Assessment and Management of Pain in Children: Knowledge and Attitude of Staff Nurses

 

Mrs. Priya Reshma Aranha1*, Mrs. Renita Priya  Dsouza1 ,  Mrs. Umarani J2, Ms. Shilpa G.S.1,

Dr. Asha P Shetty3

1Assistant Professor, Department of Paediatric Nursing, Yenepoya Nursing College, Mangalore

2Associate Professor, Department of Paediatric Nursing, Yenepoya Nursing College, Mangalore

3HOD, Department of Paediatric Nursing and   Principal , Yenepoya Nursing College, Mangalore

*Corresponding Authors Email: priyaresh.menezes@gmail.com

 

ABSTRACT:

Introduction: Pain is a subjective experience and is influenced by individuals sensory, affective, behavioural, cognitive, socio-cultural and physiologic components. The children who are the vulnerable group for the pain experience in the hospital, the pain assessment and management in children is a challenge to nurses.

Objective: To assess the knowledge and attitude of  staff  nurses regarding the assessment and management of pain in children, find correlation between the knowledge and attitude, and find association between knowledge, attitude and the selected demographic variables.

Methodology: A descriptive survey approach  was used  to assess the knowledge and attitude of  staff  nurses regarding the assessment and management of pain in children in selected hospital Mangalore. Convenience sampling technique was used to select 100 staff nurses. Data was gathered using the structured knowledge questionnaire and the attitude scale on assessment and management of pain in children. Data was analysed using descriptive and inferential statistics.

Result: The study results showed that the majority (53%) of the sample had inadequate knowledge regarding assessment and management of pain in children. Majority (77%) of the sample showed favourable attitude towards assessment and management of pain in children. In the study there was a significant association between knowledge and the selected demographic variables and the attitude and the selected variables. There was also a significant correlation between the knowledge and attitude of the staff nurses regarding assessment and management of pain in children.

Conclusion: The study concluded that the staff nurses have inadequate knowledge and a favourable attitude towards the assessment and management of pain in children. It is recommended that continuing education programmes can be conducted for the staff nurses to enhance their knowledge.

 

KEY WORDS: Children, Pain, Assessment, Management, Staff nurses.

 

 

 

INTRODUCTION:

The International Association for the Study of Pain defines pain  as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”1  According to the International Association for the Study of Pain (IASP) and  Special Interest Group on Pain in Childhood, pain relief is a human right.2

 

Pain is experienced by all and yet it is not easily understood by others who are not currently experiencing it3 as it is subjective in nature. Children are the more vulnerable group for experiencing pain as they receive a number of childhood vaccinations and during hospitalization exposure to invasive procedures. Children respond to pain based on the type of pain, extent of pain, their age and developmental levels. There are some myths and misconceptions related to pain in children. Because of these myths, children have been medicated less than adults with a similar diagnosis, leading to inadequate pain management. 4

 

Pain assessment is a broader concept than pain measurement and takes into account many dimensions of pain experience.5 Pain and its perception are multi-factorial, hence an approach to pain assessment and treatment must also be multi-faceted and multi-disciplinary. Painful experiences are dynamic, with huge inter- and intra-individual variation6 Thus when the pain assessment of children is considered, it is essential to understand the physiological, psychological as well as the sociocultural factors of children. The pain in children is associated with behavioural changes7 too. Thus it is a challenge for the paediatric nurse to assess the pain in children. The prompt assessment of pain only can lead to  prompt management of pain. The nurse’s knowledge and skill is very essential in effective pain assessment. Hence the investigators were interested to assess the knowledge  and attitude of staff nurses regarding pain assessment and management in children. Thus the researchers conducted a study with the objectives to  assess  the knowledge and attitude of  staff nurses regarding the assessment and management of pain in children,  to find correlation between the knowledge and attitude and to find an  association between the knowledge and attitude with the selected demographic variables.

 

MATERIALS AND METHODS:

With a non experimental research approach, descriptive survey  design was used for the study to assess the knowledge and attitude of  staff  nurses regarding the assessment and management of pain in children. The study was conducted in  a selected hospital  at  Mangalore. The sample consisted of 100  staff nurses. The sample was selected by Non probability convenience sampling technique. The key variables under study were  knowledge and attitude of staff nurses regarding the assessment and management of pain in children.  And the  demographic variables were Age, Gender, Educational qualification, Experience  and the area of work. Structured knowledge questionnaire and attitude scale was used to collect the data from samples. The collected data was analyzed by using descriptive and inferential statistics.

 

RESULT:

The study findings are discussed under the following headings:

 

Section I : Distribution of staff nurses according to the demographic characteristics

Table 1 shows the distribution of staff nurses according to the demographic characteristics.

 

Table 1: Distribution of sample according to demographic characteristics.

Sl.
No.

