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"A STUDY TO ASSESS THE EFFECTIVENESS OF A STRUCTURED

TEACHING PROGRAMME ON KNOWLEDGE REGARDING NON


PHARMACOLOGICAL METHODS OF PAIN MANAGEMENT IN
CHILDREN AMONG STAFF NURSES WORKING IN PEDIATRIC
WARDS OF SELECTED HOSPITALS AT TUMKUR"

PROFORMA FOR REGISTRATION OF SUBJECT FOR THE

DISSERTATION

SUBMITTED BY

MR. RINU .J. GEORGE

FIRST YEAR M.Sc NURSING

CHILD HEALTH NURSING

SRI SIDDHARTHA COLLEGE OF NURSING

AGALKOTE, B.H. ROAD

TUMKUR
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR


DISSERTATION

1. NAME OF THE CANDIDATE & MR. RINU .J. GEORGE


ADDRESS I YEAR M.Sc NURSING
SRI SIDDHARTHA COLLEGE
OF NURSING, AGALKOTE,
B.H ROAD,TUMKUR-07.

2. NAME OF THE INSTITUTION SRI SIDDHARTHA COLLEGE


OF NURSING, AGALKOTE,
TUMKUR

3. COURSE OF THE STUDY & MASTER DEGREE IN NURSING


SUBJECT CHILD HEALTH NURSING

4. DATE OF ADMISSION 8th JUNE 2009

5. TITLE OF THE TOPIC "A STUDY TO ASSESS THE


EFFECTIVENESS OF A
STRUCTURED TEACHING
PROGRAMME ON KNOWLEDGE
REGARDING
NON PHARMACOLOGICAL
METHODS OF PAIN
MANAGEMENT IN CHILDREN
AMONG STAFF NURSES
WORKING IN PEDIATRIC
WARDS OF SELECTED
HOSPITALS AT TUMKUR"

6. BRIEF RESUME OF THE INTENDED WORK


INTRODUCTION
Relief of pain is a basic need and right of all children. Effective pain management
requires that health professionals are said trying many numbers of interventions to achieve
optimal results. Basically pain-reducing methods can be grouped into two categories non
pharmacological and pharmacological. Pain is often associated with fear, anxiety and stress.
A number of non pharmacological techniques, such as distraction, relaxation, guided imagery
audio visual support, music therapy and cold application therapy, provide coping strategies
that to reduce pain perception, make pain more tolerable, decrease anxiety, and enhance the
effectiveness of analgesics. All these strategies are safe noninvasive and inexpensive and
most are independent nursing functions. Experimental studies have proven different methods
of non pharmacological procedures suitable for different age groups.1

In the selection of non pharmacological intervention it is best to use a technique


familiar to the child as to describe several strategies and let the child select the most
appealing one. Parents should be involved in the selection process. They may be familiar with
the child’s usual coping skills and can help to identify potentially successful methods to be
used. Involving parents also encourages their participation in learning the skill with the child
and acting as coach. If the parent cannot assist the child, other appropriate persons may
include such as grandparents, older sibling nurse or child-life specialist.1

There are worldwide studies regarding the effectiveness of non pharmacological


methods of pain management and showing nurses strong beliefs towards the effectiveness of
these methods. After many of these studies it has been proved very clearly that non-
pharmacological methods are effective, relevant, and provides advantage to different age
group pediatric patients undergoing painful procedures.

Heavy workload, timelessness, lack of knowledge for implementing non


pharmacological methods made it impractical for nurses to effectively use different non
pharmacological methods. Already studies and researches emphasized the need for non
pharmacological pain management. In addition to this if we could rectify the lack of
knowledge and make them to use these non-painful, inexpensive methods to their full extend,
painful procedures and their aftercare will not be a very big problem in pediatric wards
anymore.

6.1 NEED FOR THE STUDY


Pain is an unpleasant sensory and emotional experience. Children should learn a
specific strategy before pain occurs or before it becomes severe. To reduce the child's effort,
instructions for a strategy, such as distraction or relaxation, can be audio taped and played
during a period of discomfort. Music has proven benefits in alleviating children's
apprehension and discomfort associated with painful procedures.2

Pain mainly arises from fear, stress and anxiety. Always it is better to use natural
methods to alleviate it, than again showing syringe or giving bitter taste tablets. Here comes
the significance of non pharmacological methods.

