Knowledge and attitudes of nurses regarding pain in the intensive care unit patients in Rwanda

Abstract

Background: Pain is a significant burden experienced by patients admitted to the adult Intensive Care Unit (ICU). Acute conditions associated with severe pain include surgical incision, traumatic wounds, effect of prolonged immobility, and sometimes hidden infections in the body’s cavities and treatment by invasive procedures. Pain in ICU is difficult to assess due to the nature of patients admitted to that unit. Pain assessement requires health care providers to have a good knowledge of it, and involves a number of care providers including the nurses among others. However little is known about the nurses’ knowledge and attitudes related to pain management in ICU. The purpose of this study is to assess nurses knowledge and attitudes toward pain management of ICU patients in three university teaching hospitals in Rwanda.

Methods: The tool and attitudes Survey Regarding Pain “developed by Ferrell and McCaffery was adapted to local context. The tool was used in the three referral hospitals in Rwanda to assess knowledge and attitudes from 69 nurses practicing in ICU. We compared the pain management performance in regard to the age, level of education, experience and history of training in pain management between nurses. The researcher used one way ANOVA to compare nurses’ scores among hospitals with a significance level α=0.05. A multiple linear regression analysis was used to highlight independent factors associated with best performance. A p value ≤0,05 was considered as statistically significant.

Results: The results from this study showed that nurses lack adequate knowledge and have poor attitudes toward pain management. The level of nursing education (p<0.008) and the hospital where nurses worked (P<0.0001) had a strong influence on attitudes toward pain management. In addition, knowledge gap and inappropriate attitude towards pain management noticed among some ICU nurses could lead to their underestimation of pain, and under medication.

Conclusion: Poor performance in pain management in ICU is multifactorial. Continuous Professional Training and improved working environment towards standard practice are key to pick up that performance.

Keywords: Intensive care unit, pain management, nurses, knowledge attitude, medication