A model of pain management using opioid analgesics in Palliative Care Nursing in Kenya

Abstract

Satisfactory pain management is an essential component of palliative care which emphasizes on pain and symptom management in life-limiting disease. The three phased descriptive, analytical cross sectional research aimed at developing a Model of pain management by use of opioid analgesics in palliative care (PC). It was conducted in Machakos and Embu county referral Hospitals located in Eastern Kenya which were purposively sampled. In phase one, participants were systematically sampled from nurses working in the two hospitals. Data was collected by use of questionnaires, cleaned, coded and entered in Epidata 3.1 then and analyzed using Stata version 14.0. This phase adopted Diffusion of Innovations theoretical framework. In phase two and three qualitative data was collected via key informant interviews and thematically analyzed based on Classical Grounded theory. Presentation of results was done by use of tables, charts and narratives. The results showed that the level of knowledge of nurses on pharmacology of opioid analgesics was low. Hypothesis testing showed no significant relationship between knowledge of general pharmacology of opioids and education level of the nurses. Most respondents reported lack of awareness of the recommended pain management guidelines. Commonly used pain assessment tools included history taking and physical examination and use of numerical rating scales, Wong’s Faces and Palliative/ precipitating factors, Quality, Region/ radiation, Severity & Timing (PQRST) methods. The most preferred pain management tool was the World Health Organization (WHO) analgesic ladder. Gaps identified in the pain assessment tools included lack of provision for monitoring of & management of side effects and inability to assess pain in special populations. There was no standard recommended Model of pain management in PC hence participants recommended need to address the identified gaps. In conclusion there exist many barriers to pain management by use of opioid analgesics hence there is need for continued professional development for healthcare professionals. Additionally, the Government needs to develop sound policies to govern the use of opioids. Gaps identified in pain management guidelines such as lack of capacity to manage special populations and monitor treatment outcomes can be addressed by use of the appropriate tools like Behavioral Pain Scale (BPS), Face, Leg, Activity, Cry and Consolability (FLACC) plus the emergent Model.