TABLE OF CONTENTS
Content Page
Title Page i
Certification ii
Dedication iii
Acknowledgements vi
Abstract v
Table of Contents vi
List of Tables viii
List of Figures ix
Appendices x
Abbreviations xi
CHAPTER ONE: INTRODUCTION
CHAPTER TWO: REVIEW OF LITERATURE
2.0. Introduction 8
2.1. Concept of Pain 8
2.2. Effects of Pain 10
2.3. Expressions of Pain 11
2.4. Types of Pain 12
2.5. Physiology of Pain 13
2.6. Nociception 13
2.7. Pain after Surgery 15
2.8. Pain Assessment 16
2.8.1. Central Principles of Pain Assessment 17
2.8.2. Roles of Nurses in Pain Assessment 18
2.8.3. Standard Tools for Pain Assessment 19
2.8.4. Patient Self-reporting Pain Scales 21
2.9. Methods of Pain Management 24
2.9.1. Non-Drug Techniques to Manage Pain 24
2.9.2. Pharmacological Methods of Pain Management 29
2.10. Anxiety 31
2.11. Types of Anxiety 32
Content Page
2.12. Causes of Anxiety 32
2.13. Effects of Anxiety 33
2.14. Prevalence of Anxiety 34
2.15. Levels of Anxiety 35
2.16. Assessment of Anxiety in Surgical Patients 36
2.17. Management of Anxiety in Surgical Patients 38
2.18. Empirical Reviews of Surgical Patients’ Anxiety 42
2.19. Theoretical Model and Framework 45
2.19.1. Theory of Health as Expanding Consciousness 45
2.19.2. Application of the Theory to the Study 46
CHAPTER THREE: METHODOLOGY
3.0. Introduction 48
3.1. Research Design 52
3.2. Population 52
3.3. Sample size and samplingTechnique 52
3.4. Instrumentation 53
3.5. Validity and Reliability of Instrument 54
3.6. Method of Data Collection 55
3.7. Method of Data Analysis 55
3.8. Ethical Consideration 56
CHAPTER FOUR: DATA ANALYSIS, RESULTS
AND DISCUSSION OF FINDINGS
4.0. Introduction 58
4.1. Data Analysis and Result Presentations 58
4.8. Discussion of Findings 67
CHAPTER FIVE: SUMMARY, CONCLUSION, AND
RECOMMENDATIONS
5.0. Introduction 73
5.1. Summary 73
5.2. Conclusion 73
5.3. Recommendations 74
5.4. Limitation of the Study 75
5.5. Suggestion for Further Studies 75
REFERENCES 76
APPENDICES 108
LIST OF TABLES
Table Page
4.1.Socio-Demographic Data of Study Participants 53
4.2. Assessment of Anxiety States and Pain Intensity using a Tool/ instrument by nurses 55
4.3.Distribution of Study Participants and their Perception of their Anxiety in the Pre-Operative Periods (a & b) 56
4.4.Distribution of Study Participants and their Perception of their Anxiety in the Post-Operative Periods (a & b) 58
4.5. Baseline and Post-Operative Anxiety and Pain intensity among surgical patients 60
4.6. Relationship between nursing intervention for the relief of Pre-Operative anxiety and control of post-operative pain 62
4.7. Relief of anxiety state levels in response to nursing intervention on the basis of gender and educational levels 64
4.8. Relief of post-operative pain intensity in response to nursing intervention on the basis of gender and educational levels 65
4.9. Hypothesis testing of the relationship between nursing intervention for the relief of anxiety levels and post-operative pain 66
4.10.Hypothesis testing of relationship of the relief of Anxiety levels in response to nursing intervention on the basis of Gender and Educational levels 66
4.11.Hypothesis testing of relationship of the relief of Post-Operative pain in response to nursing intervention on the basis of Gender and Educational levels 67
LIST OF FIGURES
Figure Page
Conceptual Framework of Margaret Newman 47
APPENDICES
Appendix Page
Informed Consent 108
Questionnaire 110
Planned Preoperative Teaching Module 113
Ethical Approval 115
ABBREVIATIONS
AIDS Acquired Immune Deficiency Syndrome
ANOVA Analysis of Variance
CNS Central Nervous System
DSM IV-TR Diagnostic and Statistical Manual of Mental Disorders (4th edition,Text Revision)
HEC Health as Expanded Consciousness
HIV Human Immuno-deficiency Virus
HND Higher National Diploma
IASP International Association for the Study of Pain
IBM International Business Machines
JCAHO Joint Commission on Accreditation of Healthcare Organizations
NRS Numeric Rating Scale
NSAIDs Non-Steroidal Anti-Inflammatory Drugs
OND Ordinary National Diploma
PCA Patient-Controlled Analgesia
STAI State-Trait Anxiety Inventory
VAS Visual Analogue Scale
VDS Verbal Descriptor Scale
WHO World Health Organization
CHAPTER ONE
INTRODUCTION
- Background to the Study
Health has been described as the nonexistence of disease and impairment, as well as a condition of complete wellness in the mental, physical, and social realms. The persistence of the internal environment of any human system is dependent on their physiological, sociological and psychological equilibrium. Nursing care has the primary objective to render service for maintenance of health through the preservation of a stable internal environment, and assisting to ensure the restoration of equilibrium in the condition of illness (Birol, 2005; Şanli, 1991).
There are three phases in the nursing care a surgical patient passes through in the health care services called perioperative nursing. These phases include: pre-operative, intra-operative and post-operative. The pre-operative phase involves the administration of nursing care to the clients who are planned to undergo surgical procedures (Phillips, 2013; Spry, 2005). The primary responsibility of the health care providers as reported in literatures is to assess and educate the patient during this phase, to minimize the dangers during the surgery and have better outcomes of the patients. The main rationale for preoperative phase of care is linked to reduction of defects operative morbidities and decrease stay of patients at hospital (Association of Anesthetists of Great Britain, and Ireland (AABI) safety guidelines, 2010).
