Nursing Assessment and Management of pain in Federal Teaching Hospital Abakaliki.

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Nursing Assessment and Management of pain in Federal Teaching Hospital Abakaliki.

Pain is a universal condition that cuts across different ages, gender and economic status. Although everybody experiences pain, the nature of experience, the psychological context or meaning and response is unique to the individual.

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Different authors defined pain but the most acceptable definition is by Merskey, and Bogduk (1994) which stated that pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is an important signal that communicates potential or actual tissue damage and as such becomes an unpleasant protective friend that causes attention to be given to threatened organ/tissue damage before the problem become irremediable.

Pain assessment and management is very important in health care service because pain is a condition which brings most individuals to health institution. Assessment and management of pain is very important that the American Pain Society (APS) labeled pain-the fifth vital signs and emphasized its significance and to increase the awareness among health care professionals (APS, 2003).
Sofaer, (1992) stated that pain is a source of misery in people’s lives as well as the cause of much time spent off work (WAJN, 2009). It causes great human suffering, hence proficiency in assessing and managing pain is a hallmark to quality nursing care. An expert assessor of pain has to be aware of the subjective nature of pain, hence for clinical practice the best definition of pain is by Mccaffery and Pasero (2000), (Smeltzer, C.S. et al., 2008) which stated that pain is whatever the experiencing person says it is, exists when the experiencing person says it exists. That is why Smeltzer, (2008) pointed out that patient is the best authority in validation (assessment) of pain in support of Mccaffery’s definition. APS (2003) refers to pain assessment as the fifth vital signs.
Regardless of how patient’s copes with pain, pain that last for an extended period can result to disabilities. Patient with chronic pain syndrome reports depression, anger and fatigue Watson, and Coyne (2003), Radison, and Vanderah (2004). Researchers indeed proved that unrelieved pain is associated with sleep alteration, sleep deprivation affects pain experience. Kunderman. Kreig,.. et al., (2004) causing hyperalgia in which patient reports greater pain. It equally proved that poor pain management virtually affects all systems of the body in which the International Association for study of pain and pain research unit (2001) devised some techniques for assessment of pain and hence management.

Adequate knowledge of pain assessment and management skill is required by the nurse for appropriate service to be given to the patient. The nurse stays with patient most of the time and is more equipped in assessing and managing pain, evaluating its effectiveness and reassessment where necessary.
Pain assessment/management requires a good therapeutic relationship between the nurse and the patient.

Personal observation of the researcher showed that most health institutions do not have adequate assessment tools for appropriate management of pain in Federal Teaching Hospital Abakaliki, hence the patients are affected and pain assessment is not yet incorporated as the fifth vital signs but only when patient is crying of pain and not with any assessment tools.
American Pain Foundation developed patients’ bill of right which addressed pain management and hence declared year 2000 to 2010 as a decade of pain control and research because of its importance.

Statement of the Problem
Some health care personnel under-estimate pain intensity in their patients leading to poor assessment and management. They labelled some patients “complainers”. Management of pain should be based on the subjective opinion of the patient. For a long time, pain assessment has been inadequate as pain is supposed to be assessed just like vital signs of temperature, pulse, respiration, blood pressure but contrary to that, it is only done when patient may be crying of pain. In adequate assessment of pain has often resulted to poor management. Poor management may be due to lack of knowledge about pain assessment/management among health care workers or lack of assessment tools.
Equally, as perception of pain is individualized, its assessment and management should be done tactfully for quality care outcome. Personal experience of the researcher observed that some health care workers neglect patient pain complaints labeling them as complainers and their pain complaint are not addressed properly resulting in debility and complications. It is ironic that although pain is cited as the most treatable symptom but often is one of the failures of modern medicine (Mayer, T. Byolk, Noriss (2001). This inclusive motivated the researcher to research on this topic.

Purpose of the Study
The purpose of this study is to determine the level of awareness/knowledge of nurses working in Federal Teaching Hospital Abakaliki, about pain assessment and management and how they manage their patient with acute and chronic pain condition for improved quality patient’s outcome.



