Characteristics of the Final Year Nursing Students
The present study used a descriptive cross-sectional design to determine the level of knowledge and attitude on (n = 190) final year nursing students related to pain assessment and management at Asmara College of Health Sciences in 2018. The result displayed that knowledge and attitude on (n = 190) final year nursing students nurses related to pain assessment and management was not satisfactory.
In the present study majority of the respondentswere Diploma (39.5%), from age of 19–24 were (39.7%), (60.5%) were male, (56.3) mentioned no training on pain,(63.7%) had taken course on pain, (40%)&(42%) had three and four years of study in nursing respectively, 84% were Christian,(64%) were with no work category/work experience,88% were Tigrigna by ethnicity,82% were placed in the general nursing program and 59% was having commutative GPA of 2.75–3.24.
This finding was supported on a similar study by (25) carried out research entitled ‘medical nurse’s knowledge and attitude regarding pain management’ on 75 nurses and his study revealed that there were 62 females (82.7%) and (17.3%) males. There were (45.3%) of nurses between the ages of 20 to 29. This small difference could be due to increasing awareness of health profession information in Eritrea and time of the study.
Moreover, this table also demonstrated if they were given any previous training regarding pain assessment and management, 83 (43.7%) said yes, but 107(56.3%) stated no previous training. A descriptive analysis on the course was taken and the percent score of respondents about pain management and assessment from above table showed the majority of the respondent 121 (63.7%) said yes, but 69 (36.3%) did not take any course. Also, the current study agreed with (3) which had revealed that (52%) of nurses reported no previous pain education in the last five years.
On the other hand, this study found out the year/s of study in nursing by average percent score of the respondents. The highest scores were from those who had studded six Years 5(62%) followed by 7&5 years 11 (59.8%) and 18 (59%) respectively. Majority of the respondents were those who studied 3 years scored 75(43%), but all scored below the satisfactory result (80%). Most of the respondents by religion were Christian 159 (84%) and Moslem were 26 (14%) and the rest were included in other religions scored. Work category/experience was also used as a variable to study knowledge and attitude about pain assessment& management for final year nursing students. The majority said no work experience (64.7%) and the rest had work experience (35%). Majority of the ethnicity group (88%) were tigrigna followed by tigre (7.4 2), bilen (1.6%) and SAHO (1.1%). This table displayed Most of the respondents were AP 72 (38%) and generic students were 118 (62%). Specialist of nursing or type of nursing program involvement was also used as a variable of study.majority of the respondent 82% were in general nursing program, 8.9% were Anesthesia and 8.9% were Midwifery. Furthermost respondents were those who have a score of 2.745 to 3.24 (59%), but highest mean average percent score was from commutative GPA > = 3.75 (M = 56±8SD), but others had similar mean average percent score about knowledge and attitude regarding pain assessment & management on final years nursing students.
But there was no similar study arguing or supporting the above new finding for this research.
Table.1: Comparison of Knowledge and Attitude average Score with selected variables
This table presented the comparison of mean percent score of the respondents with different variables. Generally, all scores were below the satisfactory score of limit. Level of the study was compared by using diploma, Bachelor and masters. The mean score of masters was higher than the mean score of diploma and bachelors. This study was similar research conducted in Turkey (26), nurses with the highest educational level had significantly higher mean score than those with lower educational level (p = 0.001) and on another study nurses with higher educational level scored significantly higher mean score than nurses who had a lower educational level (19).
Using analysis of variance age was significant for the mean average percent score at (P<.000). There was a difference between the age group mean score among them. Moreover, there was moderate positive associational between Age and mean percent average score (r = 0.352, p =.000). On the present study, most were upgrading students, having a different year of experience in the ministry before they join the college.
To the contrary on the two studies (26, 19) no significant difference was found between the ages of the nurses, nurses work experience and the mean score of knowledge and attitude.
The mean percent score of the male was slightly higher than females, independent T-test showed (t = 1.2, p =.23), but not a statistically significant difference. When respondents were asked about any official training given before those who took were (47.3%) and did not took scores (48%). independent T-test showed this was not statistically significant. but In a research conducted in Turkey (26), nurses who had training about the pain after graduation and nurses who read books, journals on pain and its management had significantly higher mean score, in both cases p-value < 0.0001. This difference could be due to the time of study, geographical and cultural difference from country to country.
The number of study in the year was analyzed by ANOVA, the highest score was from those who studied six years and seven years. All the religions were having the same score, but both were not statically significant for the mean scores difference. On the same research (26), there was no significant relationship found between age, work experience, rank, and the nurses´ knowledge and attitude.
Besidesdes they were asked if they took any course regarding pain assessment and management, those who took scored 47.7% and those who did not take scored 52.3%. Nevertheless, independent T-test presented that this was not statically significant. A descriptive correlational design study conducted in the USA (23), nurses who attended courses or programs about pain management scored greater than those who had no training (P < 0.001) (7).
Age was also studied and categorized, the highest score by age was from PANS< = 26, PANS 27–53 and PM 23–26, which was also statistically significant for its variance at (P =.000)..In contrary a research conducted in Turkey (26) no significant association was found between age, work experience, rank, and nurses´ knowledge and attitude.