Nursing is the profession with the greatest patient contact. One of the important
nursing cares includes alleviation of pain since pain is an unpleasant sensory and emotional
experience. Children are less able to communicate their pain to staff nurses. So it is more
advisable to use non pharmacological method than pharmacological method.3

A study conducted on effectiveness of non pharmacological methods in relieving


children's post-operative pain among hospital nurses in Finland, 2001May.Convenient sample
of 162 was taken and assessed using extensive questionnaire which resulted that nurse's
attributes such as age, education, work experiences and place of work were significantly
related to the use of some non pharmacological methods. Thus the study had a conclusion
that more research is needed on the methods used by nurses to relieve children pain in
different patient group.4
Another study which described the factors influencing nurses decisions to use non
pharmacological therapies to manage patient's pain. At Western hospital, Brisbane, Australia,
2001 Sep,which collected a sample of 37 (RNS) who participated in a series of focus group
discussions that explored the use of non pharmacological therapies to help, manage patients
pain in a hospital setting. The result is highlighted that the nurses believe non
pharmacological methods offer several advantages to the management of patient's pain and
wellbeing. They further recommended improving non pharmacological pain management and
enhancing patient outcome.5

In a study of pain experiences and non pharmacological strategies for pain


management after tonsillectomy conducted at departmentt of medicine and care division of
nursing sciences, Linkoping University Sweden. The study aimed to investigate children's
experiences of pain and the non pharmacological strategies that they used to manage pain
after tonsillectomy. Six children were selected the data analyzed using a qualitative approach.
Pain assessed using (VAS) non pharmacological methods used frequently to manage pain
were thermal regulation distraction. Children rated their worst pain during 24 hours. Specific
non pharmacological strategies for pain management relative to different surgical procedures
need to be considered.6

6.2 REVIEW OF LITERATURE


The literature review help to lay the foundation for study and also inspire new
research ideas. A literature review provides readers with background for understanding
current knowledge on a topic and illuminates the significance of the new study it assesses in
interpreting study finding and developing implication and recommendation. 7

A quasi experimental study was conducted in Canada on the effectiveness of tailored


educational intervention among emergency pediatric nurses [N=50] on knowledge of pain
management and nurses pain management practices such as documentation of pain,
administration of analgesics and non pharmacological interventions. The results of paired (t)
test showed a significant difference between pre and post scores. The study revealed that
interventions contributed to the improvement of nurse's knowledge of pain management and
increased their non pharmacological interventions from baseline. The study concluded that
the intervention tailored to nurses needs and schedule has more impact than just passive
diffusion of educational content.8

A study implemented pain education for Chinese nurses using pre-post test design and
compared their use of non pharmacological methods in children's post operative pain
management. Results showed that nurses use of most of these methods for pain relief
increased significantly, which helped to improve the quality of care for children. The study
enriches nurse's knowledge in pain management and demonstrating the needs for hospitals to
provide continuous pain education to nurses.9

A study described the Chinese nurse's use of non pharmacological methods for
relieving children's post operative pain and factors related to this. A questionnaire survey was
carried out with a convenience sample of 187 nurses working in 12 surgical wards in 5
hospitals of China. The results indicated the most commonly used non pharmacological
methods were giving preparatory information, comforting, reassurance distraction and
positioning. From the statistical analysis it is evident that the nurse's limited use of non
pharmacological methods related to their lack of knowledge about pain management.10

A study conducted to investigate the knowledge base and practice of Finnish nurses in
the area of children with pain. A sample of 265 nurses were selected and results showed that
nurses used a fairly wide range of non pharmacological pain methods but in that nurses role
was active and child role was passive. It concluded that there is a clear need for further
education, nurses should take more active role in seeking new information and also should be
encouraged to use non pharmacological methods that let the children be active participants in
their own care.11

A study conducted on non pharmacological interventions to manage children pain:


immediate and the short term effects of a continuing education programme. Two group pre-
post test design was used and comparison of the results indicated a significant increase in
knowledge and comfort with using non pharmacologic techniques. Two months after the
programme, 24 nurses from both group reported increased use of the techniques in practice
compared with prior to the programme.12

A study which showed the efficiency of non pharmacological methods of pain


management in school age children receiving venipuncture in a pediatric department in which
audio visual distraction and routine psychological intervention were used. In this study 300
samples were taken in which 3 groups were set with 100 children in each group. The result
showed increased time for venipuncture in control group. Thus concluded that audio visual to
be effective and was as successful as routine psychological intervention.13

Study on the effectiveness of intra-operative music therapy during general anesthesia


and its effect on post operative outcome. This was a prospective double linked randomized
study over a period of 6 months. 3 groups were selected. 2 intervention group and 1 control
group resulted that intra-operative music probably to modification of the psychological status
of the patient alleviating the anxiety and thus modifying the psychological element in pain.
Thus concluded that non pharmacological methods like music and music with therapeutic
suggestions have a definite role in improvement of the post operative events as this group
required less analgesics and antiemetics.14

A study which was carried out to discuss nurses attitude towards and perception of
post operative pain management, knowledge of pain assessment, awareness of different
methods of pain relief and view of the necessity for education in post operative pain
management. The result showed a need for a focused education program regarding post
operative pain management.15

6.3 STATEMENT OF PROBLEM

A study to assess the effectiveness of a structured teaching program on knowledge


regarding non-pharmacological methods of pain management in children among staff nurses
working in pediatric wards of selected hospitals at Tumkur.

