University of Babylon

College of Nursing

Assessment of Nurses' Knowledge toward Pain Management

at Al-Hilla Teaching Hospital, Babylon, Iraq.

By:
Mustafa Khudhair Abbas
Murad Mohammed Murad
Mohammed Qassim Mohammed
Mustafa Maithem Hamza
Mustafa salah Hasan

Supervisor:
Dr. Hussam Abbas Dawood, PhD in Nursing.
2019/2020
 ‫جامعة بابل‬
‫كلية التمريض‬

‫تقييم معارف الممرضين حول السيطرة على األلم في مستشفى الحلة‬

‫التعليمي‪ ,‬محافظة بابل‪ ,‬العراق‪.‬‬

‫تم بواسطة‪:‬‬
‫مصطفى خضير عباس‬
‫مراد محمد مراد‬
‫محمد قاسم محمد‬
‫مصطفى ميثم حمزة‬
‫مصطفى صالح حسن‬

‫المشرف‪:‬‬
‫الدكتور حسام عباس داوود‪ ,‬دكتوراه في التمريض‪.‬‬
‫‪2020\2019‬‬
 Table of Contents
No. content Pag
e
1 abstract 4
2 Introduction 5
3 Methods and Materials 6
4 Results 8
5 Discussion 13
6 Conclusion and Recommendation 15
7 References 16
8 Modified Knowledge Survey 19
Regarding Pain (Arabic)
9 Modified Knowledge Survey 25
Regarding Pain (English)

List of Tables
No. content Pag
e
1 Table 3.1 8
2 Table 3.2 9
3 Table 3.3 9
4 Table 3.4 10
5 Table 3.5 10
6 Table 3.6 11
7 Table 3.7 12

List of Figures
No. content Page
1 Figure 1 11
ABSTRACT
Background: Pain as an unpleasant sensory and emotional experience associated with
actual or potential tissue damage, or described by the patients in terms of such damage. Pain
management is a key component of patient satisfaction and well-being in acute care
settings. Nurses spend more time with patients than any other members of the health care
team and play a major role in pain management. The present study aims to explore nurses'
knowledge toward pain assessment and management in Al-Hilla Teaching Hospital,
Babylon, Iraq.
Methods: This descriptive study non-probability (purposive) sample of (100) nurses at Al-
Hilla Teaching Hospital participated in the study. This study started from November 10th
2019 through July 4th 2020.
Results: 18% percent of participants achieved a passing score of 50% or more. Pain
Assessment questions were the least likely to be answered correctly. No significant
association were found between score and demographic variables
Conclusion: . Nurses showed low overall score in pain management. Nurses need to be
equipped with the necessary information so that they are able to effectively manage pain in
adult medical and surgical patients.
Key words: knowledge, nurses, pain, pain management, pain assessment

:‫الخالصة‬
‫ تعد‬.‫ أو ما يصفه المرضى على انه ضرر‬،‫األلم هو تجربة حسية وعاطفية مزعجة مرتبطة بتلف فعلي اومحتمل لألنسجة‬
‫ أطول من‬j‫ يقضي الممرض وقتًا مع المرضى‬.‫ رئيسيًا لرضا المريض ورفاهه في أماكن الرعاية الحادة‬j‫إدارة األلم مكونًا‬
‫ حيث تهدف هذا الدراسة‬.‫ في إدارة األلم‬j‫ الرعاية الصحية ويلعب الممرض دورًا رئيسيًا‬j‫أي أعضاء آخرين في فريق‬
.‫ العراق‬,‫ محافظة بابل‬,‫ الممرضين حول السيطرة على األلم في مستشفى الحلة التعليمي‬j‫الحالية تقييم معارف‬
‫ دراسة وصفية لعينة غير احتمالية (هادفة) لمئة ممرض يعملون ضمن مستشفى الحلة التعليمي شاركوا في‬:‫المنهجية‬
.2020 ‫ وحتى الرابع من شهر تموز عام‬2019 ‫ هذه الدراسة بدأت في العاشر من شهر تشرين الثاني لعام‬.‫هذه الدراسة‬
‫ اسئلة تقييم االلم كانت اقل االسئلة من ناحية‬.‫ اواكثر‬%50‫ من المشاركين حققوا درجة نجاح ب‬%18 ‫ نسبة‬:‫النتائج‬
‫ الديموغرافية‬j‫ الدراسة بينت عدم وجود عالقة احصائية بين معارف الممرضين وبياناتهم‬.‫االجابات الصحيحة‬
j‫ الممرضين يحتاجون الى تجهيزهم بالمعلومات‬.‫ ضعيف بالسيطرة على االلم‬j‫ الممرضين اضهروا مستوى‬:‫االستنتناج‬
‫ البالغين في الردهات الباطنية‬j‫الضرورية كي يكونوا قادرين وبشكل فععال على السيطرة على االلم في المرضى‬
.‫والجراحية‬
1. BACKGROUND:
1.1 Introduction
The American Pain Society Quality of Care Committee defined Pain as an unpleasant sensory and
emotional experience associated with actual or potential tissue damage, or described by the patients in
terms of such damage (Kumar, 2016). In according to The North direction American Nursing Diagnosis
Association (NANDA) defines that pain is a state, in which an individual experiences and reports severe
discomfort or an uncomfortable sensation; the reporting of pain may be either by direct verbal
communication or by encoded descriptors. (Miller-Keane, 2003) Pain management is a key component of
patient satisfaction and well-being in acute care settings. (Lewthwaite et al., 2011)
Studies showed that the Unrelieved and uncontrolled pain is a major health problem, and the most
widespread symptoms experienced by the patients, as well as a universal human experience (Carr, 1992;
Berry & Dahl, 2000 and Creeland, 1994). The incidence of significant pain is still 50% or higher in both
medical and surgical patients (De Jong, 2013). In addition to experiencing pain at rest, pain related to
surgery, trauma, burns, and cancer, these patients experience procedural pain. (Shaikh, 2018).
A study was done by Whelan, Jin & Meltzer found that 18% of hospitalized medical patients their pain
was inadequately controlled 6, another study showed the incidence of uncontrolled pain from 74% to 95%
in a very ill and dying hospitalized adults, although the planned measures of nurses to encourage
physicians to control pain (SUPPORT, 1995) and 70.1% of the hospitalized patients with medical illness
experienced nonprocedural pain on presentation or in the hospital. (Gu & Belgrade, 1993)
Nurses tend to spend more time with patients with pain than any other health team members. It is the
nurse who performs many interventions for pain relief or further individualizes for the patient those
interventions prescribed or performed by others. It is also the nurse who is most likely to be in a position to
evaluate the effectiveness of the pain management plan and to initiate any necessary changes (McCaffrey
and Ferrell, 1997). As the physicians are responsible for prescribing analgesia, nurses most responsibility
rests with for the comfort of patients (Carmen, 2001; Chiang, 2006; Cohen, 1980, Duke, 2010). Nurses are
primarily responsible to assess and control of pain through implement interventions, and evaluate the
interventions (Hamdan, 2011). Nurses should have a basic and sufficient knowledge about pain and pain
control practice that enable them to play their role effectively. (Lui and So, 2006)
This study aims to explore nurses' knowledge toward pain assessment and management in Al-Hilla
Teaching Hospital, Babylon, Iraq.

