Knowledge, Attitudes, and Practices of Nurses on Pain Assessment and Management in Manila, Philippines
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Nurses’ knowledge and attitude on pain greatly affect their ability to assess and manage it. The Pain Society of the Philippines recognized the inadequacy and inaccessibility of data on the knowledge, skills, and attitude of nurses about pain management in the country. This study aims to describe the level of knowledge and attitude (KA), and current practices of nurses on pain assessment and management; and determine the relationship of nurses’ KA with years of experience, training on pain management, and clinical area of practice.
A survey research design was employed. Four hospitals were selected through purposive sampling. Coordination was done among the two public and two private hospitals to gather data from Medical-Surgical and Intensive care unit (ICU) nurses. A total of 235 nurses participated in the study. The tool was a combination of the Nurses’ Knowledge and Attitude Survey Regarding Pain (NKASRP) and Acute Pain Evidence Based Practice Questionnaire (APEBPQ), with self-report questions on non-pharmacologic pain management. The data obtained was analysed using descriptive statistics and two sample T-tests for the clinical areas and training; and Pearson product correlation to identify relationship of level of knowledge and attitude with years of experience.
The mean knowledge and attitude (KA) score of the nurses was 47.14%. Similar studies such as that of Yava et al (2013) from Turkey had a reported mean correct answer rate of 39.65%, and 50.5% in Taiwan (Lai et. al, 2003). Majority answered ‘most of the time’ or ‘all of the time’ on 84.21% of practice items on assessment, implementation of non-pharmacologic interventions, evaluation and documentation. Three of 19 practice items describing morphine and opioid administration in special populations were only done ‘a little of the time’. Non-pharmacologic interventions used were deep breathing exercises (79.66%), massage therapy (27.54%), and ice therapy (26.69%). There was no relationship between knowledge scores and years of clinical experience (p = 0.05, r= -0.09). Moreover, there was not enough evidence to show a difference in nurses’ knowledge and attitude scores in relation to presence of training (p = 0.41) or areas (Medical-Surgical or ICU) of clinical practice (p = 0.53). This study showed a homogenous sample in terms of years of experience; therefore, no generalizations may be derived from the population.
The nurse's role in effective pain management is significant. Nurses are expected to possess adequate knowledge and attitude and adhere to evidence-based practices in pain management. With pain controlled and managed accordingly; the patient’s quality of life is preserved. Findings of the study suggested that the level of knowledge and attitude of nurses on pain assessment and management is suboptimal. There was no relationship between nurses’ knowledge and attitude and years of experience in this study. Nurses were also noted to use non-pharmacologic interventions in adjunct to pharmacologic treatment. Inadequate pain management is related to lack of knowledge, apprehension on side effects, restricted opioid use, and absence of pain management in the curricula of medical and nursing schools in developing countries (IASP, 2011). In this study, the results may have been influenced by non-prioritization of pain management in the Philippine Health Care Setting as noted by Tamalayan in 2012.
Further research may seek to determine the relationship of training, clinical area, and other variables such as pain perception and experience among nurses. It is recommended that further studies look into in the nursing curriculum on pain education, formulate culture-specific pain management protocols, and create a matrix for assessment for knowledge and attitudes; and implementation of evidenced- based practices in the country.