Background & Aims
Pain is very common in hospitalised children, which is already known to be undertreated (Eccleston et al., 2021). Undertreatment of pain can result in physical, physiological, and psychological consequences. Lack of resources is a major factor that divides developed from developing countries, consequently, there is a treatment gap with regards to paediatric pain management in developing countries due to barriers such as lack of education, medical resources and government policies (Bond, 2011). This is compounded by the underuse of opioid medication in low to middle income countries (Berterame et al., 2016). Literature from Ghana suggest barriers to effective paediatric pain management by nurses include, inadequate training and staffing, lack of Pain assessment, and lack of prescribing authority by nurses (Amponsah et al., 2020; Wuni et al., 2020). This study therefore aimed to explore the paediatric pain management practices in a municipal hospital in the northern part of Ghana.
Methods
A qualitative design was employed to conduct this study. Data collection was undertaken via observation (observer as a participant) between 21st November and 4th December 2023. Twelve nurses from the children’s ward were shadowed by three researchers on both day (morning and afternoon) and night shifts. A total of 78 hours of observations were undertaken. Participants included Nurse Assistant Clinical, registered general Diploma nurses, Registered General Degree nurses, Paediatric Associate Specialist nurses, and Paediatric Degree nurses. Data analysis drew on Braun and Clarke’s thematic analysis framework (Braun & Clarke, 2006).
The principles of research ethics and governance was observed appropriately during the conduct of the study. Ethical approval was obtained for the study, and measures such as autonomy, informed consent, confidentiality, data protection, potential effects and safeguarding of participants was adhered to.
Results
Findings revealed inadequate paediatric pain management practices in the children’s ward. Themes identified includes lack of formal pain assessment, inadequate pharmacological/nonpharmacological pain management, and inadequate communication about pain. No validated pain scales were seen in the ward, Consequently, no nurse was observed assessing pain and when asked they articulated it was not formalised in the institution compared to the other vital signs. The commonest pain medications observed in use was acetaminophen, IV, oral or suppository as well as syrup ibuprofen. Morphine was rarely used, the only time morphine was observed to be administered was for a sickle cell crises child. With regards to non-pharmacological interventions, none was observed used. A number of children were seen undergoing procedures such as canulation and iv draws without any pharmacological or non-pharmacological intervention. Communication between nurses and children/parents was almost non-existent.
Conclusions
Paediatric pain management practices was woefully inadequate in the children’s ward. This could be attributed to lack of policies such as formalising pain assessment and guidelines for pain management. Additionally, nurses exhibited inadequate knowledge on the topic. More so there were no assessment scales in the ward for pain assessment. There is therefore the need for training of the nurses, provision of resources and policies on paediatric pain management to ensure optimal pain management.
References
Amponsah, A. K., Kyei, E. F., Agyemang, J. B., Boakye, H., Kyei-Dompim, J., Ahoto, C. K., & Oduro, E. (2020). Nursing-related barriers to children’s pain management at selected hospitals in Ghana: A descriptive qualitative study. Pain Research and Management, 2020(1), 1–7. https://doi.org/10.1155/2020/7125060
Berterame, S., Erthal, J., Thomas, J., Fellner, S., Vosse, B., Clare, P., Hao, W., Johnson, D. T., Mohar, A., & Pavadia, J. (2016). Use of and barriers to access to opioid analgesics: A worldwide, regional, and national study. The Lancet, 387(10028), 1644–1656. https://doi.org/10.1016/S0140-6736(16)00161-6
Bond, M. (2011). Pain education issues in developing countries and responses to them by the International Association for the Study of Pain. Pain Research and Management, 16(6), 404–406. https://doi.org/10.1155/2011/654746
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.
Eccleston, C., Fisher, E., Howard, R. F., Slater, R., Forgeron, P., Palermo, T. M., Birnie, K. A., Anderson, B. J., Chambers, C. T., Crombez, G., Ljungman, G., Jordan, I., Jordan, Z., Roberts, C., Schechter, N., Sieberg, C. B., Tibboel, D., Walker, S. M., & Radcliffe, J. (2021). Delivering transformative action in paediatric pain: A Lancet Child & Adolescent Health Commission. The Lancet. Child & Adolescent Health, 20, 23–23. https://doi.org/10.1016/S2352-4642(20)30277-7
Wuni, A., Salia, S. M., Mohammed Ibrahim, M., Iddriss, I., Abena Nyarko, B., Nabila Seini, S., Tonsagri, I., & Mohammed, J. (2020). Evaluating Knowledge, Practices, and Barriers of Paediatric Pain Management among Nurses in a Tertiary Health Facility in the Northern Region of Ghana: A Descriptive Cross-Sectional Study. Pain Research and Management, 2020(11), 1–11. https://doi.org/10.1155/2020/8846599
Presenting Author
Francisca Achaliwie
Poster Authors
Francisca Achaliwie
PhD, MSc, BSc
School of Nursing and Midwifery, C. K. Tedam University of Technology and Applied Sciences
Lead Author
Margaret, W. Kukeba. PhD
MSc
School of Nursing and Midwifery, C. K. Tedam University of Technology and Applied Sciences
Lead Author
Jamilatu, B. Kappiah. MSc
BSc
School of Nursing and Midwifery, C. K. Tedam University of Technology and Applied Sciences
Lead Author
Topics
- Pain in Special Populations: Infants/Children