- Title
- Pain assessment and management in infants and children: A mixed methods study of the knowledge and attitudes of nurses working in Saudi Arabia
- Creator
- Alotaibi, Khalaf
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2019
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Unrelieved pain amongst hospitalised infants and children remains a widespread problem, despite decades of extensive research and the development and ready availability of evidence-based guidelines and standards supporting clinical practice for effective management of children’s pain. Research into pain in hospitalised children shows that their pain is often ignored or neglected, under diagnosed, poorly assessed, under treated, unmanaged and unaddressed. Whilst relief from pain is a fundamental human right, hospitalised children worldwide continue to experience unrelieved pain and distress. Unrelieved pain may be harmful to children both physiologically and psychologically and it has many adverse effects, short term and long term. Providing effective pain care is an integral part of the nurse’s professional role and practice. This thesis focuses on the understanding of knowledge, attitudes and beliefs of professional nurses in SA (Saudi Arabia), who are largely expatriates providing care for Saudi children with pain. In the light of the large expatriate workforce, it was also important to understand the barriers and facilitators to pain management and the impact of cultural differences on the pain care provision for children. At the time of writing this thesis, there were no published studies conducted in SA on this topic to guide the improvement of children’s pain management. Aims of the Study: The aims of the study were to: (1) examine the knowledge and attitudes of Saudi and non-Saudi nurses in relation to infants’ and children’s pain assessment and management, (2) identify the barriers and facilitators to effective pain assessment and management for infants and children in SA, and (3) identify the cultural factors impacting pain assessment and management for infants and children in SA. Methods: A two-phase sequential explanatory mixed-methods design was used in the study reported in this thesis. In Phase 1, a descriptive cross-sectional survey, the Paediatric Nurses’ Knowledge and Attitudes Survey Regarding Pain (PNKAS-Shriners Revision) was distributed amongst 750 eligible Registered Nurses (RNs) working at five government hospitals in the Riyadh region of SA. Data were analysed using descriptive (frequency, percentage, mean and standard deviation) and inferential statistics, including Pearson Correlation, Independent Samples t-test and one-way ANOVA tests. Phase 2 of the study adopted a qualitative approach involving semi-structured interviews with 17 nurses, drawn from the survey participants. These interviews explored the nurses’ experiences of working in SA with children in pain. Data were transcribed verbatim and thematically analysed. Significant relevant statements were highlighted, coded, categorised and clustered thematically. Results: In Phase 1, 410 valid surveys were received representing an overall response rate of 54.7%. The overall mean correct score achieved by all participants; Saudi (n=75, 18.3%) and non-Saudi nurses (n=335, 81.7%), was 15.04 on the 31 items assessed for knowledge. While on the nine items relating to attitude, their overall score for correct answers was 3.08. Poor overall knowledge and attitudes about children’s pain and its management was evident in this study in different areas, such as pharmacology, non-pharmacological approaches and pain assessment. Phase 2 of the study identified many barriers to managing children’s pain effectively. Themes that emerged from the data were (1) children’s pain: a low priority, (2) culture, religion, mistrust, and pain, and (3) understanding/misunderstanding childhood pain behaviour. Pain in children was not a priority of care for either nurses, physicians or hospitals as health organisations. Barriers to effective pain management included cultural and language differences and misunderstandings, religious matters and conflicts, distrust in expatriate nurses’ care as well as poor team communication and collaboration. Facilitators for pain management included parents’ participation in their child’s pain care and developing a trusting relationship with the child during hospitalisation. Conclusion: This thesis shows that many expatriate nurses in SA were unable to care for children in pain because of cultural, religious and language challenges. Findings should be responded to with urgency to ensure quality pain care for children in SA. Recommendations include prioritising children’s pain into hospital policy and daily routine practice, and improving team communication and collaboration through a teamwork approach to pain management. Ongoing educational opportunities are essential on culture and pain management for families of children, for nurses, and for any health professionals who are involved in childcare. This study is the first of its kind in SA and also the first of its kind globally on pain management in children involving a heterogeneous nursing population. The findings of this study could be used to improve nursing care and pain management practices in multicultural healthcare settings similar to those of SA and neighbouring Arab countries, and across the globe.
- Subject
- pain management; pain assessment; Saudi Arabia; children; knowledge; attitudes; barriers; facilitators; culture; nurses; mixed methods
- Identifier
- http://hdl.handle.net/1959.13/1412105
- Identifier
- uon:36428
- Rights
- Copyright 2019 Khalaf Alotaibi
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 2 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 267 KB | Adobe Acrobat PDF | View Details Download |