Saudi Journal of Medicine and Medical Sciences

ORIGINAL ARTICLE
Year
: 2017  |  Volume : 5  |  Issue : 2  |  Page : 155--159

Pain knowledge and attitude survey among health-care professionals at a university hospital in Saudi Arabia


Summayah M. A Fallatah 
 Department of Anesthesia and Pain Medicine, College of Medicine, University of Dammam, Dammam, Saudi Arabia

Correspondence Address:
Summayah M. A Fallatah
Department of Anesthesia and Pain Medicine, College of Medicine, University of Dammam, P.O. Box 40081, Al Khobar, 31529
Saudi Arabia

Abstract

Background: There is growing awareness in the hospital setting toward pain management to decrease patients' suffering, improve postsurgical outcomes and to decrease cost. Objective: The aim of this study was to get an overview of the knowledge and attitude among health-care professionals toward pain management in the King Fahd Hospital of the University, and the need for an educational plan to improve pain service in hospitals. Materials and Methods: We conducted a survey over a 3-month period based on a 30-question questionnaire to test pain knowledge and attitude among nurses and physicians of different specialties, the level of education and years of experience. Results: The results of the data showed that knowledge and attitude of pain were deficient and unsatisfactory. Conclusion: We concluded that efforts to spread knowledge and education of proper pain management among health-care professionals are required. Further surveys involving more hospitals are warranted.



How to cite this article:
Fallatah SM. Pain knowledge and attitude survey among health-care professionals at a university hospital in Saudi Arabia.Saudi J Med Med Sci 2017;5:155-159


How to cite this URL:
Fallatah SM. Pain knowledge and attitude survey among health-care professionals at a university hospital in Saudi Arabia. Saudi J Med Med Sci [serial online] 2017 [cited 2019 Jun 25 ];5:155-159
Available from: http://www.sjmms.net/text.asp?2017/5/2/155/204855


Full Text

 Introduction



Pain is one of the most common consequences after surgical procedures and is often associated with fear and anxiety, delayed mobilization, prolonged recovery and increased patient morbidity.[1] An adequate level of knowledge and positive attitude are essential components in proper pain management. However, literature suggests that inadequate pain control continues to bedevil postsurgical patients despite increased awareness among health-care professionals of the detrimental effects of inadequately treated pain.[2]

In a large study, exploring nursing opinions about pain, researchers concluded that there is a tendency for nurses' personal opinions about patients' pain to influence their choice of opioid dose.[3] Literature suggests that nurses' concerns about patient addiction and respiratory depression are likely causes of the under-treatment of pain.[3],[4],[5]

Some studies based on nurses' knowledge and attitude toward pain control have included complete study questionnaires.[6],[7],[8] Other studies have examined nurses' involvement in pain control using a number of different approaches based on the research objectives. Most researchers have examined a combination of different issues in the same study, including nurses' beliefs about the incidence of pain; the comparison of patient and nurse perceptions and knowledge of the physiology of pain; attitudes and beliefs about pain control, current practice, knowledge of drug therapy and side effects as well as the effectiveness of educational programs.[9],[10],[11],[12],[13],[14]

The aim of this study was to assess the knowledge and attitude among health-care professionals about pain management in King Fahd Hospital of the University (KFHU), Al-Khobar, Saudi Arabia. The researcher's plan was to use the collected information to improve the knowledge and performance of health-care professionals by conducting educational sessions and different pain awareness programs.

 Materials and Methods



After approval by the local ethics and hospital committees, a cross-sectional study was conducted from December 2012 to March 2013 in KFHU. Thirty true-and-false-type questions were distributed to all nursing units and clinical departments. Each head nurse was responsible for distributing the questionnaire to the nursing staff on the unit, and each medical secretary was responsible for distributing the survey questionnaire to physicians and paramedics in the clinical departments. The numbers of copies given to each unit were documented. The nurses and secretaries returned the questionnaires via a designated envelope assigned to the unit at the end of the data collection period.

The choice of the items in the questionnaire was based on revised McCaffery questionnaire (questions numbers 3, 4, 17, 18 and 19) and the questionnaire of Visentin et al. (questions number 1, 3 and 11).[15],[16] Revisions were made on the aforementioned questions to match the drugs and instruments used in KFHU. The remaining questions were formulated by the author to match the specific objectives.

Questions were divided into two categories; Questions 1–19 to assess knowledge and Questions 20–30 to assess attitude toward pain management. A correct response was given a value of one and an incorrect response or an unanswered question was given a value of zero.

Statistical Package for Social Science version 20 (SPSS Japan Inc., Tokyo, Japan) was used for statistical analysis. Data were presented in the form of numbers and percentages. Fisher's exact test was used for comparison. Statistical significance was considered P< 0.05.