6.4 OBJECTIVES OF THE STUDY

1. To assess the existing level of knowledge of staff nurses regarding the non
pharmacological methods of pain management.
2. To provide a structured teaching program on non pharmacological methods of pain
management.

3. To assess the knowledge of staff nurses regarding non- pharmacological methods pain
management after STP.

4. To analyze the effectiveness of structured teaching program by comparing the pre and
post test scores.

5. To find out the association between the knowledge of staff nurses regarding the non-
pharmacological measures of pain management and selected demographic variables.

6.5 OPERATIONAL DEFINITIONS

Assess:- In this study "assess" refers to gathering information regarding non-


pharmacological measures of pain management among staff nurses.

Effectiveness:- It refers to optimum knowledge acquired by staff nurse after


structured teaching program.

Structured teaching program: -It is a systemically developed program with teaching


aids, designed to impart knowledge regarding non-pharmacological method of pain
management among staff nurses.

Knowledge: -refers to information possessed by the staff nurses regarding non-


pharmacological measures to reduce pain.

Non-pharmacological methods:- refers to a group of intervention other than


medication help to manage pain.

Staff nurses: Nurses who is professionally qualified and registered and working in
pediatric wards of selected hospitals at Tumkur.

6.6 ASSUMPTIONS

The study assume that


 The staff nurses may have some knowledge regarding the Non-pharmacological
methods of pain management.
 STP is an effective strategy to improve the level of knowledge.

 There will be a considerable gain in knowledge after STP.


 After STP the staff nurses will increase the use of the Non- pharmacological
intervention in their practice.
6.7 RESEARCH HYPOTHESIS

H1: The mean post test knowledge regarding non-pharmacological methods of pain
management will be significantly higher than pretest score among staff nurses.

H2: There will be significant association between knowledge of staff nurses


regarding non-pharmacological methods of pain management and selected demographic
variables.

6.8 DELIMITATION

This study is limited to staff nurses working in pediatric wards of selected hospitals at
Tumkur.

7. MATERIALS AND METHODS OF THE STUDY.

7.1 SOURCE OF DATA

The data will be collected from staff nurses working in pediatric wards of selected
hospitals at Tumkur.

7.1.1 RESEARCH DESIGN

Quasi experimental type one group pre-test post-test design is chosen for conducting
the study.

7.1.2 VARIABLES OF THE STUDY

 Dependent variable: The knowledge of staff nurses regarding non-pharmacological


methods of pain management.

 Independet variable: The structured teaching program.

7.1.3 STUDY SETTING

The study will be conducted in selected hospitals at Tumkur.

7.1.4 POPULATION

The population of the study will be staff nurses at Tumkur.


7.2 METHODS OF DATA COLLECTION

7.2.1 SAMPLING TECHNIQUE


Non random sampling procedure of convenient sampling technique is used to select
the sample of staff nurses.

7.2.2 SAMPLE SIZE


The sample size of the study is 60 staff nurses working in pediatric wards of selected
hospitals at Tumkur.

7.2.3 CRITERIA FOR SELECTION OF THE STUDY

Inclusion criteria
1. Staff nurses from selected hospital at Tumkur
2. Staff nurses working in pediatric ward.

Exclusion criteria:
1. Staff nurses who are not available at the time of data collection.
2. Staff nurses who are not willing to participate in the study.

7.2.4 INSTRUMENT

A structured questionnaire will be prepared to assess the knowledge of staff nurses. It


will consist of two parts.

Section A:- The demographic data of the staff nurses.


Section B:- Questionnaire to assess the knowledge of staff nurses regarding
non-pharmacological methods of pain management in children.

7.2.5 METHOD OF DATA ANALYSIS AND PRESENTATION

The data being collected through structured questionnaire will be carefully analyzed
through following statistical technique.

I. DESCRIPTIVE STATISTICS

a. Frequency and percentage analysis used to describe the demographic


characteristics of staff nurses.

b. Mean, Range, Standard deviation and mean score percent will be used to
assess the knowledge before and after STP.

II. INFERENTIAL STATISTICS

a. Paired t-test will be used to compare the pre and post test knowledge level of
staff nurses.
b. Chi- square test will be used to determine the association between level of
knowledge of staff nurses and selected demographic variables

7.2.6 PILOT STUDY

A pilot study will be conducted by selecting 8 staff nurses to assess the feasibility of
main study.

