Pain assessment and management in children at Lusaka Children’s Hospital: a mixed methods study
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Date
2020-09-01
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Abstract
Pediatric pain is a neglected area in child health, particularly in low resource settings. All
health workers poorly manage pain in children generally. Since Nurses are the closest
health workers to the patient their knowledge, attitudes, and practices on pain affect the
patients directly. The aim of the study was to explore nurses’ experiences in management
of pain in children. The study used a convergent parallel mixed methods design. Qualitative and quantitative data were collected using the questionnaires, focus group
discussions, and a case review. 40 nurses responded to a survey done using the Pediatric
nurses' Knowledge and Attitudes Survey tool. This was followed up by three focus group
discussions made up of at least six (6) nurses in each group and a two (2) case file
review. Quantitative data were analyzed using STATA 15, for associations using chi-square, and Fisher’s exact tests. Overall, the nurses’ scored poorly, with a median score of 40.7%, while the World Health Organization’s (WHO) expected pass mark is 80%. Neither self rated knowledge nor years of experience had any significant association with the score. A higher level of education was both significantly associated with a higher
score (Fisher’s exact 0.038). Qualitative data was analyzed using content analysis. Some
of the themes, which emerged, were nurse’s lack of knowledge on the management of
pain, barriers to pain management, and influencers for deciding on management of pain
in children. Nurses made negative statements about self-reported patient pain, attributing
child and parent reports as attention-seeking behaviors, yet at the same time, the nurses expressed a positive desire to have training on pediatric pain management augmented by clear hospital policies and protocols. Heath workers rarely use a tool to assess and manage child pain and this was reinforced by the two file case reviews. The overall findings suggest that nurses were lacking in knowledge and practice for providing appropriate pain management to children. It is being recommended that the guidelines on pediatric pain management in pre-service curriculum and in-service training be cemented, and to explore forming hospital pediatric pain management teams to address in-facility needs.