Non–pharmacological interventions for pain management used by Nurses at the Mezam Polyclinic Bamenda, Cameroon

 

Kimbi, RB Ambola¹, Nabila VS Ajong, Emmanuel N Tufon²

¹Department of Medical Biochemistry and Research St Louis University of Health and Biomedical Sciences, Mile Three Nkwen Bamenda, Cameroon

²Department of Nursing St Louis University of Health and Biomedical Sciences, Mile Three Nkwen Bamenda, Cameroon

 

ABSTRACT:

Pain is the most frequent reason for seeking health care and it can significantly interfere with the patient’s physical, emotional and spiritual well-being. Pain management is a very important aspect of nursing care and it has been documented that nurses use non – pharmacological interventions which have unique advantages in relieving pain that medications do not have such as giving the patients a more active role in managing their pain. This cross – sectional study therefore was aimed at evaluating the non – pharmacological interventions for pain management used by nurses at the Mezam polyclinic Bamenda, Cameroon. 30 male and female nurses were randomly selected to take part in this study. Data was collected using a self – administered questionnaire composed of both open and closed ended questions and was analyzed using SPSS version 20.0. The results showed that most of the nurses were females (70.0%) in the age range of 20 – 29 years (53.0%) who had mostly obtained a diploma in nursing (43.3%). Majority of the nurses had been trained on non – pharmacological pain management (87%). Most of the nurses reported using combined non – pharmacological pain management interventions such as counselling, distraction and massage (56.0%) with heat/cold compress (20.0%) being the most common single non – pharmacological therapy used followed by distraction (13.0%). The main health care system barriers to the use of non – pharmacological intervention was nurses’ work load (40.0%) while the main patient related barrier was patient’s strong believe in analgesics (50.0%). In conclusion, majority of the nurses at the Mezam polyclinic have been trained on non – pharmacological pain management (87%) with most of them using combined non – pharmacological pain management interventions such as counselling, distraction and massage (56.0%). The main barriers to the use of non – pharmacological interventions were nurses’ work load (40.0%) and patient’s strong believe in analgesics (50.0%)

 

 

INTRODUCTION:

Due to the fact that the perception and tolerance of pain vary widely from individual to individual, it is difficult to define and describe pain. However, pain has been defined by the International Association for the study of pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage (IASP, 1986).

Pain is the most frequent reason for seeking health care and it significantly alters patient’s quality of life physically, emotionally and spiritually (Alexandrina de Jesus and Jacinta, 2013; Yava et al, 2013). Unrelieved pain may result in distress and suffering (Ward et al, 1993; AHCPR, 1994), decreased ability to participate in activities of daily life (Ward et al, 1993; De Palma and Weisse, 1997), decreased patient satisfaction and increased health care costs (AHCPR, 1994). Nurses are essential in pain diagnosis and management in all health care settings and therefore are in the best position to intervene.

In the past, pain management focused on the use of pharmacological agents but however, pain is influenced by an array of physical and psychosocial factors. It is therefore important to have a range of options such as the non – pharmacological therapies that are available in order to effectively manage patient’ s pain. As such, the Agency for Health Care Policy and Research recommends the inclusion of non – pharmacological therapies for pain where appropriate to ensure optimal pain control is achieved (AHCPR, 1994). Also, non – pharmacological interventions have been recognized as a valuable, simple and inexpensive alternative to pharmacological approaches to pain management (Allred et al, 2010) and that it gives patient’s a more active role in managing their pain. This study was therefore aimed at evaluating the non – pharmacological interventions for pain management used by nurses at the Mezam polyclinic Bamenda, Cameroon.

 

METHODOLOGY:

Study Design and Setting:

This cross – sectional hospital based descriptive study that lasted for a period of one month took place at the Mezam polyclinic located in Bamenda in the North West Region of Cameroon. In Bamenda, Mezam polyclinic is located at Azire New Church Road Mankon which is within Bamenda II sub – division. Mezam polyclinic is a well-equipped private clinic with modern facilities.

 

Sample Size and Sampling:

30 male and female nurses were randomly selected to take part in the study selection was based on willingness to participate.

 

Data Collection:

Data was collected using a self – administered questionnaire which consisted of four parts :

Part One: Nurses demographic characteristics

Part Two: Proportion of nurses trained in non – pharmacological pain management

Part Three: Non – pharmacological interventions nurses have used and are still using

Part four: Barriers to the use of non – pharmacological pain management interventions

 

Data Analysis:

Data collected were edited severally for errors and then entered into Microsoft excel 2010 and the uploaded into IBM SPSS version 20.0 for descriptive analysis.

 

Ethical Considerations:

Clearance was obtained from the Ethical Review Committee of the St Louis University Institute of Health and Biomedical Sciences mile 3 Nkwen Bamenda and a written permission to carry out the study was sought from the Director of the Mezam polyclinic. Also, an authorization letter was obtained from the North West Regional Delegation of Public Health. All information collected from the participants were considered anonymous and each participant signed a consent form before participation.

