– Assessment of Knowledge and Approaches of Nurses Towards Cancer Pain Management in Elderly Patients in Ahmadu Bello University Teaching Hospital, Zaria Kaduna State –
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ABSTRACT
Pain is the most disturbing and annoying symptom experienced by cancer patients, yet it is poorly managed. About 60-70% of cancer cases in Nigeria present in advance stage; at least 30% of such cases experience one or more types of pain,
which is almost pathognomic of the disease state. As a result, the study aimed at assessing nurses‟ knowledge, approaches rendered to elderly patient with pain and the challenges they encounter during cancer pain assessment and management at Ahmadu Bello University Teaching Hospital, Zaria.
A cross sectional descriptive research design was used where both questionnaire and observation were used to obtain information from 73 nurses.
The data obtained were analysed using descriptive and inferential statistics with the aid of SPSS version 22.0 as a tool for analysis.
Findings on level of knowledge revealed that only 24 (32.8%) of the nurses have knowledge on cancer pain in elderly which is below average.
The challenges nurses encountered during pain assessment include too many patients to assess (mean 4.1); absence of time for assessing patients with pain (mean 4.0);
TABLE OF CONTENT
Title page …………. ii
Declaration ………………iii
Certification…………………..iv
Acknowledgement……….vi
Table of Content ………………….vii
List of Tables…………………x
List of Figures …………………..xii
Abbreviation, Glossary and Symbols……………… xiii
Definition of Operational Terms……………. xiv
CHAPTER ONE…………….. 1
1.0 INTRODUCTION……………… 1
1.1 Background to the Study ………………… 1
1.2 Statement of the Problem ……………………….. 4
1.3 Aim and Objectives of the Study…………… 6
1.4 Significance of the study ………………. 7
1.5 Research Questions ………………… 8
1.6 Scope of the study ……………… 8
CHAPTER TWO………… 10
2.0 REVIEW OF RELATED LITERATURE …………… 10
2.1 Introduction ………………… 10
2.2 Conceptual Review of Cancer Pain…………. 10
2.2.1 Causes of Cancer Pain …………….. 11
2.2.2 Types of therapies that stimulate pain in cancer patients………….. 11
2.2.3 Classification of cancer pain……………. 13
2.2.4 Pathophysiology of Cancer Pain………………… 14
2.3 Knowledge of Nurses on cancer pain in elderly patients. ………… 15
2.4 Cancer Pain Assessment in elderly……………….. 17
2.4.1 Assessment Tools……………….. 18
2.4.2 Challenges faced by Nurses during cancer pain assessment in elderly ……………. 24
2.5 Cancer Pain Management in Elderly…………………. 26
2.5.1 Pharmacologic Management of Pain in the Elderly …………. 26
2.5.2 Non pharmacologic Management of Pain …………………… 31
2.5.3 Challenges faced by Nurses during Management of cancer pain in elderly………. 34
2.6 Effects of pain on the life of an elderly ……………… 36
2.7 Approaches of Nurses in Cancer Pain Management ………………… 37
2.8 Empirical Review………………………….. 38
2.9 Theoretical Review…………………….. 40
CHAPTER THREE ………………………… 44
3.0 RESEARCH METHOD…………….. 44
3.1 Introduction ……………….. 44
3.2 Research Design …………… 44
3.3 Study Area……………………………. 44
3.4 Population of the Study ……………….. 45
3.4.1 Inclusion criteria……………. 46
3.4.2 Exclusion Criteria……………… 46
3.6 Sample Size ……………….. 46
3.6 Sampling Technique……………. 46
3.7 Instruments for Data Collection …………….. 47
3.8 Validity……………… 48
3.8 Reliability ………………. 48
3.10 Method of Data Analysis………….. 50
3.11 Ethical consideration ………………… 50
CHAPTER FOUR …………….. 51
RESULTS……………………. 51
4.1 Introduction ………………….. 51
CHAPTER FIVE……………….. 67
DISCUSSION………………….. 67
5.1 Introduction ……………………. 69
5.4 Discussion of findings in relation to Roy Adaptation Model……….. 73
CHAPTER SIX………………. 76
SUMMARY, CONCLUSION AND RECOMMENDATIONS ……….. 76
6.0 Introduction ……………….. 76
6.1 Summary …………………….. 76
6.2 Conclusion………………………. 77
6.3 Implications to nursing…………………. 78
6.4 Limitations of the study……………….. 78
6.5 Recommendation………………… 79
6.6 Suggestion for further studies………………………. 80
References…………………. 81
INTRODUCTION
Cancer is a term for diseases in which abnormal cells divide without control and can invade nearby tissues (National Cancer Institute, 2015).
Defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs, the latter process is referred to as metastasis (National Cancer Institute, 2015). Metastases are a major cause of death from cancer (World Health Organisation, 2017).
Cancer is the second leading cause of death globally, and was responsible for 8.8 million deaths in 2015. Globally, nearly 1 in 6 deaths is due to cancer (World Health Organisation, 2017).
Ageing is a fundamental factor for the development of cancer because the incidence of cancer rises dramatically with age, most likely due to a build-up of risks for specific cancers that increase with age (World Health Organisation, 2017).
The incidence of malignancies after the age of 65 years has increased 11-fold compared to younger adults (Marosi & Köller, 2016).
Nearly 80% of all cancers are diagnosed in persons beyond the age of 55 years (Palli, Fortpied, & Wedding, 2010).
The median age of diagnosis in many tumours lies beyond the age of 60 years, for example, hormone-sensitive breast cancer, multiple myeloma, renal, prostate and colon cancer (Arnold, Karim-Kos, & Coebergh, 2015).
The prevalence of cancer pain is estimated in 25 to 50% for recently diagnosed patients, in 33 to 80% for patients under treatment, and in approximately 75 to 100% for those in advanced and terminal states (Oliveira, Sobrinho, & Cunha, 2016).
REFERENCES
Adewuyi, S., Ajekigbe, A., Campbell, O., Mbibu, N., Oguntayo, A., Kolawole, M., . . . Shehu,
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Radiotherapy and Oncology Centre, Ahmadu Bello University Teaching Hospital, Zaria
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