Nurses’ knowledge and practices related to pain assessment in critically ill patients at Mulago hospital, Uganda

Abstract

Nurses’ knowledge and practices related to pain assessment in critically ill patients at Mulago National Hospital, Uganda. Critically ill patients experience moderate to severe acute pain which minimizes their comfort. If inadequately managed, acute pain leads to negative physiological and psychological sequelae including the development of chronic pain syndromes. Optimal pain relief is reliant on nurses’ systematic and consistent assessment, and regular documentation of pain. Research related to nurses’ knowledge and practices regarding pain assessment in the critical care setting remains limited. There has been no study in Uganda about nurses’ knowledge and practices related to pain assessment among critically ill patients. The study was designed to describe nurses’ knowledge, practices and barriers related to pain assessment for critically ill patients at Mulago National Hospital. Methodology: A descriptive cross-sectional study design was employed. Data was collected using a semi-structured questionnaire from a convenient sample of 170 nurses caring for critically ill patients at Mulago Hospital. The study was approved by ethical committees at Muhimbili University of Health and Allied Sciences and Mulago Hospital. Analysis: Data was analyzed using SPSS version 14.0. Results were summarized using frequencies and percentages, and presented using figures, tables and text. Results: Majority (90%) of the participants reported to assess pain among critically ill patients but almost all of them (96%) do not use pain assessment tools. More than three quarters (79.1%) of the participants who assessed for pain documented findings after assessment. Majority of the participants (91.2%) had adequate knowledge. Almost half lacked knowledge on key pain assessment principles ; 43.5% mentioned people other than the patient as the most accurate in rating the pain intensity for the patient, and 44% do not always agree with patients’ statements about pain. Barriers to pain assessment included; nursing workload (84.1%), lack of availability of assessment tools (74.1%), lack of education on assessment tools (82.4%) , lack of familiarity with tools (78.2%) , lack of protocols and guidelines on pain assessment and management (74.1%), poor documentation of pain assessment and vi management (77.6%) and poor communication of pain assessment priorities at the unit (74.7%). Conclusion Assessment and documentation of pain is done by majority of nurses. However, assessment tools are minimally used. Nurses had adequate knowledge on pain assessment. However, almost half of them did not know that it is the patient who best assesses their pain and do not always agree with patients’ statements on pain. This is a knowledge gap which can affect practice. Perceived barriers included; lack of guidelines and protocols, assessment tools, documentation charts and education on assessment tools, poor documentation of pain assessment and management, and poor communication of pain assessment priorities at the unit. Recommendations There is need of a multifaceted approach by Ministry of Health, hospital leadership, nurse leaders, Nursing Council , clinical nurses and nurse- educators to; conduct a continuous professional education program on pain assessment for nurses caring for critically ill patients. In addition, introduction of pain assessment tools, guidelines and protocols, and charts for documentation that are appropriate to the setting coupled with practical training and support supervision is recommended. A mixed methods research exploring the actual practices is recommended.