Objective of the Study
The Specific Objectives include:
To assess the awareness of Federal Teaching Hospital Abakaliki nurses about the concept of pain.
To ascertain how they assess pain in their patients
To determine how the nurses manage pain in their patients
To evaluate the nursing management of pain in Federal Teaching Hospital Abakaliki.
Significance of the Study
The study when completed will bring to light, the concept of pain and the appropriate techniques for assessing and managing pain and thereby increase the nurses’ knowledge about pain generally.
The study will also enable the student nurse and other health workers to gain knowledge about pain assessment and management.

When health care worker assess and manage pain effectively, the patient benefits as their pain is reduced or relieved.
The Patients sick-off as a result of pain and suffering is reduced.

Proper assessment and management of pain at the end of life can make a “peaceful” death possible.
The result of the research can be very resourceful to other researchers in the same area.

Research Questions
1. What is the concept of pain?
2. What techniques are used in assessing pain by nurses working in Federal Teaching Hospital Abakaliki.
3. How is pain managed generally by nurses in Federal Teaching Hospital Abakaliki.
4. What are the effects of management techniques?

Scope of the Study
The study is delimited to the trained nursing staff both males and females working in Federal Teaching Hospital Abakaliki to determine their knowledge about pain assessment and management of pain in patients under their care.

Operational Definition of Terms
Pain is whatever the experiencing person says it is.
Pain assessment tools are the techniques used in rating the intensity of pain.
Awareness means having knowledge of a particular phenomenon.
Patient is an individual who is in need of health care.
Knowledge here means being conversant with a particular phenomenon
Pain threshold is the minimal level of pain perception.
Management of pain is the ways of treating pain to reduce or prevent patient’s suffering.

Pain is a universal phenomenon and is of great significance in health care delivery. This chapter reviews the concept of pain, the theoretical and empirical review of pain, assessment and management of pain.

The Concept of Pain
For ages, the definition of pain has not being an easy one, several attempts to define pain were made by some experts, e.g. Keel and Neil (2005) defined pain as an unpleasant sensory experience distinct from other modalities such as touch, warmth and cold. Keel and Neil were right in describing pain as an unpleasant sensory experience but they failed to describe what it is apart from pain, itching, noise and unpleasant experiences.
Sherington defined pain as a psychical adjunct of an imperative protective reflex. The definition could not exactly describe pain since there are many other reflexes e.g. blinking of eyes, which is protective influenced by psyche.
Merskey and Bogdik (2007) defined pain as an unpleasant sensory and emotional experience associated with potential or actual tissue damage. This definition added an important dimension of pain as encountered in clinical practice when it is associated with actual or potential tissue damage. Yet pain is not the only unpleasant sensory and emotional experience associated with actual potential tissue damage e.g. odour emanating from a putrefying septic wound (tissue damage) is unpleasant sensory and emotional yet cannot be described as pain.

In the absence of an exact definition of pain, need for working definition of pain that seems accurate with what the patient is experiencing becomes imperative for the purpose of clinical assessment and management of pain in client. For this case Mccaffery and Pasero (2000) defined pain as whatever the experiencing person says it is, existing whenever the experiencing persons says it does is recommended.
The above definition gives no description of pain but explains the subjective nature of pain’s description hence Kozier, Erb … et al., (2004) warns “The client self report of pain is what must be used to determine pain intensity. Pain is subjective and individualized. It is a symptom and not a disease.


Smeltzer, C., Brenda, G. et al., (2008). Categorized pain according to its duration, location and etiology.
It includes acute, chronic and cancer related pain.

Acute Pain – is sudden in onset, associated with a specific injury, it indicates that damage or injury has occurred, it lasts from seconds to 6months although 6months is criticized by some writers. E.g. Brookoff, (2000) because most acute injuries heal within a few weeks (Smetzer, C. 2008);

Chronic Pain – is an intermittent pain that persists. Any pain that lasts for months to years is a chronic pain. Chronic pain is non protective in nature but is distressing.
Cancer related pain can be acute or chronic and is due to cancer. The pain can be directly associated with cancer or as a result of cancer treatment e.g. surgery.

Classification of Pain According to Location
This depends on the part of body concerned e.g. pelvic pain, muscle pain and headache etc.

Classification by Etiology
This is named depending on the cause of pain e.g. burns pain, post hepatic, neuralgia etc.

Classification According to Duration
Acute and chronic pain.