 

RESULTS AND DISCUSSION :

Demographic Characteristics of the Participants:

The demographic characteristics showed that majority of the nurses were females (70%) in the age range of 20 – 29 years (53%) who had mostly a diploma in nursing (43.3%) and most of them had worked for 0 – 5 years (76.6%). This result is congruent with an earlier study which reported that in terms of education, majority of the nurses (77.2%) were in possession of a diploma in nursing (Fourie, 2008).

 

Table 1: Demographic characteristics of the study participants :

Variables	Number	Percent
Sex Male Female	21 9	70.0 30.0
Age range (in years) 20 – 29 30 – 39 40 – 49+	16 13 1	53.0 43.3 3.3
Level of education Degree Diploma Nursing assistant	12 13 5	40.0 43.3 16.7
Years of experience 0 – 5 years 6 – 10 years 11 years and above	23 4 3	76.6 13.3 10.0
Total	30	100

 

Proportion of Nurses Trained in Non– Pharmacological Pain Management

From the results, majority of the nurses working at the Mezam polyclinic reported to have been trained in non – pharmacological pain management (87%) with just a few who were not trained (13%). This result is not in line with that of Yu and Petrini (2007) who revealed that 89.3% of the nurses had not attended any educational classes on non – pharmacological pain management and also deviates from the results of Hanan et al (2013) who reported in their study that 70% of nurses in a hospital (hospital 1) had not attended courses in non – pharmacological pain management.

 

 

Figure 1: Proportion of nurses who have been trained on non – pharmacological pain management

 

Non – Pharmacological Interventions Used:

Most of the nurses in this study reported using combined non– pharmacological interventions commonly coun-selling, distraction and massage (56.0%). This result is similar to that of Erin (2004) who reported massage, distraction and heat/cold compress non – pharma-cological interventions were used by nurses (51.1%). Other studies have also supported the combination of use of non – pharmacological interventions in pain manage-ment (Uman et al, 2006; Smeltzer et al, 2008). This could be supported by the fact that distraction for example is one of the non – pharmacological methods but patients who suffer from severe pain may not benefit from distraction as the pain could hinder them from concentrating  enough on complicated physical or mental task (Smeltzer et al, 2008). The most single non – pharmacological intervention used by the nurses were heat/cold compress (20.0%) and distraction (13.0%). This results is similar to that of Idang et al, (2014) who reported that majority of the nurses in their study stated that heat/cold compress and use of diversional methods (distractions) were the best non – pharmacological methods of pain management. Also, Hasanpour et al, (2006) reported that topical sources of heat/cold can be administered to painful areas to relieve pain. Distraction has been found to reduce sensory and affective emotional components of pain (Sinha et al, 2006). 

 

Figure 2: Non – pharmacological methods used by nurses to manage pain

Barriers to The Use of Modern Family Planning Methods:

Despite the perceived benefits of non – pharmacological pain management interventions, several barriers were also identified which may be hindering their effective use. The main health care system related barrier was nurses’ work load (40.0%) followed by lack of time (36.6%). This result is in agreement to that of Nahla (2014) who revealed that the most significant obstacle to the use of non - pharmacological methods for critically ill patients was the lack of time and nurses’ work load. This findings also agrees to that of Ferrell et al, (1991) and Morgan (2012) who reported that time has been identified by nurses as one of the hindering factors to the use of non – pharmacological methods. The time needed to implement non – pharmacological therapies is long, thereby discouraging most nurses from its use (Hanan et al, 2013).

 

The main patient related barrier was patient’s strong believe in analgesics (50.0%) followed by uncooperative nature of some patients (30.0%). The researchers suggest that this may be due to the fact that non – pharmacological therapies are not considered as a standard practice by patients therefore to some patients it is not a priority. Some turn to insist an analgesics while simply were not cooperative. At this point the researchers recommend that patient education could go a long way to improve the acceptance of non – pharmacological methods by the patients.

 

Table 2: Barriers to the use of non – pharmacological pain management intervention by nurses at the Mezam polyclinic

Barriers	Frequency	Percent
Health care system related Work load Lack of time Regulatory issues	12 11 7	40.0 36.6 23.3
Patient related Strong believe in analgesics Uncooperative patients Patients think it is unimportant	15 9 6	50.0 30.0 20.0

 

CONCLUSION :

From the results obtained, majority of the nurses at Mezam polyclinic have been trained on non – pharmacological (87%) with most of them using combined non – pharmacological therapies commonly counselling, distraction and massage (56.0%). The main barriers to the use of non – pharmacological interventions were nurses’ work load and patient’s strong believe in analgesics

 

LIMITATIONS:

This study was done on a small scale and so findings cannot be generalized to the whole country but looking at the importance of the subject matter, we recommend that same research be conducted on a larger scale so that results could be used for policy making in the country.

 

ACKNOWLEDGEMENT:

The researchers are indebted to the participants for their time, the Director of the Mezam polyclinic and to the Regional Delegate of public health for the North West Region of Cameroon for the authorization to run this research.

 

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Received on 19.07.2016       Modified on 16.08.2016

Accepted on 23.08.2016      ©A&V Publications All right reserved