1.2 Objectives:
The present study aims to achieve the following objectives:
1. This study aims to explore nurses' knowledge toward pain assessment and management in Al-Hilla
Teaching Hospital, Babylon, Iraq.
2. To find out the relationships between nurses’ knowledge and the demographic variables of age,
gender, marital status, residency, educational level, training sessions in pain management, Ward or
Department and years of experience in pain management.
2. METHODS AND MATERIALS
3.1 Design, Setting, and Sample: This quantitative study utilized a descriptive and correlational study
design to examine demographic variables and knowledge of nurses towards pain management. A non-
probability (purposive) sample of (100) nurses that work in a variety of practice settings participated in the
study. This study started from November 10th 2019 through July 4th 2020.

2.2 Instruments: For the purpose of the present study, a questionnaire consisted of two parts:
Demographic Characteristics tool and a modified version of the “Knowledge and Attitudes Survey
Regarding Pain” NKAS (Ferrell & McCaffery, revised 2014) was used. Demographic Characteristics tool
consisted of age, gender, marital status, residency, educational level, training sessions in pain management,
ward or department and years of experience in pain management. The modified version of the NKAS
consisted of 31-items each item had a definite correct/ incorrect answer. Items concerning pediatrics and
cancer were deleted. The 31-item survey consisted of 5 items on pain assessment, 11 items on general
knowledge about pain and non-pharmacological pain management, 11 items on pharmacological pain
management, and 4 items on to narcotic/opioid addiction. Thus, four subscores and one overall nurses’
score were obtained. Two case studies to evaluate nurses’ assessment of pain level and subsequent
pharmacologic interventions were part of this survey (Ferrell & McCaffery, revised 2014). The case studies
include two patients (A and B) were complaining of the same level of pain and have received the same
dose of treatment of morphine. The only difference between the two scenarios is that one patient is
grimacing while the other is smiling. Instrument validity was determined through content validity by a
panel of experts.

2.3 Data Collection: approvals letters and permissions for data collection were provided by the university
and hospital. One hundred and twenty empty questionnaires were distributed to each unit, targeting nurses
working in surgical and medical units within Al-Hilla Teaching Hospital. A letter that explained the study
aims and goals, procedures, and participants’ role was attached to the questionnaires. one hundred
questionnaires were completed and gathered in the offices of head nurses in each unit and subsequently
collected by the research team. No identifying information was asked of potential participants. Data
collection started from December 20th 2019 through January 16th 2020.

2.4 Data Analysis: Analysis of data was performed through using descriptive statistics (frequency,
percentage, mean (x), standard deviation, mean of scores, and relative sufficiency) and inferential statistics
(Chi-square). Data were entered and analyzed by using SPSS Version 23. Answers were scored into 2
points Likert scale (scored as 2 for correct answers and 1 for incorrect answers) which were obscured to the
participant when administered to them.
 1. Descriptive data analysis: This approach was performed through: Frequencies, Percentage,
Mean of score (MS) and Relative sufficiency (RS)
 Mean of scores (MS): The data were ordered in the two-points Likert scale and scored as
(2 for correct answer, 1 for incorrect answer), so, the MS ranged between (1-2) and the
cut-off point was (1.5).
 Relative sufficiency (RS): assessed for nurse's knowledge categorized by three degrees
(low, moderate, high). The minimum value of relative sufficiency is (50%) and maximum
value (100%) so the interval is (16.66) between first and last value in the same degree.
Based on the previous facts, the RS ranged between (50-100%) and was categorized into 3
degrees as followed: Low level (50-16.66) Moderate level (66.67-83.33) High level
(83.34- 100).

2. Inferential data analysis: a. Chi-square (χ2) tests: This statistical procedure used to find the
significance of statistical association between the demographic characteristics and the
knowledge score of nurses, the chi square divided the nurses' knowledge to two scores:
Cut of point = 100-0/2=50
Range = (0-49.99) the nurse gets fail if answering less than half of the items of knowledge part correctly
and (50-100) the nurse get pass if answering more than half of the items of knowledge part correctly.
3. RESULT
Table 3.1: Distribution of Nurses to Their Demographical Characteristics
Age (years): Mean 25.7 year (±4.95). Frequency Percentage
20-30 92 92%
31-40 6 6%
41 or more 2 2%
Total 100 100%

Gender Frequency Percentage

Male 71 71%
Female 29 29%
Total 100 100%
Marital Status Frequency Percentage
Single 32 32%
Married 68 68%
Total 100 100%
Residency Frequency Percentage
Urban 62 62%
Rural 38 38%
Total 100 100%
Educational level Frequency Percentage
High Nursing School 21 21%
Nursing Institute 48 48%
Nursing college 31 31%
Total 100 100%

Training Sessions in Pain Management Frequency Percentage

yes 31 31%
no 69 69%
Total 100 100%
Ward or Department Frequency Percentage
burn unit 12 12%
emergency department 17 17%
ENT 5 5%
HDU 11 11%
orthopedic ward 17 17%
surgical room 9 9%
surgical ward 29 29%
Total 100 100%

Years of Experience Frequency Percentage

1-4 years 78 78%
5-9 years 14 14%
10 years and more 8 8%
Total 100 100%

This table represents the distribution of the nurses to their demographic characteristics in term of frequencies
and percentage. Out of (100) subject who participated in this study most of them were male (71%). The majority of
nurses age group were (20-30 year), age mean was 25.7 year ( ±4.95). Concerning marital status, a most of
participants were married (68%), and (62%) of participated were urban residents. Regarding the educational
attainment and work experience, most of nurses were institute graduated work at surgical wards for 1-4 years without
training course in pain management. were ask for medical consultations only when they feel sick.
Table 3.2: Distribution of Nurses to Pain Assessment Items.
Items descending from highest relative sufficiency to lowest Correct Incorrect
relative sufficiency answers answers MS R.S Degree
f % f % (%)
Giving patients sterile water by injection (placebo) is a useful test to 33 33% 67 67% 1.33 66.50 low
determine if the pain is real.
The most accurate judge of the intensity of the patient’s pain is 28 28% 72 72% 1.28 64.00 Low
If the source of the patient’s pain is unknown, opioids should not be 28 28% 72 72% 1.28 64.00 Low
used during the pain evaluation period, as this could mask the
ability to correctly diagnose the cause of pain.
Patient B, question No.1 23 23% 77 77% 1.23 61.50 Low
Patient A, question No.1 20 20% 80 80% 1.20 60.00 Low
Total Relative sufficiency 63.2 low
f=frequency, %= percentage, MS=mean of scores, RS=relative sufficiency, (degree: “50-66.66” Low, “66.67-83.33” Moderate and “83.34-100” High)

.
This table represents the distribution of the nurses to pain assessment items in term of frequencies,
percentage, mean of scores and relative sufficiency. The Total Relative sufficiency was 63.2% (Low
degree).