7.2.7 PROJECTED OUTCOME

The structured teaching program will improve the knowledge regarding non-
pharmacological methods and enhance practice of these methods in pediatric wards,
thereby improving the standard of nursing practice.

7.2.8 DURATION OF THE STUDY

The study plan to conduct with the time duration at about 6 to 8 weeks.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATON OR


INTERVENTION TO BE CONDUCTED ON PATIENT OR
OTHER HUMANS OR ANIMALS? IF SO PLEASE DESCRIBE
BRIEFLY.

Yes, structured teaching program will be administered to staff nurses, working in


pediatric wards in increasing their knowledge regarding non-pharmacological
methods of pain management in children.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR


INSTITUTION IN CASE OF 7.3?

The study will be conducted after the approval of research committee. The purpose
and the details of the study will be explained to the study subjects and an informed
consent will be obtained from them. Assurance will be given to the study subjects on
the confidentiality of the data collected from them.

8. LIST OF REFERENCES:
1. Hockenberry. J.Marilyn, Wilson, Winkelstein,“Wongs Essentials of Pediatic
Nursing” ,7th edition published Elsevier India Pvt. Ltd, New Delhi, 2006 Page No. 669
2. Stouffer. W.Janice,Sherk.J. Berly,Polomano, C. Rosemary “Practice guidelines for
music interventions with hospitaliezed pediatric patiens”, Journal of pediatric
Nursing, Vol: 22,No-6 December,2007, Page No-448-456.

3. Johnson. Celeste & etal. “one- on-one Coaching to improve pain assessment and
management practices of pediatric nurses, journal of pediatric nursing, Vol;22 No;6
December,2007, Page No-467-478

4. Pietila.M.A,K.Julkunen-wehvilainen,T.Polkki,“non-pharmacological methods in
relieving children’s post operative pain: a survey on hospital nurses in Finland”, J.
Adv Nurs.2001 May; 34 (4): 483-92

5. S. Helmrich, P. Yates, R. Nash, A. Hobman, V.Poulton, L. Berggren. “ Factors


influencing Nurses decisions to use non-pharmacological therapies to manage patients
pain”. Aust J. Adv Nurs. 2001 Sep- Nov; 19 (1) : 27-35

6. E.Iduall, Cholm, I Runeson. “Pain experiences and non- pharmocologica Strategies for
pain management after tonsillectomy: a qualitative interview study of children and
parents.” J Child Health Care. 2005 Sep; 9 (3): 196- 207.

7. Polit DF. "Nursing research principle and methods", 7th edition, Lippincott Worters K.
lower Company; 2004.

8. S.Le May and etal. “Pain management Practices in a Pediatric Emergency Room
(PAMPER) Study: interventions with nurses. Pediatr Emerg Care. 2009 Aug; 25 (8):
498-503.

9. Hg He, Polkki T, AM. Pietila, K. Vehvilaimen- Julkunen,” Chinese parent’s use


nonpharmacological methods in children’s postoperative pain relief. Scand j Caring
Sci. 2006 Mar; 20 (1): 2-9.

10. Hg he, Polkki T, K. Vehvilainen- Julkunen, Am. Pietila. “Chinese nurses’ use of non-
pharmacological methods in children’s postoperative pain relief. J.Adv Nurs. 2005
Aug; 51(4): 335-42.

11. S.Salantera, S. Lauri, TT. Salmi, H. Helenius. “Nurses knowledge about


pharmacological and nonpharmacological pain management in children. J Pain
Symptom Manage. 1999 Oct; 18(4): 289-99

12. C.Pederson. “ Nonpharmacologic interventions to mange children’s pain: immediate


and short- term effects of a continuing education program. J. Contin Educ Nurs”. 2000
May- Jun; 27 (3): 131-40.
13. ZX.Wang, LH. Sun, AP. Chen. “The efficacy of non-pharmacological methods of
pain management in school age children receiving venepuncture in a controlled trial of
audiovisual distraction and routine psychological intervention”-. Swiss Med Wkly
2008; 138 (39-40): 579-584.

14. Dr. Jayaraman Lakshmi, Dr. Sharma Shikha, Dr. Sethi Nitin. “Does intraoperative
music therapy or positive therapeutic suggestions during general anesthesia affect the
postoperative outcome? a double blind randomized controlled trial”. Indian journal of
anesthesia, August 2006; 50 (4): 258-261.

15. JA. Vessey, KL. Carlson. “No pharmacological interventions to use with children in
pain”. Issues Compr Pediatr Nurs. 1996 Jul- Sep; 19 (3): 169-82.