Determinants of nurses’ knowledge gap on pain management in Ghana

There are concerns about adequacy of nurses’ knowledge and skill in effective pain management since effective pain management promotes early recovery after surgery. This study explores factors that accounted for Ghanaian nurses’ inadequate knowledge of postoperative pain management using a focused ethnographic design for data collection at a tertiary teaching hospital in Ghana. Fourteen nurses designated as key informants with different backgrounds as nurse educators and leaders were purposively sampled to participate. Data were collected through in-depth individual interviews; all interviews were conducted in English, audio-taped and transcribed verbatim. The study revealed that nurses’ inadequate pain management knowledge might have resulted from curriculum gaps during training; inadequate clinical supervision, study days, and workshops for practising nurses; lack of funding for organising regular workshops; and, negative attitudes of nurses whereby new information learned at workshops was not readily applied in clinical practice. It was concluded that nursing curricula at all levels of training in Ghana should incorporate credit-bearing courses on pain management, and appropriate pain management education programmes should be instituted for practising nurses. Regular monitoring and evaluation of the impact of such education programs is required.Web of Scienc

Perspectives of the surgeons, anaesthetists, and pharmacists on post-operative pain management roles in the Ghanaian context

Post-operative pain is best managed by a multi-disciplinary team approach. An extensive review of the literature indicated that little is known about the roles of surgeons, anaesthetists, and pharmacists regarding post-operative pain management in Ghana. Therefore, this study was undertaken in order to fully understand how health professionals perceive their roles and the challenges that influence their decisions about post-operative pain management. A qualitative approach with a focused ethnographic design was employed involving eleven in-depth individual interviews. Purposive sampling approach was employed. The study was conducted at a tertiary hospital in Accra, Ghana. The study revealed that surgeons and anaesthetists practised pre-emptive analgesia by administering intra-operative analgesia, giving nerve blocks, and infiltrating surgical wounds. Sometimes, epidural analgesia and perfusers were used for patients who could afford them, particularly if they were expected to experience severe post-operative pain. Challenges reported by all the participants related to inadequate personnel, opioid effect and availability, inadequate training and collaboration, and effects of organisational culture were identified. It was concluded that effective collaboration among health professionals could enhance post-operative pain management. There is a need for enhanced commitment, in order to provide more effective post-operative pain management.Department of HE and Training approved lis

An ethnographic exploration of postoperative pain experiences among Ghanaian surgical patients

The experience of pain associated with surgery has been a challenge for health care professionals for many years, and culture is said to influence pain. Purpose: This study focused on patients’ experiences of postoperative pain (POP) and factors that affect POP. Design: The study employed qualitative ethnographic principles. Method: Data were collected through individual face-to-face interviews. Data were saturated after analyzing data from 13 patients from two hospitals in Ghana. Findings: Themes that emerged were the subjective nature of pain, which described pain dimensions and communication; psycho-sociocultural factors, such as personal inclinations and sociocultural background; and health system factors, such as personnel attitudes and health financing. Implications for Future Research and Practice: Health professionals need to understand the sociocultural effects of pain in order to give effective care. Conclusion: The study highlighted the need for patient education and the importance that health care professionals understand context-specific factors that influence POP management.Department of HE and Training approved lis

Psychosocial factors influencing Ghanaian family caregivers in the post -operative care of their hospitalised patients

This study explored the psychosocial factors influencing family caregivers during the care of patients who had undergone surgery and were in pain. Family caregivers play key roles in the care of post-surgical patients in different cultures. However, research has not adequately explored family caregivers’ experiences within the post-operative context in Ghana. An exploratory qualitative design was employed. Data collection involved individual interviews. Concurrent content analysis was undertaken and saturation of data was achieved with 12 family caregivers and 1 key informant. The participants were recruited from the surgical department of a tertiary health facility in Accra, the capital city of Ghana. The study revealed six themes that influenced family caregivers in the care of post-surgical patients: faith, fear, feeling of relief, empathy, commitment and inadequate knowledge. Health professionals should meaningfully integrate and educate family caregivers on patient care and pain management within the post surgical context.Department of HE and Training approved lis

The Ghanaian surgical nurse and postoperative pain management: a clinical ethnographic insight

This study aimed at illuminating the perceptions and responses of Ghanaian surgical nurses regarding their patients’ POP. It also identified the factors that influenced nurses’ pain responses. A focused ethnography was used, and data were collected through individual interviews. Sampling was performed purposively to include junior, senior, day, and night nurses who cared for surgical patients. Concurrent data analysis was performed and data were saturated with 12 individual interviews. The findings indicated that nurses perceived POP as an individual phenomenon, and nurses responded to patients’ pain by administering analgesics and by using nonpharmacologic measures. Factors that influenced the nurses’ response were individual factors, such as commitment, discretion, fear of addiction, and organizational factors, such as organizational laxity and challenges of teamwork. The study recommended that nurses should be educated, supported, and encouraged to ensure pain relief after surgery and that they should see pain relief as a priority postoperative care to avert the negative repercussions of poorly managed POP.Web of Scienc