Table 3.3: Distribution of Sample to General Knowledge About Pain Management Items
Items descending from highest relative sufficiency to lowest Correct Incorrect
relative sufficiency answers answers MS R.S Degree
f % f % (%)
Sedation assessment is recommended during opioid pain management 82 82% 18 18% 1.82 91.00 High
because excessive sedation precedes opioid-induced respiratory
depression.
The most likely reason a patient with pain would request increased 69 69% 31 31% 1.69 84.50 High
doses of pain medication is
Respiratory depression rarely occurs in patients who have been 63 63% 37 37% 1.63 81.50 Moderate
receiving stable doses of opioids over a period of months.
Vital signs are always reliable indicators of the intensity of a patient’s 57 57% 43 43% 1.57 78.50 Moderate
pain.
Analgesics for post-operative pain should initially be given 57 57% 43 43% 1.57 78.50 Moderate
Patients who can be distracted from pain usually do not have severe 53 53% 47 47% 1.53 76.50 Moderate
pain.
Elderly patients cannot tolerate opioids for pain relief. 51 51% 49 49% 1.51 75.50 Moderate
Patients’ spiritual beliefs may lead them to think pain and suffering are 48 48% 52 52% 1.48 74.00 Moderate
necessary.
Patients should be encouraged to endure as much pain as possible 33 33% 67 67% 1.33 66.50 Low
before using an opioid.
Patients may sleep in spite of severe pain. 30 30% 70 70% 1.30 65.00 Low
Which statement is true regarding opioid induced respiratory 29 29% 71 71% 1.29 64.50 Low
depression?
Total Relative sufficiency 76.0 Moderate
f=frequency, %= percentage, MS=mean of scores, RS=relative sufficiency, (degree: “50-66.66” Low, “66.67-83.33” Moderate and “83.34-100” High)

This table represents the distribution of the nurses to general knowledge about pain management items in
term of frequencies, percentage, mean of scores and relative sufficiency. The Total Relative sufficiency
was 76.0% (Moderate degree).
Items descending from highest relative sufficiency to lowest Correct Incorrect
relative sufficiency answers answers MS R.S Degree
(%)
 f % f %
After an initial dose of opioid analgesic is given, subsequent doses 68 68% 32 32% 1.68 84.00 High
should be adjusted in accordance with the individual patient’s
response.
Benzodiazepines are not effective pain relievers and are rarely 66 66% 34 34% 1.66 83.00 Moderate
recommended as part of an analgesic regiment.
The usual duration of analgesia of 1-2 mg morphine IV is 4-5 hours. 61 61% 39 39% 1.61 80.50 Moderate
Combining analgesics that work by different mechanisms (e.g., 54 54% 46 46% 1.54 77.00 Moderate
combining an NSAID with an opioid) may result in better pain
control with fewer side effects than using a single analgesic agent.
A 30 mg dose of oral morphine is approximately equivalent to: 49 49% 51 51% 1.49 74.50 Moderate
The recommended route administration of opioid analgesics for 47 47% 53 53% 1.47 73.50 Moderate
patients with brief, severe pain of sudden onset such as trauma or
postoperative pain is
The time to peak effect for morphine given IV is 45 45% 55 55% 1.45 72.50 Moderate
Anticonvulsant drugs such as gabapentin (Neurontin) produce 34 34% 66 66% 1.34 67.00 Moderate
optimal pain relief after a single dose.
Patient B ques.2 18 18% 81 81% 1.18 59.00 Low
Patient A ques.2 12 12% 88 88% 1.12 56.00 Low
The time to peak effect for morphine given orally is 9 9% 91 91% 1.09 54.50 Low
Total Relative sufficiency 71.1 Moderate
Table 3.4: Distribution of Sample to Pharmacological Pain Management Items
f=frequency, %= percentage, MS=mean of scores, RS=relative sufficiency, (degree: “50-66.66” Low, “66.67-83.33” Moderate and “83.34-100” High)

This table represents the distribution of the nurses to pharmacological pain management items in term
of frequencies, percentage, mean of scores and relative sufficiency. The Total Relative sufficiency was
71.1% (Moderate degree).

Table 3.5: Distribution of Sample to Narcotic/Opioid Addiction Items

Items descending from highest relative sufficiency to lowest Correct Incorrect
relative sufficiency answers answers MS R.S Degree
(%)
f % f %
Narcotic/opioid addiction is defined as a chronic neurobiologic 60 60% 40 40% 1.60 80.00 Moderate
disease, characterized by behaviors that include one or more of the
following: impaired control over drug use, compulsive use, continued
use despite harm, and craving.
How likely is it that patients who develop pain already have an alcohol 28 28% 72 72% 1.28 64.00 Low
and/or drug abuse problem?
Following abrupt discontinuation of an opioid, physical dependence is 25 25% 75 75% 1.25 62.50 Low
manifested by the following:
Opioids should not be used in patients with a history of substance 17 17% 83 83% 1.17 58.50 Low
abuse.
Total Relative sufficiency 66.3 Low
f=frequency, %= percentage, MS=mean of scores, RS=relative sufficiency, (degree: “50-66.66” Low, “66.67-83.33” Moderate and “83.34-100” High)

This table represents the distribution of the nurses to addiction items in term of frequencies, percentage,
mean of scores and relative sufficiency. The Total Relative sufficiency was 66.3% (Low degree).

Scores Percentage Mean Std. Deviation Assessment

Frequency
Overall Nurses
Fail 82 82%
Knowledge
42.03 9.28 Fail
Pass 18 18%
 Total 100 100%
Table 3.6: The Overall Nurses' Knowledge About Pain Management
Std. Deviation: standard deviation.

This table presented the overall nurse’s knowledge about pain management. Finding reveals that the
majority of (82%) get “Fail” in knowledge of nurse’s about pain management in Al-Hilla teaching hospital.
(Figure 1)

Figure 1: Nurses Knowledge Scores (“fail” when the score from 0 to 49.9 and “pass” when
the score from 50 to 100)

Table 3.7: Statistical Relationship between Nurses' Knowledge About Pain Management and their
Demographic Characteristics
Demographic data Nurses' Knowledge About Pain Management
Fail Pass Total χ2obs. d. P-value
 f
Age 3.531 2 0.171
74 18 92 NS
6 0 6
2 0 2
82 18 100
Gender
26 3 29 1.622 1 0.203
56 15 71 NS
82 18 100
Marital Status
25 7 32 0.479 1 0.489
57 11 68 NS
82 18 100
Residency
54 8 62 2.872 1 0.090
28 10 38 NS
82 18 100
Educational level
17 4 21 0.107 2 0.948
39 9 48 NS
26 5 31
82 18 100
Training Sessions in Pain
Management
26 5 31 0.107 1 0.744
56 13 69 NS
82 18 100
Ward or Department
11 1 12 7.126 6 0.309
12 5 17 NS
4 1 5
8 3 11
12 5 17
8 1 9
27 2 29
82 18 100
Years of Experience
61 17 78 3.635 2 0.162
13 1 14 NS
8 0 8
82 18 100
χ2= Chi-square, Df= Degree of freedom, P-value= Probability value, S= Significant association, NS= No Significant association.

This table presented that relationship between nurses’ knowledge about Pain Management and their Demographic
Characteristics. There was no significant association between them at p-value >0.05.