 Results



A total of 346 questionnaires were distributed in the hospital to nursing units and clinical departments. Only 255 questionnaires (74%) were returned from all areas, and 26 were excluded because they left either the gender (15) or the job title (11) blank. Two hundred and twenty-nine (90%) respondents were analyzed. Of the total respondents, 60 were physicians (26.20%) and 169 were nurses (73.80%). Of the total number of physicians, 38 were residents (63.3%), 2 were registrars (3.3%), 7 were specialists (11.6%) and 13 were consultants (21.6%) comprising different specialties (medical 17, surgical 23 and anesthesia 16). The years of experience are shown in [Table 1]. The nurses were of different levels of seniority: 28 (0–P = 0.0001), significantly answered positively in attitude-based questions (P = 0.0001) and in all questions as a whole (P = 0.0001) [Table 2] and [Figure 1]. The range of correct answers in knowledge questions were 29.59–95.27% for nurses and 41.67–96.67% for physicians, while the range of positive answers for attitude questions was 13.02–95.27% for nurses and 26.67–96.67% for physicians. Nurses scored <50% in Questions 6, 7, 8, 20, 21, 23, 24, 25 and 27, while physicians scored <50% in Questions 8, 23 and 27.{Table 1}{Table 2}{Figure 1}

 Discussion



Despite the remarkable progress in pain management, health-care professionals continue to underestimate, under-medicate and mismanage patients in pain.[16],[17] This study provides an overview of knowledge and attitude toward pain management among health-care professionals in KFHU, Al-Khobar, Saudi Arabia. It demonstrates deficient knowledge and negative attitude toward pain management among physicians and nurses. Previous surveys conducted in other health-care centers reported similar issues that resulted in suboptimal pain management, such as poor pain assessment, insufficient knowledge and negative attitude together with inadequate guidance from pain specialists.[18],[19] Further concord is found between this study and other studies with regard to opioid “phobia” that results from an over-concern of medication addiction and respiratory depression when opioids are used.[4],[7],[15]

In contrast to our findings, previous surveys conducted at the University of Helsinki, Finland, and King Abdulaziz University, Jeddah, Saudi Arabia, revealed a positive attitude toward pain management in elderly patients with cancer.[20],[21] However, these studies were conducted among medical students who were not yet involved in actual patient management. Moreover, those surveys were limited to cancer patients. Furthermore, in the survey conducted at King Abdulaziz University, a English questionnaire was distributed to Arabic-speaking students which could have affected the surveyors' understanding of the questions and, therefore, the results.

Nurses scored <50% in Questions 6, 7, 8, 20, 21, 23, 24, 25 and 27, while physicians scored <50% in Questions 8, 23 and 27. Scoring <50% in attitude questions is in contradistinction to the findings reported by others in which they demonstrated that the lowest scores were mainly related to knowledge.[7],[15],[16],[17],[18],[19],[20],[21],[22] It has been suggested that the professionalization process of health-care providers reinforced negative attitudes associated with lack of enthusiasm to prescribe opioids, over concern of respiratory depression, patient addiction and drug regulatory agency sanctions.[23] We suggest that barriers to optimal pain management might be due to the deficient educational programs on pain management, which has contributed to the lack of knowledge among health-care providers over the years. This has subsequently led to a negative attitude toward pain management due to fear of liability, unfamiliarity and anticipated risks that might include addiction, dependence and respiratory depression. Further research is needed refute or to support these suggestions.

This study revealed that physicians had a significantly better knowledge and less negative attitude as compared with nurses. A previous study indicated that many nurses lack sufficient knowledge of appropriate pain management and showed that nurses answered <70% of questions correctly.[24] A possible explanation is the deficiency of pain management education in their nursing curricula.[25] It has been shown that introduction of a short pain management course for final-year medical students improved their knowledge with regard to pain and led to better pain management.[26] Furthermore, a recent study that assessed undergraduate nursing students' pain knowledge after participation in a simulation scenario recommended that future pain simulations should be included to give more opportunities for students to choose appropriate pain medications when “as needed orders” are prescribed.[27]

Limiting the study to one health organization limited the number of health-care practitioners included in the survey. In addition, it is understandable that the knowledge of the health-care providers is not comparable to that of a physician. Our recommendation is that KFHU conducts more educational programs to staff either through pamphlets, small group pain management workshops and poster presentations.