Community leaders’ perspectives on facilitators and inhibitors of health promotion among the youth in rural South Africa

INTRODUCTION: There are a number of factors that influence health promotion activities among the youth. This study sought to gain a comprehensive understanding of the facilitators and inhibitors of health promotion among the youth from the perspectives of community leaders in a rural setting in South Africa. METHODS: The study adopted an exploratory, descriptive and contextual qualitative approach involving community leaders in rural South Africa. Data saturation occurred after individual interviews with 21 participants. Data analysis employed the principles of content analysis. RESULTS: We found that facilitators of health promotion were access to education on the benefits of health promotion activities, efforts of organizations and community leaders/teachers, access to health care services and engaging in physical activities, and youth motivation and positive role modelling. The themes that described the inhibitors of health promotion were inadequate recreational and health facilities and health personnel, the impact of stringent religious doctrines, unemployment, social vices and poor parenting. CONCLUSION: We concluded that there is the need to implement more engaging activities and opportunities for the youth and parents in rural communities to enhance health promotion

Labour pain experiences and perceptions: a qualitative study among post-partum women in Ghana

BACKGROUND: Women have experienced severe labour pain over the years and various attempts have been made to effectively manage labour pain. However, there is paucity of literature on the labour pain experience and perceptions about labour pain with the contemporary Ghanaian health system. Therefore this study sought to gain an in-depth understanding on labour pain experiences and perceptions of post-partum women. METHODS: The study adopted an exploratory descriptive qualitative approach and collected data through individual interviews. Informed consent was obtained from all the participants who were purposively sampled. After transcription of interviews, the data were analyzed inductively using content analysis techniques. RESULTS: Women in this study experienced pain during labour rated as mild, moderate and severe and the pain was felt at the waist area, vagina, lower abdomen and the general body. The women expressed labour pain through crying, screaming and shouting. They prayed to God to help reduce the severe pain. Some women endured the pain, cried inwardly and others showed no sign of pain. Some women believed that crying during labour is a sign of weakness. Pain reliefs such as pethidine (Meperidine) was occasionally given. Non-pharmacologic measures employed included walking around, deep breathing, side-lying, waist holding, squatting, taking a shower and chewing gum. The individuality of pain experience and expression was emphasized and the socio-cultural orientation of women made some of them stoic. CONCLUSION: We concluded that it is necessary for all health professionals to manage labour pain effectively taking the socio-cultural context into consideration

Realities of post-operative pain management in Ghana: Evidence from method and participant triangulation

Session presented on Sunday, November 8, 2015: Introduction: Post-operative pain has been a problem over the years for many countries including Ghana. Thus patients continue to experience moderate to severe post-operative pain. Aim: The study aimed to understand the factors that contribute to ineffective post-operative pain management at two hospitals in Accra, Ghana. Method: A focused ethnography was employed using multiple data collection methods such as individual interviews, observation, and documentary review. The participants included patients (13), nurses (11), surgeons (3), pharmacists (1), and anaesthetists (1). Sixteen participant observations with partial immersion were conducted and 44 nurses\u27 documentation of care was reviewed. Purposive sampling was used to recruit participants and the sample size was determined by data saturation. Content analysis was used to analyse the data generated and the NVivo 9 software was used to manage the data. Findings: It was realized that multiple factors contributed to ineffective post-operative pain management. These factors were related to the individual, the health system and national policies. The individual factors included socio-cultural, psychological, and inadequate knowledge. Health system factors were negative attitude, poor supervision and team work. National factors included lack of policies and unavailability of opioids. Conclusion: The study concluded that a multidisciplinary and multi-sectorial approach is required to enhance post-operative pain management in a resource-limited clinical context such as Ghana. The need for a context appropriate clinical guideline was highlighted

Keeping pace : understanding youth engagement in rural America through family structure lenses

With rapid shifts in the family economy, various family structures have continually emerged. Understanding the impact these changes have on youth engagement is foundational to developing interventions that will encourage participation in community life. Factors including rural-urban migration, the great recession, lower fertility rates, marrying at older ages and influx of women into professional employment have contributed to the emergence of new and more complex family types such as single parent and blended families. Youth growing up in these evolving settings (changing family structures) are vested with uncommon challenges. With less than 46% of children born into intact families, understanding the impact these challenges have on the ability of youth to stay engaged in family and community life is foundational to the building of appropriate interventions. Poverty, low educational attainment and lack of employment opportunities, increase the likelihood of breakdown and inadvertently disturb the emotional equilibrium of the home environment. These factors increase the likelihood of breakdown within resource-limited rural communities placing them at a disadvantage compared to families resident in urban areas