4. DISCUSSION:
4.2 Distribution of Nurses to Their Demographical Characteristics
Through the data analysis distribution of demographic variables (Table 1), according to the present study
the most frequent of age group was (20-30) years old which accounted for 92%, age mean was 25.7 year
(±4.95). These findings are supported by a study done by (Gaffar, 2016) showed the age of the study
sample was within the age group of (23-26) years of age and within 25.1 ± 3.8 mean of age. The most of
the sample were males (71%), (48%) from nursing institute. (68%) of the nurses were married. These
results agree with study done by (Abdollahi, et al., 2003) that reveals the most of the sample are males and
graduated from nursing institute
While these findings disagreed with the result of study (Bagherian B, Sabzevari S, Mirzaei T, Ravary A
2017) where reported that age group were between 31 and 49 years old and with (mean=38.5) and the
majority were female (88.9).

4.3 Distribution of Nurses to Their Knowledge Regarding Pain Management:

Four major findings emerged from this study; Overall knowledge of pain management score, Pain
assessment subscore, General knowledge about pain and pain management, Pharmacologic pain
management subscore, and narcotic/opioid addiction. Overall knowledge of pain management scores was
42.03 (± 9.28). In this study, 18% of nurses achieved a score of 50% or more (16 or more correct
questions). This represents a similar low proportion of nurses “passing” like other studies that used a
modified version of the KASRP (Innis et al., 2004; McCaffery & Robinson, 2002; Naser et al., 2005; Tapp
& Kropp, 2005; Wilson, 2007).and the nurses failed in regarding to pain management.
the highest subscore were the items relating to general knowledge regarding pain and pain management
which were scored as (total RS 76%), a study done by Hanan Said Ali in 2013 concluded that nurses in her
study have a satisfactory level of knowledge in applying non-pharmacological methods for pain
management. This contradicted the findings of an earlier study by Lui et al. (2006) who reported nurses
have inadequate knowledge about non-pharmacological interventions for pain management. The highest
three items of this section were “Sedation assessment is recommended during opioid pain management
because excessive sedation precedes opioid-induced respiratory depression.”, “The most likely reason a
patient with pain would request increased doses of pain medication is” and “Respiratory depression rarely
occurs in patients who have been receiving stable doses of opioids over a period of months.” scored
91.00%, 84.50% and 81.50% respectively. These finding reveal that nurses may be the result of
overconcern complication of opioids and risk of respiratory depression when opioids are used (Coulling,
2005; Horbury et al., 2005)
Then, the second highest subscore were items related to pharmacological pain management (RS 71.1%)
which evaluated as moderate. Nurses may perceive physicians and pharmacists as pharmacology experts
and rely on their expertise for direction with analgesia regimes (Lewthwaite et al 2011). Wilson (2007)
suggested that some nurses may feel a sense of powerlessness when there is an analgesic order with limited
flexibility to tailor the drug or dosage to the particular situation.
Narcotic/opioid addiction sored as moderate (RS 66.3%), items related to this section were
“Narcotic/opioid addiction is defined as a chronic neurobiologic disease, characterized by behaviors that
include one or more of the following: impaired control over drug use, compulsive use, continued use
despite harm, and craving.”, “How likely is it that patients who develop pain already have an alcohol
and/or drug abuse problem?”, “Following abrupt discontinuation of an opioid, physical dependence is
manifested by the following:” and “Opioids should not be used in patients with a history of substance
abuse.” These items RS was 80.00%, 64.00%, 62.50%, and 58.50% respectively.
This finding reveal that nurses are overconcerned with opioid and addiction of opioid as previously
discussed in this study.
The lowest subscore were the items related to pain assessment items (RS 63.2%). All the 5 items of this
section degrees were low. Accurate pain assessment is essential for effective pain management. The highly
subjective nature of pain means that pain assessment is one of the most common and yet difficult activities
a nurse performs (Berman, 2010). M. E. John, conducted a study on assessment and management of pain in
hospitalized patients in Calabar, of the fifty nurses interviewed, 84% assessed pain before managing it,
while 16% did not. Of those who assessed pain, only 18% assessed intensity of pain. The techniques used
for pain assessment were observation of pain-related behaviors and vital signs. No nurses used any graphic
or numerical tool to assess pain quality or intensity, the reasons being unavailability of such tools in
hospitals.
Chi square was used to assess the relationship between nurses’ knowledge about Pain Management and
their Demographic Characteristics. There was no significant association between them at p-value >0.05.

5. CONCLUSION
5.1 Implementation
The study concludes that nurses expressed a lower level of pain knowledge than that reported worldwide.
Continuous education and reforming undergraduate curricula to address pain management are
recommended. Level of knowledge regarding non-pharmacological methods of pain management is good
which may lead to a high level of practices. Poor score in assessment of pain is a cause for concern since
nurses play a pivotal role in pain assessment. Nurses need to be equipped with the necessary information so
that they are able to effectively manage pain in adult medical and surgical patients. Continuing education
opportunities are essential to achieve improvement in patient care and will have a significant impact on
nurses’ knowledge towards pain assessment and management
The findings also reveal no relationship between ages, gender, marital status, residency, educational level,
training sessions in pain management, ward or department, years of experience with the knowledge.

5.2 Recommendation:
1. Increasing pain management lectures for nursing students in academic education to improve their
knowledge, also applying training sessions for nurses on pain assessment and management
2. Increase nurses' participation in documenting and pain assessment in order to provide the necessary
practical application of the acquired knowledge.