Work experience or work category was also used as a variable for the studying of pain assessments and management. Those who worked scored 64% and those who did not score 35%, which was not statistically significant for the difference. Another similar study that looked if the difference in knowledge and attitude exists between oncology and non-oncology nurses using the same instrument found no difference between these groups of nurses (19). The highest mean percent score by ethnicity was from Blien and Saho and Tigre had not statically significant.
Cumulative GPA was statistically significant at (P =.001). The highest score was from those who have 3.25 to 3.49, 3.5 to3.74 and > = 3. 75. Placement of the respondent was also compared and analyzed by independent T-test. Generic students had a higher score than AP students, which was statistically significant (P =.009).In research conducted in Turkey (19) no significant relationship was found between age, work experience, rank and nurses knowledge, and attitude.
Field of specialization area was studied and had statistical significance at (P =.000), the highest score was from Anesthesia and critical care (CC) followed by midwifery and general nursing.
Similar Study conducted to assess the knowledge and attitude of nurses working in the emergency department found no statistical differences between the average scores and the demographic data of the participants such as age, emergency working experience and level of education (16).
From the table of an association (table.3) with selected variable, the correlation result showed the only level of education, age, years of study, cumulative GPA and placement of study has an association with percent knowledge and attitude score, but the rest did not.
This result was not congruent with the study conducted by (10, 11, 19, 23 and 26). That had cited no significant relationship was found between age, work experience, rank, and the nurses' knowledge and attitude. But the only Level of education has moderate positive associational (r =.479, p =.000,). This could be described as the level of study increases, knowledge and attitude about assessment and management of pain to a final year nursing students also increases. The same result was found in research conducted in Turkey (26) nurses with the highest educational level had a significantly higher mean score than those with a lower educational level (p = 0.001). Besides, a study conducted in Jordan, nurses with a master degree scored higher in knowledge and attitude than those with baccalaureate degree P = 0.001, (23).
In this study Work experience or category did not have an association with the knowledge and attitude mean average percent(r =.109, p =.134). The same result was founded on research conducted in Turkey (26). No significant relationship was found between age, work experience, rank and nurse‘s knowledge, and attitude.
Another similar study that observed if the difference in knowledge and attitude exists between oncology and non-oncology nurses using the same instrument found no difference between these groups of nurses (19).
Any official training about pain management had a moderate positive association, but not statically significant with knowledge and attitude score of final year nursing students’(r =.034, P =.643). but In a research conducted in Turkey (26) similarly, nurses who had training about the pain after graduation and nurses who read books and journals on pain and its management had significantly higher mean score in both cases P = < 0.0001.Because most of the respondents were not engaged in training in the college or the ministry. Age had also an association with a mean percent score of knowledge and attitude at (r =.32, P =.000). Hence as age increase, knowledge and attitude also increase. A similar result was found from a study done by (14, 7), a descriptive correlational design study conducted in USA (23) found significant positive correlation between age and additional training in pain management (r = 0.32; P< .01).
Commutative GPA had positive correlation (r = 0.306** P =.000).Hence students with good GPA they also had good knowledge and attitude to assessment and management of pain. In research conducted in Turkey (26), no significant relationship was found between age, work experience, rank, and nurses´ knowledge and attitude. This difference showed the trend in pain issue is being changing.
Placement had weak negative correlation at(r = –0.189** P =.000).as placement in generic or regular academic status their assessment and management on pain decrease.but if they were upgrading or comes from workplace their score increased. There was no comparable result to this new finding.
This study found no statically significance on Work experience in nursing or related field of study (r = 0.109, P = 0.134).Similar study showed that Faculty who had a longer period for practice felt less prepared to manage pain properly than faculty with a shorter period to practice (23). A positive correlation was found between years of working experience and adequate preparation (r = 0.21) (23).
Similarly, nursing students mean score was 16.1±3.0 (41.3%) with a minimum score of 7 and a maximum score of 26(19).
Fig.3: Level of knowledge and attitude of final year nursing students
The average percent score was (47.7%±11.5). The lower mean percent average scores was 22 and highest was 94.4, this was out of eighty percent (80%). From 36 knowledge and attitude survey question about pain assessment and management the mean score was (17.2 ±4), with their lowest score was 8 and the highest was 34. Deficiencies in the management of pain have been directly related to the passive participation of nurses in assessing and managing patients with pain (2).
A similar survey was conducted to assess the nursing students’ knowledge and attitudes regarding pain management on children at three Jordan private universities (1). The mean score of the participants was 18.36 (SD = 6.30) from the Pediatric Nurses' Knowledge and Attitudes Survey (PNKAS) of 42 questions. Only 23.7% of the students obtained half and above, but none of the participants answered all the questions. The researcher concluded that Jordanian nursing students had poor knowledge and attitude regarding the management of pain in children (1).
On the contrary, on a similar study of nurses’ knowledge and attitudes regarding pain in Northern Ireland, (15) reported a mean score of 73.8% which was more favorable than this present study.