Surgery is one of the major life changes that cause anxiety. Hospitalization provokes anxiety in the patient admitted for surgery, even in the absence of disease. Stress resulting from protracted anxiety may eventually endanger the client if not discovered early and slow-down recovery(Goebel, Kaup, & Mehdorn, 2011; Jafar & Khan, 2009; Swindale, 2004; Yilmaz, Sezer, Gurler, & Beker, 2011). Surgery can trigger a panic attack in a patient who is prone to anxiety. The preparative care of surgical patients becomes very challenging with the increasing existence of anxiety before surgery.
Anxiety experience is common to most patients awaiting elective surgery and generally seen as normal response(Jawaid, Mushtaq, Mukhtar, & Khan, 2007). Surgical patients perceived the day of surgery as highly terrifying in their lives. Patients manifest anxiety with varying degrees in relation to what is expected in future and these are associated with many factors which may be type and extent of the proposed surgery, gender, age, previous surgical experiences, and personal tendency for unpleasant events(Ping, Linda, & Antony, 2012). The intervention for employed by the healthcare providers has been found to promote, comfort, and favorable surgical outcomes. Nurses and other healthcare givers needs to know patients who are prone to anxiety in the population in order to reduce the occurrence of anxiety resulting from surgery.
The Babylonian clay tablets revealed the evidence of thephenomenon of pain as referenced in achieves. The Greek philosopher, Aristotle, in the 4th century B.C., identified pain as an emotion, and a reciprocal of pleasure. Although emotions certainly play an important role in pain perception, there is much more to the experience than the feelings involved. In the Middle Ages, pain had religious interpretations, in which pain was seen as God’s punishment for sins or as evidence that an individual was possessed by demons. This meaning of pain is embraced by some clients with the mindset that the suffering is their “cross to bear.” The relief of pain may not be the goal for individuals who believe in this definition of pain. Spiritual counseling may need to be implemented before this person is willing to work toward relief. The most widely accepted definition of pain is one developed by the International Association for the Study of Pain (IASP). This organization defines pain as an offensive sensation and mind-blowing experience associated with actual or potential tissue damage or described in terms of such damage (IASP, 2008).
Postoperative pain is very common and develops naturally as a warning(Apfelbaum, Chen, & Mehta, 2003). The development of postoperative pain can be predicted, should be prevented and treated (Power, 2005). Besides the disagreeable aspects and physiological repercussions of postoperative pain, it delays ambulation and hospital discharge. Some authors believe that, despite the drugs and anesthetic techniques available, the prevalence of postoperative pain is still high(Apfelbaum, Chen, & Mehta, 2003; Omote, 2007; Power, 2005). The most unwelcomed outcome of surgery is postoperative pain. This pain can result to prolonged hospital stay and hinder rapid recovery if poorly managed(Schug & Chong, 2009).
Research studies have repeatedly reported that about 20 to 80% of patients having surgical procedures experience pains which are poorly managed (Lorentzen, Hermansen, &Botti, 2011; Marks &Sachar, 1973). Pain is grouped among grievous public health challenges both in the modernized (Stephens, Laskin, Pashos, Pena, & Wong, 2003) and in developing countries(Klopper, Andersson, Minkkinen, Ohlsson, &Sjostrom, 2006; Lin, 2000; Shen, Sherwood, McNeill, & Li, 2008). Pain continues to be poorly controlled and pose a substantial obstacle to the care of surgical patients with the protracted existence of postoperative pain as a serious public health problem, and the increased knowledge and resources for treating pain(Botti, Bucknall, & Manias, 2004; Dihle, Helseth, Kongsgaard, & Paul, 2006; Helfand& Freeman, 2009; Manias, Bucknall, &Botti, 2005).
In Africa, pain associated with HIV/AIDS and cancer has been greatly explored (Dekker, Amon, & Le Roux, 2012; Powell, Radbruch, Mwangi-Powell, Cleary, &Cherny, 2013; Selman, Simms, Penfold, Powell, &Mwangi-Powell, 2013), although greater burden is associated with pain from surgical procedures. Studies in the past have revealed that underdeveloped countries endure lack of analgesia and little priority is given to pain control in these countries.
In Nigeria, 95% of surgical patients were reported by Kolawole and Fawole (2003) to have experienced postoperative pain of various degrees. Another study carried out in Nigeria reported that inadequate pain relief after surgery is suffered among a high percentage of patients in Nigeria (Size, Soyannwo, & Justins, 2007). A Human Rights Watch’s report (Human Rights Watch, 2011) revealed that only 10% of this group of patients is able to receive the best of pain control. Powell, Radbruch, Mwangi-Powell, Cleary, and Cherny (2013), and Vijayan (2011) reported that shortage of clinicians, rigorous law enforcement on morphine access, and insufficient knowledge left millions of people to suffer because of poor pain control, even though various workshops and African Union summits adopted pain relief as basic human right.
Inadequate clinical practice in the post-operative assessment and management of pain has been reported by several studies (Dihle, Helseth, Kongsgaard, & Paul, 2006; Manias, Bucknall, &Botti, 2005; Schafheutle, Cantrill, &Noyce, 2001; Schoenwald& Clark, 2006). It is the duty of nurses to know how to assess pain by appropriate planning and implementing the adequate treatments in pain management. The nurse requires to monitor the adverse effects and advocate for the patient during the assessment of the effectiveness of those interventions. This helps the healthcare giver to know when the interventions are ineffective in relieving pain (Lippincott, 2013).
- Statement of the Problem