REFERENCES:
1. Kumar, K. H., & Elavarasi, P. (2016). Definition of pain and classification of pain disorders. Journal of Advanced
Clinical and Research Insights, 3(3), 87-90.
2. Miller-Keane M. Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health. 7th ed.
Philadelphia, PA: Saunders, An Imprint of Elsevier, Inc.; 2003.
3. Carr, D.B., Jacox, A.K., Chapman, C.R., Ferrell, B.R., Fields, H.L., Heidrich, G., Hester, N.K., Hill, C.S., Lipman,
A.G., McGarvey, C.L., Miaskowski, C., Mulder, D.S., Payne, R., Schlecter, N., Shapiro, B.S., Smith, R.S., Tsou, C.V.,
& Vecchiarelli, L. (1992). Acute Pain Management: Operative or Medical Procedures and Trauma: Clinical Practice
Guideline No. 1 (AHCPR publication 92-0032). Rockville, MD: US Public Health Service, Agency for Health Care
Policy and Research.
4. Berry PH, Dahl JL (2000) The new JCAHO pain standards: implications for pain management nurses. Pain Manage
Nurs 1(1): 3–12
5. Cleeland, C.S., Gonin, R., Hatfield, A.K., Edmondson, J.H., Blum, R.H., Stewart, J.A., & Pandya, K.J. (1994). Pain and
its treatment in outpatients with metastatic disease. The New England Journal of Medicine, 330, 592-596.
6. Whelan, C. T., Jin, L., & Meltzer, D. (2004). Pain and satisfaction with pain control in hospitalized medical patients: no
such thing as low risk. Archives of Internal Medicine, 164(2), 175-180.
7. SUPPORT Study Principle Investigators. (1995). A controlled trial to improve care for seriously ill, hospitalized
patients: A study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). Journal of
the American Medical Association, 274, 1591-1598.
8. Gu, X., & Belgrade, M. J. (1993). Pain in hospitalized patients with medical illnesses. Journal of pain and symptom
management, 8(1), 17-21.
9. Carmen R. Green, John R.C. Wheeler, Beverly Marchant, Frankie LaPorte, Eloisa Guerrero, Analysis of the Physician
Variable in Pain Management, Pain Medicine, Volume 2, Issue 4, December 2001, Pages 317–327,
https://doi.org/10.1046/j.1526-4637.2001.01045.x
10. Cohen, F. L. (1980). Postsurgical pain relief: Patients’ status and nurses’ medication choices. Pain, 9, 265-274..
11. Chiang LC, Chen HJ, Huang L (2006) Student nurses’ knowledge, attitudes, and self-efficacy of children’s pain
management: evaluation of an education program in Taiwan. J Pain Symptom Manage 32(1): 82–9
12. Duke G, Haas BK, Yarbrough S, Northam S (2010) Pain management knowledge and attitudes of Baccalaureate
nursing students and faculty. Pain Manage Nurs 14(1): 11–19
13. Hamdan, A., 2011. Nurses Knowledge Regarding Pain Management in Hail Region Hospitals, Saudi Arabia. Australia:
RMIT University
14. Lui, L.Y.Y. and So, K.W., 2006. The knowledge and attitudes regarding pain management among the medical nursing
staff in Hong Kong. 2006.
15. de Jong A, Molinari N, De Lattre S. Decreasing severe pain and serious adverse events while moving intensive care
unit patients: A prospective interventional study (the NURSE-DO project). Critical Care. 2013;17:R74
16. Shaikh, N., Tahseen, S., Haq, Q. Z. U., Al-Ameri, G., Ganaw, A., Chanda, A., ... & Kazi, T. (2018). Acute pain
management in intensive care patients: facts and figures. In Pain Management in Special Circumstances. London,
England: IntechOpen
17. McCaffrey, M. and Ferrell, B.R., 1997. Nurses' knowledge of pain assessment and management: How much progress
have we made?. Journal of pain and symptom management, 14(3), pp.175-188.
18. Gaffar, B. (2016). Assessment of Nurses Knowledge Regarding Care of Unconsciousness Patients in El-mak Nimer
University Hospital (Doctoral dissertation, Shendi University
19. Abdollahi A.; Rahmani H.; KHodabakhshi B.; Behnam N.: Determine knowledge, attitude and practice nurses of
Golestan university medical sciences about hospital infection control, Gorgan Univ Med Sci J, Vol. 5, N. 1, 2003, p. 80.
20. Bagherian B, Sabzevari S, Mirzaei T, Ravary A (2017) Meaning of Caring from Critical Care Nurses’ Perspective: A
Phenomenological Study. J Intensive & Crit Care Vol. 3 No. 3:33.
21. Innis, J., Bikaunieks, N., Petryshen, P., Zellermeyer, V. and Ciccarelli, L., (2004). Patient satisfaction and pain
management: an educational approach. Journal of Nursing Care Quality, 19(4), pp.322-327.
22. McCaffery, M., & Robinson, E. S. (2002). Your patient is in pain: Here’s how you respond. Nursing, 32(10), 36-47.
23. Naser, E., Sinwan, S., & Bee, W. H. (2005). Nurses’ knowledge on pain management. Singapore Nursing Journal,
32(2), 29-36.
24. Tapp, J., & Kropp, D. E. (2005). Evaluating pain management delivered by direct care nurses. Journal of Nursing Care
Quality, 20(2), 167-173.
25. Wilson, B. (2007). Nursing knowledge of pain. Journal of Clinical Nursing, 16, 1012-1020.
26. Ali, H.S., Ibrahim, Y. and Mohamed, E., 2013. Non-pharmacological pain management: nurses’ knowledge, attitudes
and practices in selected hospitals at Makkah El-Mukarramah. Life Science Journal, 2(10).
27. Coulling, S. (2005). Nurses’ and doctors’ knowledge of pain after surgery. Nursing Standard, 19(34), 41-49
28. Horbury, C., Henderson, A., & Bromley, B. (2005). Influences of patient behavior on clinical nurses’ pain assessment:
Implications for continuing education. The Journal of Continuing Education in Nursing, 36(1), 18-24.
29. Lewthwaite, B.J., Jabusch, K.M., Wheeler, B.J., Schnell-Hoehn, K.N., Mills, J., Estrella-Holder, E. and Fedorowicz, A.,
2011. Nurses’ knowledge and attitudes regarding pain management in hospitalized adults. The Journal of Continuing
Education in Nursing, 42(6), pp.251-257.
30. Berman, A., Snyder, S.J., Kozier, B., Erb, G., Levett-Jones, T., Dwyer, T., Hales, M., Harvey, N., Luxford, Y.,
Moxham, L. and Park, T., 2010. Kozier and Erb's fundamentals of nursing (Vol. 1). Pearson Australia.

‫جامعة بابل‬
 ‫كلية التمريض‬

‫مشروع بحث التخرج‬

‫استبانة تقييم معارف الممرضين فيما يتعلق باأللم‬

‫عزيزي الممرض ‪ /‬الممرضة‪:‬‬

‫تهدف هذه الدراسة إلى تقييم معارف الممرضين والممرضات تجاه األلم وإدارته في مستشفى الحلة التعليمي في بابل‪.‬‬
‫علما ان المعلومات سرية و ستستخدم‪ j‬الغراض علمية ومهنية من أجل التركيز على تقديم أفضل رعاية ممكنة للمرضى‬
‫الراقدين في المستشفى الذين يعانون من األلم من خالل معالجة األلم بالطرق‪ j‬العالجية الدوائية وغير الدوائية ‪ ،‬وكذلك‬
‫‪.‬منع اإلدمان العرضي‪ j‬نتيجة الستهالك األدوية األفيونية‬

‫‪.‬يرجى اإلجابة على األسئلة بمصداقية وموضوعية‪ .‬يسمح ألي مشارك باالنسحاب في أي وقت دون أي مبرر‬

‫شكرا لتعاونكم‬

‫الجزءاالول‪ :‬المعلومات الديموغرافية‬

‫العمر‪ …………… :‬سنة‬

‫أنثى‬ ‫ذكر‬ ‫الجنس‪:‬‬

‫ارمل‪/‬ة‬ ‫مطلق‪/‬ة‬ ‫متزوج‪/‬ة‬ ‫اعزب‪/‬عزباء‬ ‫الحالة الزوجية‪:‬‬

 ‫الجزء الثاني‪ :‬تقييم معارف الممرضين حول األلم‬
‫‪ ‬‬

‫صواب ‪ /‬خطأ ‪ -‬ضع ‪‬أمام العبارة الصحيحة و ‪ ‬أمام العبارة الخاطئة‪.‬‬

‫العالمات الحيوية دائما تعتبر مؤشرات موثوقة لشدة آالم المريض‪.‬‬ ‫‪.1‬‬

‫المرضى الذين يمكن صرف انتباههم عن األلم ال يعانون عادة من ألم شديد‪.‬‬ ‫‪.2‬‬

‫من الممكن ان ينام المرضى على الرغم من األلم الشديد‪.‬‬ ‫‪.3‬‬

‫من النادر حدوث تثبيط الجهاز التنفسي (نقص التهوية الرئوية) في المرضى الذين يتلقون جرعات ثابتة من المواد األفيونية على مدى‬ ‫‪.4‬‬

