Volume 7, Issue 6, December 2018, Page: 223-230
Factors Influencing Post-Operative Pain Management Among Neonates at Moi Teaching and Referral Hospital, Kenya
Mosol Priscah, Department of Midwifery & Gender, School of Nursing, College of Health Sciences, Moi University, Kesses, Kenya
Mukami Martina, Moi Teaching and Referral Hospital, Eldoret, Kenya
Received: Sep. 25, 2018;       Accepted: Oct. 16, 2018;       Published: Oct. 29, 2018
DOI: 10.11648/j.ajns.20180706.14      View  149      Downloads  5
Abstract
Background: Neonatal post-operative pain management poses a unique challenge particularly with regard to assessing and treating the pain. In spite of the existence of empirical evidence on safety and effectiveness of neonatal postoperative pain management strategies, little is known about postoperative pain assessment and management practices in neonatal units in Kenya. In the Newborn Unit (NBU) at Moi Teaching and Referral Hospital (MTRH), neonatal assessment and treatment of neonatal postoperative pain is influenced by the knowledge base and personal decision of the health care provider. Objective: The objective of the study was to determine factors influencing postoperative pain management practices among neonates at MTRH, in Kenya in order to inform policy. Methods: This was a descriptive cross-sectional study design. The study was done at the newborn unit at MTRH, Eldoret. A semi –structured questionnaire and observation check-list was used to collect data. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0 program and presented in tables, graphs, frequencies and content analysis. Statistical techniques including logistic regression and correlation statistical procedures were employed in analysis. Results: Data from 45 health care providers were collected. The mean years of practice were 9 years, while the mean score for the assessment was 3.7. There was a negative correlation (r = - 0.058) between professional years of practice and assessment scores though it was not significant 0.703. There was a positive correlation between the intervention scores and professional years of practice (r = 0.028, p > 0.05) hence not significant. There was a positive correlation between the intervention scores and assessment scores (r = 0.546) and it was statistically significant p < 0.001. The mean score between doctors and the nurses differed and was slightly higher on assessment as compared to intervention. All health care providers cited that there were no written guidelines and pain assessment scale for use at NBU. Majority of the doctors and nurses had adequate knowledge on assessment of postoperative pain in neonates and the subsequent intervention to alleviate pain although none of them had attended any course on the same. Conclusion and Recommendations: From the study, there was lack of provision of objective tools to assess neonatal pain. Postoperative pain management was influenced by the knowledge base and personal decision of the health care provider. The study recommends the need for evidence-based guidelines for postoperative pain management at the newborn unit of MTRH. In addition, there is need for Continuing Professional Development for professional staff working at the newborn unit on the systematic assessment and management of postoperative pain in neonates.
Keywords
Influencing Factors, Postoperative Pain, Neonate
To cite this article
Mosol Priscah, Mukami Martina, Factors Influencing Post-Operative Pain Management Among Neonates at Moi Teaching and Referral Hospital, Kenya, American Journal of Nursing Science. Vol. 7, No. 6, 2018, pp. 223-230. doi: 10.11648/j.ajns.20180706.14
Copyright
Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Bell, L., & Duffy, A. (2009). Pain assessment and management in surgical nursing: British Journal of Nursing, 18(3), 153-156.
[2]
Hummel, P., Puchalski, M., Creech, S. D., & Weiss, M. G. (2008). Clinical reliability and validity of the n-pass: Neonatal pain, agitation and sedation scale with prolonged pain. Journal of Perinatology, 28, 55-60. doi: 10.1038.
[3]
Berde, B. B., Jaksic, T., Lynn, A. M., Maxwell, L. G., Soriano, S. G., & Tibboel, D. (2005). Anesthesia and analgesia during and after surgery in neonates. Clinical Therapeutics, 27(6), 900–921.
[4]
Spence, K., Gillies, D., Harrison, D., Johnston, L., & Nagy, S. (2005). A reliable pain assessment tool for clinical assessment in the neonatal intensive care unit. Journal of Obstetric Gynecologic and Neonatal Nursing, 33(5), 80-86.
[5]
International Association for the Study of Pain. (2013). Ethical guidelines for pain research in humans, accessed at: http://www.iasp-pain.org. Research_in_Humans.
[6]
Lippert, W. C. Mehlman, C. T., Lippert, A. M., & Melissa, A. M. (2012). Documentation of postoperative pain in the neonatal brachial plexus palsy population. Journal on Clinical Nursing. 21(9-10):1263-73.
[7]
McNair, C., Ballantyne, M., Dionne, K., Stephens, D., Stevens, B. (2004). Postoperative pain assessment in the neonatal intensive care Unit.; 89:537– F541.
[8]
Macintyre, P. E., Schug, S. A., & Scott, D. A, et al. (2010). Acute Pain Management: Scientific Evidence. 3rd edn. Melbourne.
[9]
International Association for the Study of Pain-(IASP) (2005). Core curriculum for professional education in pain.
[10]
Gradin, M. & Eriksson, M., (2010). ‘Neonatal pain assessment in Sweden – a fifteen-year follow up. Pediatrics (100):159–315.
[11]
Wilson, B., & McSherry, W. (2005). A study of nurses' inferences of neonates' physical pain. Journal of Clinical Nursing, 15(4), 459-468.
[12]
Latimer, M. A., Johnston, C. C., Ritchie, J. A., Clarke, S. P., & Gilin, D. (2009). Factors affecting delivery of evidence-based procedural pain care in hospitalized neonates. Journal of Obstetric, Gynecologic & Neonatal Nursing, 38(2), 182-194.
[13]
Gimbler-Berglund, I., Ljusegren, G., & Ensk R. K. (2008). Factors influencing pain management in neonates. Pediatrics Nursing, 20(10): 21-24.
[14]
Kyololo, O. M., Stevens, B., Gastaldo, D., and Gisore P., (2014). Procedural pain in neonatal units in Kenya. Archives of Disease in Childhood: Fetal and Neonatal Edition. doi:10.1136.
[15]
Brown, D., O'Neill, O., & Beck, A. (2007). Postoperative pain management: Transition from epidural to oral analgesia. Nursing Standard, 21(21), 35-41.
[16]
Werner, M. U., Soholm, L., Rotboll-Nielsen, P., & Kehlet, H. (2008). Does an acute pain service improve postoperative outcome? Anesthesia & Analgesia, 95(5), 1361-1372.
[17]
Norina, W., Seth, C., Christopher, E., & Hans, B. (2016). A Guide to Pain Assessment and Management in the Neonate. Current Emergency and Hospital 4: 1–10.
[18]
Stevens, B., Johnston, C., Petryshen, P., & Taddio, A. (1996). Premature Infant Pain Profile: development and initial validation. Clinical Journal for Pain; 12:13–22.
[19]
Krechel, S. W., & Bildner, J. (1995). “CRIES: a new neonatal postoperative pain measurement score. Initial testing of validity and reliability,” Paediatric Anaesthesia, 5 (1), 53–61.
[20]
Craig, K. D., Lilley, C. M., Gilbert, C. A. (1996). Social barriers to optimal pain management in infants and children. Clinical Journal for Pain; 12:232–242.
[21]
Costa T, Rossato LM, Bueno M, Secco IL, Sposito NPB, Harrison D, et al. (2017). Nurses’ knowledge and practices regarding pain management in newborns. DOI: http://dx.doi.org/10.1590/S1980-220X2016034403210.
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