Doctor of Philosophy (PhD) Theses and Dissertations
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Item A MODEL OF NURSING CARE FOR CANCER PAIN MANAGEMENT AMONG ADULT PATIENTS AT GARISSA COUNTY REFERRAL HOSPITAL(2018-09-01) AFFEY, FATUMA ADENCancer pain is a complex feeling due to sensory and emotional hostile experiences linked with a negative impact on the quality of life of patients. More than 50% of patients with cancer complain of pain hence the need for nursing care model for pain management. Cancer pain in Garissa is a concern due to the limited access to pain management in healthcare facilities. The pastoral lifestyle of the communities exacerbates it.The nursing care model is tailored for such a unique lifestyle in the provision of holistic pain management that is assumed to cultivate care of patients at Garissa County. Phase one was a descriptive exploratory study design. A mixed method approach was utilised to recruit participants that include 94 cancer patients, 84 clinical nurses and 15 critical informants for this study. Various sampling procedures, including random, purposive and snowball sampling were employed to recruit all study participants voluntarily. Modified Brief Pain Inventory (MBPI) tool combined with focus group discussion was used to obtain data from cancer patients. ECOG performance status was also utilised to assess the functional disease progress. Questionnaires were randomly administered to all clinical nurses and Key informants caring for cancer patients to ascertain their knowledge, practice and availability of pain control medications. Descriptive statistics, Chi-square and linear regression, analysed the quantitative information while qualitative data was analysed through the categorisation of themes, a cluster of themes and direct quotes of participants. The sample population was 188 participants. Cancer patients had mean age 51year with composition of 44.7 % (42) male and 55.3% (52) female. Prevalence of cancer pain was at 78 % (73) with intensity ranging from moderate to severe. A total of 78 % (66) of clinical nurses indicated had no tool for pain assessment, 83.2 %( 70) of them did not know how to utilise WHO analgesic ladder. Majority of patients 82 %( 78) were on incorrect WHO analgesic ladder for pain management with negative PMI (p-value < 0.05) of under treatment. Majority of patients considered alternative treatment for cancer pain such as Quran recitation and Somali herbs accounting for 65% (61) and 77.6% (73) respectively. Almost all KI 93% (14) indicated the inadequate availability of pain medication. Phase two entailed the development of “Xanuun” nursing care model for pain management and pre-testing of the same from expert opinion and nurse managers GCRH. Findings from experts showed that 80% of respondents agreed that the developed model captured the challenges of cancer pain management and 60% of them predicted that the model could be utilised. However, 100% of the experts suggested that the model will bring a positive change, though 90% of them upheld that there will be potential challenges of implementing such a model. This study revealed a high prevalence of cancer pain due to under treatment and inaccessibility of pain medication associated with the dynamic of a nomadic lifestyle. The study found limited knowledge and negative attitude among clinical nurses at GCRH. Thus, recommends the need to implement contextual “Xannun” Nursing Care model at GCRH, for a better approach of cancer pain management