‫أشهر‪.‬‬

‫قد يؤدي الجمع بين المسكنات التي تعمل بواسطة آليات مختلفة (على سبيل المثال ‪ ،‬الجمع بين مضادات االلتهاب غير الستيروئيدية‪ j‬مع‬ ‫‪.5‬‬

‫مادة أفيونية) إلى تحسين السيطرة على األلم مع آثار جانبية أقل من استخدام عامل مسكن واحد‪.‬‬

‫المدة المعتادة لتسكين األلم بعد اعطاء ‪ 2-1‬ملغ من المورفين بالحقن الوريدي هي ‪ 5-4‬ساعات‪.‬‬ ‫‪.6‬‬

‫ال يجوز أن تستخدم المواد األفيونية في المرضى الذين لديهم تاريخ من تعاطي المخدرات‪.‬‬ ‫‪.7‬‬

‫المرضى المسنين ال يستطيعون تحمل المواد األفيونية كعالج لتخفيف اآللم‪.‬‬ ‫‪.8‬‬

‫يجب تشجيع المرضى على تحمل أكبر قدر ممكن من األلم قبل استخدام المواد األفيونية‪.‬‬ ‫‪.9‬‬

‫المعتقدات الروحية للمرضى قد تقودهم إلى التفكير بأن األلم والمعاناة ضروريين‪.‬‬ ‫‪.10‬‬

‫بعد إعطاء جرعة أولية من مسكن األفيونيات ‪ ،‬يجب ضبط الجرعات الالحقة وفقًا الستجابة الفردية المريض‪.‬‬ ‫‪.11‬‬

‫إعطاء المرضى الماء المعقم ‪ Sterile water‬عن طريق الحقن (الدواء الوهمي) هو اختبار مفيد لتحديد ما إذا كان األلم حقيقيًا‪.‬‬ ‫‪.12‬‬
‫إذا كان مصدر ألم المريض غير معروف ‪ ،‬يجب عدم استخدام المواد األفيونية خالل فترة تقييم األلم ‪ ،‬ألن هذا قد يؤثر على تشخيص‬ ‫‪.13‬‬

‫سبب األلم بشكل صحيح‪.‬‬

‫األدوية المضادة للصرع مثل الجابابنتين (‪ )gabapentin‬تخفف األلم بشكل مثالي بعد جرعة واحدة‪.‬‬ ‫‪.14‬‬

‫البنزوديازيبينات ‪ Benzodiazepines‬ليست مسكنات لأللم ونادراً ما يوصى بها كجزء من المسكنات‪.‬‬ ‫‪.15‬‬

‫يُع َّر ف إدمان المخدرات و المواد األفيونية بأنه مرض بيولوجي عصبي مزمن ‪ ،‬يتميز بسلوكيات تشمل واحداً أو أكثر من األمور‬ ‫‪.16‬‬

‫التالية‪ :‬اساءة استخدام االدوية ‪ ،‬والتعاطي القهري ‪ ،‬والتعاطي المستمر على الرغم من األذى‪ ,‬والرغبة الملحة في اخذ الدواء‪.‬‬

‫يوصى بتقييم تخدير األلم (تسكين االلم) أثناء عالج األلم بواسطة المواد األفيونية ألن التخدير المفرط يؤدي الى تثبيط الجهاز التنفسي‬ ‫‪.17‬‬

‫(نفص التهوية) الناتج عن المواد األفيونية‪.‬‬

‫اختر االختيار الصحيح مما يلي‪:‬‬

‫طريق االعطاء الموصى بها للمسكنات األفيونية للمرضى الذين يعانون من آالم وجيزة‪,‬حادة و مفاجئة مثل الصدمة أو ألم ما بعد‬ ‫‪.1‬‬
‫الجراحة هو‪:‬‬
‫أ‪ .‬وريدي‬
 ‫ب‪ .‬حقن عضلي‬
‫ج‪ .‬تحت الجلد‬
‫د‪ .‬عن طريق الفم‬
‫ه‪ .‬شرجي‬
‫جرعة ‪ 30‬ملغ من المورفين عن طريق الفم تعادل تقريبا‪:‬‬ ‫‪.2‬‬
‫أ‪ .‬المورفين ‪ IV 5‬ملغ‬
‫ب‪ .‬المورفين ‪ IV 10‬ملغ‬
‫ج‪ .‬مورفين ‪ IV 30‬ملغ‬
‫د‪ .‬مورفين‪ IV 60‬ملغ‬
‫في البداية‪ ,‬يجب إعطاء مسكنات األلم بعد العملية الجراحية‪:‬‬ ‫‪.3‬‬
‫أ‪ .‬على مدار الساعة على جدول زمني محدد‬
‫ب‪ .‬فقط عندما يسأل المريض عن الدواء‬
‫ج‪ .‬فقط عندما بحدد الممرض‪/‬ة أن المريض يعاني من ألم متوسط الشدة او اعلى‪.‬‬
‫السبب األكثر ترجي ًحا لطلب المريض المصاب باأللم لجرعات متزايدة من الدواء هو‪:‬‬ ‫‪.4‬‬
‫أ‪ .‬المريض يعاني من زيادة األلم‪.‬‬
‫ب‪ .‬المريض يعاني من زيادة القلق أو التثبيط‪.‬‬
‫ج‪ .‬يطلب المريض المزيد من انتباه الموظفين‪.‬‬
‫د‪ .‬ترتبط طلبات المريض باإلدمان‪.‬‬
‫الشخص األكثر دقة في قياس شدة آالم المريض هو‬ ‫‪.5‬‬
‫أ‪ .‬الطبيب المعالج‬
‫ب‪ .‬الممرض‪/‬ة‬
‫ج‪ .‬المريض‬
‫د‪ .‬الصيدالني‬
‫ه‪ .‬زوجة المريض أو عائلت‬
‫‪ .‬ما مدى احتمالية إصابة المرضى الذين يعانون من األلم بالفعل بمشكلة تعاطي الكحول و ‪ /‬أو المخدرات‬ ‫‪.6‬‬
‫أ‪٪1< .‬‬
‫ب‪٪15 - 5 .‬‬
‫ج‪٪50 - 25 .‬‬
‫د‪٪100 - 75 .‬‬
‫وقت ذروة تأثير المورفين ‪ IV‬هو‪:‬‬ ‫‪.7‬‬
‫أ‪ 15 .‬دقيقة‬
‫ب‪ 45 .‬دقيقة‬
‫ج‪ 1 .‬ساعة‬
‫د‪ .‬ساعاتين‬
‫وقت ذروة تأثير المورفين المعطى عن طريق الفم هو‪:‬‬ ‫‪.8‬‬
‫أ‪ 5 .‬دقائق‬
‫ب‪ 30 .‬دقيقة‬
‫ج‪ 12 .‬ساعة‬
‫د‪ 3 .‬ساعات‬

