somehow improves the level of knowledge of nurses and attitude toward it. These findings are similar to the study conducted in Italy where nurses working in the special units (e.g. subintensive care units) have better positive attitudes towards pain management than those nurses from the ordinary wards.[22] Another study in the UK elicited the same idea where specialist nurses showing advanced knowledge that generalist nurses.[26] This finding contributes to be used as a basis to provide an opportunity for the ward nurses to have a cross-training in special areas to be exposed and eventually developed their skills, knowledge, and attitude on nursing skills such as pain assessment and management. The cross-training is important to refresh the forgotten nursing skills by ward nurses who usually do routine skills. While some nurses may have gained knowledge previously, little exposure from patients suffering in pain may cause depletion on their skills to manage such.

Despite the number of literature and studies linking education to increase the knowledge of nurses, problems exist. In this study, a vast majority of nurses never attended any short course or training in this matter. On the positive side, those who previously had pain education performed better in the KASRP questionnaire. It is important to note that the positive correlation of the number of training simply suggests that it is not enough to attend a single lecture, but rather a frequent or series of training and courses about pain are necessary to improve the scores and eventually reached an adequate (80%) knowledge. This is evident with a study conducted in Kenya wherein the nurse's scores increased from 46.1% to 70% immediately after 7 h of focused education, and after 2 weeks, the knowledge still remained with the nurses.[27] Other studies, which point out the positive impact of having previous pain education to the level of knowledge about pain, are constant in the research field.[10],[11],[21] However, a study in Saudi Arabia contradicts with this idea noting that nurses manifest equal knowledge with or without training.[28] This finding contributes to strengthening short course and training provided by the nursing education department of every hospital. Pain education should be given regularly as part of the annual hospital activity. It may also be included in the orientation.

The difference between the level of knowledge on pain assessment of the respondents and their number of training showed a weak positive relationship. This implies that nurses who attended more pain education short courses or training are more knowledgeable compared to those without or little attendance. This only shows that mastery comes with repetition and frequent exposure, which is the key to achieve an adequate knowledge of nurses about pain. A policy on provision of a series of lectures, cross-training, and monitoring of pain management skills through the use of the KASRP instrument is necessary based on the findings of the study.


  Conclusion Top


Nurses in this study were found out to have a low level of knowledge and attitude regarding pain management. The area/unit of assignment has shown to influence the knowledge and attitude, while number of trainings has a positive effect to the knowledge and attitude. Therefore, nurses must hold correct and up to date knowledge as well as acceptable attitude towards pain. Legislation and policies are necessary to draw guidelines for improvement of such skill to relieve patients from the unpleasant experience. Clinical competencies should begin with the inclusion of pain education in nursing curriculum. Assessment of nurses' knowledge can be done with the use of the KASRP instrument from the orientation period and followed by a regular monitoring until they post an appropriate and acceptable level. Pain education such as cross-training and lectures should go hand in hand with this monitoring. Such efforts may take time and a lot of commitment, but the foreseen results will be beneficial to all patients in pain.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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