Sampling characteristics

Frequency

Percentage (%)

1

Age in years

 

21- 25 

72

72

 

26-30 

22

22

 

31-35

3

3

 

Above 35

3

3

2

Gender

 

Male

5

5

 

Female

95

95

3

Education qualification

 

GNM

54

54

 

Basic B.Sc nursing

37

37

 

Post Basic B.Sc nursing

9

9

 

M.Sc Nursing

Nil

Nil

4

Experience

 

Below 1 year

32

32

 

1-3 year

45

45

 

4-6 years

14

14

 

7 years and above

9

9

5

Current working  unit

 

Ward

68

68

 

OPD

13

13

 

NICU

12

12

 

PICU

7

7

6

Previous exposure to training  on pain assessment and management

 

Yes

28

28

 

No

72

72

 

Section II : Knowledge of staff nurses regarding the assessment and management of pain in children

 

Figure 1 : Knowledge of staff nurses regarding the assessment and management of pain in  children

Figure 1 shows that majority (53%) of sample had inadequate knowledge, 45% had moderately adequate and 2% had adequate knowledge regarding assessment and management of pain in  children.

 

Section II: Attitude of staff nurses regarding the assessment and management of pain in children

The study showed that majority (77%) of the staff nurses had favourable attitude and 23% have moderately favourable attitude towards assessment and management of pain in  children.

 

Section III: Association of knowledge and attitude with the demographic variables

The study showed that there was a significant association between the knowledge and the years of experience of the staff nurses (c2(2) =9.09, p<0.05), attitude and years of experience of the staff nurses (c2(2) =9.72, p<0.05) and the attitude and the current working unit of the staff nurses (c2(2) =25.66,  p<0.05).

 

Section IV: Correlation between the knowledge and attitude 

The study showed a positive correlation between knowledge and attitude of staff nurses regarding assessment and management of pain in children, (r = 0.467).

 

DISCUSSION:

As the pain is subjective in nature the assessment of pain becomes  complex. In the paediatric population, as the children are from different age groups and at different developmental stages pain assessment becomes difficult. The pain assessment and management in children is an important responsibility of the nurse. Nurse should have the adequate knowledge and a favourable attitude towards the pain assessment and management in children so that they can provide atraumatic care to the children. The current study findings are in accordance with a study conducted to assess the knowledge, attitude and practice of nursing personnel caring critically ill children in developing country which concluded  that there are several lacunae in the knowledge and practice of nurses in developing countries which need to be improved by training7. Another study was conducted to assess the knowledge, attitude and practices among health care professionals regarding pain in children. The study results showed that the knowledge about pain scales among the studied healthcare professionals was not widespread. Majority of respondents believed that the best judge of intensity of pain is the child. Nearly two-thirds of the respondents felt that non-pharmacological measures were better to control pain8.

 

CONCLUSION:

The study has shown that the staff nurses lack the knowledge regarding the assessment and management of pain in children. The children deserve a very good assessment and management of pain during hospitalization as they are precious and vulnerable population. Thus the investigators recommend that nurses should undergo the training programme or education programme on assessment and management of pain in children so that they will be able to provide a good quality care to children.

 

ACKNOWLEDGEMENT:

The authors would like to express the gratitude to all the study participants for their cooperation and the management of Yenepoya University for the timely help.

 

CONFLICTS OF INTEREST:

The authors declare that they have no competing interest.

 

REFERENCES:

1.        American Academy of Paediatrics, Canadian paediatric society. Prevention and management of pain and stress in the neonates. Clinical Therapeutics. 2009;31(2):152-157.

2.        Mercedes S, Deborah P. Relationship Between Knowledge, Attitudes, and Self-Efficacy of Nurses  In the Management of Paediatric Pain. Paediatric Nursing.2013;39(4):165-171.

3.        Lissauer T, Clayden G. Illustrated textbook of paediatrics. 3rd ed. Elsevier: Mosby; 2007.

4.        Morton NS. Pain assessment in children. Paediatric Anaesthesia. 2007; 7: 267-272

5.        Katherine B, Colleen C. Pain assessment in children. Anaesthesia and Intensive care medicine. 2010; 11(6): 214-216

6.        Cohen LL. Reducing infant immunisation distress through distraction. Health psychology. March  2002;21(2):207-11.

7.        Mathew PJ, Mathew JL, Singhi S.  Knowledge, attitude and practice of paediatric critical care nurses towards pain: Survey in a developing country. Journal of Postgraduate Medicine. 2011; 57( 3): 196-201

8.        Avanya S, Manju V,  and Rakesh L. Knowledge, Attitude and Practices Among Health Care Professionals Regarding Pain.  Indian Journal of Paediatrics. September 2009; 76 :913-916.

 

 

 

Received on 16.02.2015          Modified on 17.03.2015

Accepted on 21.03.2015          © A&V Publication all right reserved

Int. J. Nur. Edu. and Research 3(2): April-June, 2015; Page 137-139