‫بعد التوقف المفاجئ لألفيونيات ‪ ،‬يتجلى االعتماد الجسدي (االدمان) بما يلي‪:‬‬ ‫‪.9‬‬
‫أ‪ .‬التعرق والتثاؤب واإلسهال واثارة المشاكل مع المرضى عندما يتم إيقاف األفيونيات بشكل مفاجئ‪.‬‬
‫ب‪ .‬ضعف السيطرة على تعاطي المخدرات ‪ ،‬واستخدام القهري ‪ ،‬والرغبة‬
‫ج‪ .‬الحاجة إلى جرعات أعلى لتحقيق نفس التأثير‪.‬‬
‫د‪ .‬أ و ب‬
‫أي العبارات التالية هو الصحيح فيما يتعلق بالتثبيط التنفسي (نقص التهوية) الذي تسببه األفيونيات‪:‬‬ ‫‪.10‬‬
 ‫أ‪ .‬يحدث بصورة شائعة بعدة ليال بعد العملية الجراحية بسبب تراكم المواد األفيونية‪.‬‬
‫ب‪ .‬توقف التنفس أثناء النوم هو عامل خطر مهم لالصابة بنقص التهوية‪.‬‬
‫ج‪ .‬يكون اكثر حدوثا ّ في اولئك الذين هم بالفعل يأخذون جرعات اكبر من المواد األفيونية قبل الجراحة‪.‬‬
‫د‪ .‬يمكن تقييمها بسهولة باستخدام مقياس تأكسج النبض المتقطع ‪.pulse oximetry‬‬

‫الحاالت (يرجى اختيار إجابة واحدة لكل سؤال)‪ :‬يتم تقديم حالتين لكل مريض حيث يطلب منك اتخاذ قرارات بشأن األلم‬
‫والدواء‪.‬‬

‫المريض أ‪ :‬علي يبلغ من العمر ‪ 25‬عا ًم ا ‪ ،‬اليوم هو أول يوم له بعد جراحة في البطن‪ .‬عند دخولك غرفته ‪ ،‬يبتسم علي إليك ويواصل‬ ‫‪.11‬‬
‫الحديث والمزاح مع زائريه‪ .‬وعند اخذك لعالماته الحيوية تجد ان ضعط الدم يساوي ‪120/80 :‬؛ معدل دفات قلبه = ‪ 80‬دقه لكل‬
‫دقيقه ؛ ومعدل تنفسه = ‪ 18‬؛ على مقياس من ‪ 0‬إلى ‪ = 0( 10‬ال يوجد ألم ‪ /‬إزعاج ‪ = 10 ،‬أسوأ ألم ‪ /‬إزعاج) علي يق ّدر ألمه ‪.8‬‬
‫أ‪ .‬في سجل المريض ‪ ،‬يجب عليك وضع عالمة على شدة ألمه بالمقياس أدناه‪ .‬ضع دائرة حول الرقم الذي يمثل تقييمك لشدة ألم علي‪:‬‬
‫‪10‬‬ ‫‪9‬‬ ‫‪8‬‬ ‫‪7‬‬ ‫‪6‬‬ ‫‪5‬‬ ‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬
‫‪--------------------------------------------------------------------------------------------------------------------‬‬
‫أسوأ ألم ‪ /‬إزعاج‬ ‫ال ألم ‪ /‬إزعاج‬

‫ب‪ .‬تم إجراء تقييمك ‪ ،‬أعاله ‪ ،‬بعد ساعتين من تلقيه اجرعة مورفين ‪ 2‬مجم ‪ . IV‬تراوحت معدالت األلم بعد نصف ساعة من الحقن من ‪6‬‬
‫إلى ‪ 8‬ولم يكن لديه أي تثبيط في الجهاز التنفسي (نقص التهوية) أو تخدير أو أي آثار جانبية أخرى غير مرغوب فيها سريريًا‪ .‬وقد حدد‬
‫‪ 2/10‬كمستوى مقبول لتخفيف اآلالم‪ .‬الطبيب الخاص به قد وصف "مورفين ‪ IV 3-1‬ملغم كل ساعة عند الحاجة‪ ".‬تحقق من اإلجراء الذي‬
‫ستتخذه في هذا الوقت‪.‬‬
‫‪ .1‬عدم اعطاء أي المورفين في هذا الوقت‪.‬‬
‫‪ .2‬اعطاء المورفين ‪ 1‬ملغ الرابع ‪IV‬‬
‫‪ .3‬اعطاء المورفين ‪ 2‬ملغ ‪ IV‬اآلن‪.‬‬
‫‪ .4‬اعطاء المورفين ‪ 3‬ملغ ‪ IV‬اآلن‪.‬‬

‫‪.12‬المريض ب‪ :‬أحمد يبلغ من العمر ‪ 25‬عا ًم ا ‪ ،‬واليوم هو أول يوم له بعد جراحة البطن‪ .‬عند دخولك غرفته ‪ ،‬تجد احمد يستلقي بهدوء على‬
‫السرير و يتلوى وهو يستدير في السرير‪ .‬وعند اخذك لعالماته الحيوية تجد ان ضعط الدم يساوي‪BP = 120/80 :‬؛ معدل دقات قلبه= ‪ 80‬؛‬
‫ومعدل التنفس = ‪ 18‬؛ على مقياس من ‪ 0‬إلى ‪ = 0( 10‬ال يوجد ألم ‪ /‬إزعاج ‪ = 10 ،‬أسوأ ألم ‪ /‬إزعاج) أحمد يق ّدر ألمه إلى ‪.8‬‬
‫ج‪ .‬في سجل المريض ‪ ،‬يجب عليك وضع عالمة على شدة ألمه بالمقياس أدناه‪ .‬ضع دائرة حول الرقم الذي يمثل تقييمك لشدة آلم احمد‪:‬‬
 ‫‪10‬‬ ‫‪9‬‬ ‫‪8‬‬ ‫‪7‬‬ ‫‪6‬‬ ‫‪5‬‬ ‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬
‫‪--------------------------------------------------------------------------------------------------------------------‬‬
‫أسوأ ألم ‪ /‬إزعاج‬ ‫ال ألم ‪ /‬إزعاج‬

‫ب‪ .‬تم إجراء تقييمك ‪ ،‬أعاله ‪ ،‬بعد ساعتين من تلقيه اجرعة مورفين ‪ 2‬مجم ‪ . IV‬تراوحت معدالت األلم بعد نصف ساعة من الحقن من ‪6‬‬
‫إلى ‪ 8‬ولم يكن لديه أي تثبيط في الجهاز التنفسي (نقص التهوية) أو تخدير أو أي آثار جانبية أخرى غير مرغوب فيها سريريًا‪ .‬وقد حدد‬
‫‪ 2/10‬كمستوى مقبول لتخفيف اآلالم‪ .‬الطبيب الخاص به قد وصف "مورفين ‪ IV 3-1‬ملغم كل ساعة عند الحاجة‪ ".‬تحقق من اإلجراء الذي‬
‫ستتخذه في هذا الوقت‪.‬‬
‫‪ .1‬عدم اعطاء أي المورفين في هذا الوقت‪.‬‬
‫‪ .2‬اعطاء المورفين ‪ 1‬ملغ الرابع ‪IV‬‬
‫‪ .3‬اعطاء المورفين ‪ 2‬ملغ ‪ IV‬اآلن‪.‬‬
‫‪ .4‬اعطاء المورفين ‪ 3‬ملغ ‪ IV‬اآلن‪.‬‬

‫شكرا لتعاونكم‬

‫‪University of Babylon‬‬

‫‪College of Nursing‬‬
 Graduation Research Project

Knowledge and Attitudes Survey Regarding Pain (KASRP)

This study aims to explore nurses' knowledge toward pain assessment and management

in Al-Hilla Teaching Hospital, Babylon. Results will only be used for scientific research

discussion in order to focus on the best possible care for hospitalized patients suffering

from pain through pain management with pharmaceutical and non- pharmaceutical

therapies, as well as preventing accidental addictions as a result of opioid medications

consumption.