 Conclusion



We concluded that there is a lack of knowledge and a negative attitude among health-care professionals in KFHU, Al-Khobar, KSA, to pain management and there is a strong need to improved their knowledge to achieve better patient care.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1American Academy of Pediatrics, Committee on Psychosocial Aspects of Child and Family Health; Task Force on Pain in Infants, Children, and Adolescents. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics 2001;108:793-7.
2Ho SE, Choy YC, Rozainiee A. Survey of nurses' knowledge and attitude regarding post operative pain management at a teaching hospital in Malaysia. J Med Health 2009;4:47-52.
3McCaffery M, Ferrell B, O'Neil-Page E, Lester M, Ferrell B. Nurses' knowledge of opioid analgesic drugs and psychological dependence. Cancer Nurs 1990;13:21-7.
4Horbury C, Henderson A, Bromley B. Influences of patient behavior on clinical nurses' pain assessment: Implications for continuing education. J Contin Educ Nurs 2005;36:18-24.
5Drayer RA, Henderson J, Reidenberg M. Barriers to better pain control in hospitalized patients. J Pain Symptom Manage 1999;17:434-40.
6Chapman PJ, Ganendran A, Scott RJ, Basford KE. Attitudes and knowledge of nursing staff in relation to management of postoperative pain. Aust N Z J Surg 1987;57:447-50.
7McCaffery M, Ferrell B. Do you know a narcotic when you see one? Nursing 1990;20:62-3.
8Donovan M, Dillon P, McGuire L. Incidence and characteristics of pain in a sample of medical-surgical inpatients. Pain 1987;30:69-78.
9Rankin MA, Snider B. Nurses perceptions of cancer patients pain. Cancer Nurs 1984;7:149-55.
10Ketovuori H. Nurses' and patients' conceptions of wound pain and the administration of analgesics. J Pain Symptom Manage 1987;2:213-8.
11Camp LD. A comparison of nurses recorded assessments of pain with perceptions of pain as described by cancer patients. Cancer Nurs 1988;11:237-43.
12Hauck SL. Pain: Problem for the person with cancer. Cancer Nurs 1986;9:66-76.
13Dalglish S. Pain teaching project. Can Nurse 1990;86:16.
14Abbott FV, Gray-Donald K, Sewitch MJ, Johnston CC, Edgar L, Jeans ME. The prevalence of pain in hospitalized patients and resolution over six months. Pain 1992;50:15-28.
15McCaffery M, Ferrell BR, Pasero C. Nurses' personal opinions about patients' pain and their effect on recorded assessments and titration of opioid doses. Pain Manag Nurs 2000;1:79-87.
16Visentin M, Trentin L, Marco R, Zanolin E. Knowledge and attitudes of Italian medical staff towards the approach and treatment of patients in pain. J. Pain Symptom Manage 2001;22:925-30.
17Bergeron DA, Bourgault P, Gallagher F. Knowledge and beliefs about chronic non cancer pain management for family medicine group nurses. Pain Manag Nurs 2015;16:951-8.
18Xue Y, Schulman-Green D, Czaplinski C, Harris D, McCorkle R. Pain attitudes and knowledge among RNs, pharmacists, and physicians on an inpatient oncology service. Clin J Oncol Nurs 2007;11:687-95.
19Eftekhar Z, Mohaghegh MA, Yarandi F, Eghtesadi-Araghi P, Moosavi-Jarahi A, Gilani MM, et al. Knowledge and attitudes of physicians in Iran with regard to chronic cancer pain. Asian Pac J Cancer Prev 2007;8:383-6.
20Niemi-Murola L, Nieminen JT, Kalso E, Pöyhiä R. Medical undergraduate students' beliefs and attitudes toward pain: How do they mature? Eur J Pain 2007;11:700-6.
21Kaki AM. Medical students' knowledge and attitude toward cancer pain management in Saudi Arabia. Saudi Med J 2011;32:628-32.
22McCaffery M, Robinson ES. Your patient is in pain – Here's how you respond. Nursing 2002;32:36-45.
23Visentin M, Zanolin E, Trentin L, Sartori S, de Marco R. Prevalence and treatment of pain in adults admitted to Italian hospitals. Eur J Pain 2005;9:61-7.
24McMillan SC, Tittle M, Hagan S, Laughlin J, Tabler RE. Knowledge and attitudes of nurses in veterans hospitals about pain management in patients with cancer. Oncol Nurs Forum 2000;27:1415-23.
25Romero-Hall E. Pain assessment and management in nursing education using computer-based simulations. Pain Manag Nurs 2015;16:609-16.
26Sloan PA, Montgomery C, Musick D. Medical student knowledge of morphine for the management of cancer pain. J Pain Symptom Manage 1998;15:359-64.
27Evans CB, Mixon DK. The evaluation of undergraduate nursing students' knowledge of post-op pain management after participation in simulation. Pain Manag Nurs 2015;16:930-7.