Ganong, W. F. (2012) described the nature of pain. It includes fast and slow pain
Fast pain involves a painful stimuli that causes bright sharp localized pain sensation carried by A.d fibres.

Slow pain are dull, aching, diffuse and unpleasant feeling carried by ‘c’ fibres.
Pain can equally be deep or superficial. Deep pain is poorly localized nauseating and frequently associated with sweating and changed in blood pressure but superficial pain is well localized and not nauseating.


Physiology of Pain
According to Ganong, W. (2002), the sense organ for pain are naked nerve endings found almost in every tissue of the body pain impulse and are transmitted to central nervous system by 2 fibres system.
The first system is the myelinated Ad fibres 2-5~ in at the rate of 12-30mls.

The second system is the unmyelinated ‘c’ firbe 0.4 -1.2~) at a slower rate of 0.5 to 2m/s. Both fibres transmit impulse to the lateral spinothalamic tract neurone and pain impulse ascend via the tract to the posterior media or posterior lateral nuclei of the thalamus. From there, they are relayed to the posterior gyri of cerebral cortex. The descending fibres send back impulse to the organ concerned.
Pain impulse involves stimulation of pain nerve endings called nociceptors. Paice, (2010) stated that nociception is the transmission of pain impulse and it involves four processes:
Perception and
Here, the noxious substance interacts with tissue causing release of biochemical mediators like prostaglandius, substance phistamine and serotonia that transmit pain impulse. Pain killers inhibit production of these chemical.
Involves the relay of pain impulse from nociceptor endings to the cerebral cortex. Transmission involves 3 segments (i) transmission from peripheral norciceptors to the spinal cord (ii) spinothalamic fibres from spinal cord to the thalamus (iii) Thalamo-cortical fibres from thalamus to sensory area of cerebral cortex.
According to Paice (2002), perception enables an individual to become aware or conscious of pain. This occurs at the lower center and thalamic level. The cerebral cortex interprets the nature of pain and initiate decision in respect to pain (e.g. whether to drop a hot object).

Here an attempt is made to control or remove the body away from the noxious object. According to Ganong, W. (2002), the impulse from brain travels through the efferent nerves via cortico-thalamic tract neurone, then through the dorsolateral tract along the white column into the dorsal column of the spinal cord. The descending fibres release substances such as endogenous opiates, serotonins and non-epinephrine which inhibit ascending pain impulse thereby reducing pain sensation.
Pain in a symptom – not a disease and its affects the physical, psychological, emotional, behavioural aspect of an individual.
Clinical Manifestation of Pain
¬According ¬to Mccaffery (2013), pain is purely subjective and individualized. It may include, grimace, groaning, excessive perspiration, increase in pulse rate, increase in respiration, crying can even lead to shock etc. Pain can be seen as a best friend that can force an individual away from injurious substance. Pain sensation depends on pain threshold of the concerned individual including other factors that influence pain perception.

These factors includes:
Past experiences most of the time increase anxiety and fear for pain.
Culture – According to Smeltzer (2008), beliefs about pain and how to respond to pain differ from culture to culture.
Environmental and personal support
Developmental stage/Age
Genetic factor
Anxiety and fear amongst others
All the above may lead to increase is pain perception or vice versa.

Assessment of Pain
APS, (2003) noted the importance of pain assessment and labelled it as the fifth vital sign. For proper assessment of pain, the health care provider must have knowledge of pain physiology and subjective nature of pain perception. Mccaffery (2000).
According to Hornby (2001), assessment is the act of judging or forming an opinion about something or somebody that has been thought about very carefully. Pain assessment requires a good rapport between the health care worker and patient and is a continuous process of collecting data about client’s pain and forming an opinion about pain. Patient is the best person that can accurately describe the degree of pain and the amount of suffering involved, Mccaffry and Pasero (2000) Walsh, (2010). A comprehensive assessment of pain experience has psychologic, behavioural, emotional, socio-cultural implications to really manage pain.
Nurse’s Assessment of Pain

The American pain society stressed on the need for proper assessment of pain in patient’s for improve quality of care.

The nurse can assess pain through

1. Collection of relevant pain history (self report). The client gives history of pain, the nature, location and duration etc.

To Place An Order For The Complete Project Material Pay N,5000 To

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