Please answer the questions with credibility and objectively. Any participant will be

allowed to withdraw at any time without any justification.

THANK YOU FOR YOUR PARTICPATION

First Part: Demographic Characteristics

Age: …....... years

Gender: Male Female

Material Status: Single Married Divorced Widowed

Residence: Urban Rural

Educational level: Intermediate High Nursing School Nursing Institute

Nursing college

Training Sessions in pain management: Yes No

Second Part: Nurses Knowledge Survey Regarding Pain

True/False – put T in front of true statement and F in front of false statement.

1. Vital signs are always reliable indicators of the intensity of a patient’s pain.
2. Patients who can be distracted from pain usually do not have severe pain.
3. Patients may sleep in spite of severe pain.
4. Respiratory depression rarely occurs in patients who have been receiving stable doses
of opioids over a period of months.
5. Combining analgesics that work by different mechanisms (e.g., combining an NSAID
with an opioid) may result in better pain control with fewer side effects than using a
single analgesic agent.
6. The usual duration of analgesia of 1-2 mg morphine IV is 4-5 hours.
7. Opioids should not be used in patients with a history of substance abuse.
8. Elderly patients cannot tolerate opioids for pain relief.
9. Patients should be encouraged to endure as much pain as possible before using an
opioid.
10.Patients’ spiritual beliefs may lead them to think pain and suffering are necessary.
11. After an initial dose of opioid analgesic is given, subsequent doses should be adjusted
in accordance with the individual patient’s response.
12.Giving patients sterile water by injection (placebo) is a useful test to determine if the
pain is real.
13.If the source of the patient’s pain is unknown, opioids should not be used during the
pain evaluation period, as this could mask the ability to correctly diagnose the cause of
pain.
14.Anticonvulsant drugs such as gabapentin (Neurontin) produce optimal pain relief after
a single dose.
15.Benzodiazepines are not effective pain relievers and are rarely recommended as part of
an analgesic regiment.

16.Narcotic/opioid addiction is defined as a chronic neurobiologic disease, characterized

by behaviors that include one or more of the following: impaired control over drug
use, compulsive use, continued use despite harm, and craving.
17.Sedation assessment is recommended during opioid pain management because
excessive sedation precedes opioid-induced respiratory depression.
section Multiple Choice – Place a check by the correct answer.

18. The recommended route administration of opioid analgesics for patients with brief, severe pain of
sudden onset such as trauma or postoperative pain is
a. Intravenous
b.Intramuscular
c. Subcutaneous
d.Oral
e.Rectal
19. A 30 mg dose of oral morphine is approximately equivalent to:
a. Morphine 5 mg IV
b.Morphine 10 mg IV
c. Morphine 30 mg IV
d.Morphine 60 mg IV
20. Analgesics for post-operative pain should initially be given
a. around the clock on a fixed schedule
b.only when the patient asks for the medication
c. only when the nurse determines that the patient has moderate or greater discomfort
21. The most likely reason a patient with pain would request increased doses of pain medication is
a. The patient is experiencing increased pain.
b.The patient is experiencing increased anxiety or depression.
c. The patient is requesting more staff attention.
d.The patient’s requests are related to addiction.
22. The most accurate judge of the intensity of the patient’s pain is
a. the treating physician
b.the patient’s primary nurse
c. the patient
d.the pharmacist
e. the patient’s spouse or family
23. How likely is it that patients who develop pain already have an alcohol and/or drug abuse problem?
a. very low
b. low
c. medium
d. high
24. The time to peak effect for morphine given IV is
a. 15 min.
b. 45 min.
c. hour.
d. hours
25. The time to peak effect for morphine given orally is
a. 5 min.
b. 30 min.
c. 1 – 2 hours
d. 3 hours
26. Following abrupt discontinuation of an opioid, physical dependence is manifested by the following:
a. sweating, yawning, diarrhea and agitation with patients when the opioid is abruptly
discontinued.
b. Impaired control over drug use, compulsive use, and craving.
c. The need for higher doses to achieve the same effect.
d. a and b
27. Which statement is true regarding opioid induced respiratory depression:
a. More common several nights after surgery due to accumulation of opioid.
b. Obstructive sleep apnea is an important risk factor.
c. Occurs more frequently in those already on higher doses of opioids before surgery.
d. Can be easily assessed using intermittent pulse oximetry.

Case Studies (Please select one answer for each question.): Two patient case studies are
presented. For each patient you are asked to make decisions about pain and medication.

28. Patient A: Ali is 25 years old and this is his first day following abdominal surgery. As you enter his
room, he smiles at you and continues talking and joking with his visitor. Your assessment reveals the
following information: BP = 120/80; HR = 80; R = 18; on a scale of 0 to 10 (0 = no pain/discomfort, 10
= worst pain/discomfort) he rates his pain as 8.
A. On the patient’s record you must mark his pain on the scale below. Circle the number that
represents your assessment of Ali’s pain:

0 1 2 3 4 5 6 7 8 9 10

-----------------------------------------------------------------------------------------------------------------------------------------------

No pain/discomfort Worst Pain/discomfort

B. Your assessment, above, is made two hours after he received morphine 2 mg IV. Half hourly
pain ratings following the injection ranged from 6 to 8 and he had no clinically significant
respiratory depression, sedation, or other untoward side effects. He has identified 2/10 as an
acceptable level of pain relief. His physician’s order for analgesia is “morphine IV 1-3 mg q1h
PRN pain relief.” Check the action you will take at this time.
a. Administer no morphine at this time.
b. Administer morphine 1 mg IV now.
c. Administer morphine 2 mg IV now.
d. Administer morphine 3 mg IV now.
29. Patient B: Ahmed is 25 years old and this is his first day following abdominal surgery. As you enter his
room, he is lying quietly in bed and grimaces as he turns in bed. Your assessment reveals the
following information: BP = 120/80; HR = 80; R = 18; on a scale of 0 to 10 (0 = no pain/discomfort, 10 =
worst pain/discomfort) he rates his pain as 8.
C. On the patient’s record you must mark his pain on the scale below. Circle the number that
represents your assessment of Ahmed’s pain:

0 1 2 3 4 5 6 7 8 9 10

-----------------------------------------------------------------------------------------------------------------------------------------------

No pain/discomfort Worst Pain/discomfort

D. Your assessment, above, is made two hours after he received morphine 2 mg IV. Half hourly
pain ratings following the injection ranged from 6 to 8 and he had no clinically significant
respiratory depression, sedation, or other untoward side effects. He has identified 2/10 as an
acceptable level of pain relief. His physician’s order for analgesia is “morphine IV 1-3 mg q1h
PRN pain relief.” Check the action you will take at this time:
a. Administer no morphine at this time.
b. Administer morphine 1 mg IV now.
c. Administer morphine 2 mg IV now.
d. Administer morphine 3 mg IV now.

THANK YOU FOR YOUR PARTICPATION