Factors Influencing Post-Operative Pain Management Among Neonates at Moi Teaching and Referral Hospital, Kenya

Abstract

Background: Neonatal post-operative pain management poses a unique challenge particularly with regard to assessing and treating the pain. In spite of the existence of empirical evidence on safety and effectiveness of neonatal postoperative pain management strategies, little is known about postoperative pain assessment and management practices in neonatal units in Kenya. In the Newborn Unit (NBU) at Moi Teaching and Referral Hospital (MTRH), neonatal assessment and treatment of neonatal postoperative pain is influenced by the knowledge base and personal decision of the health care provider. Objective: The objective of the study was to determine factors influencing postoperative pain management practices among neonates at MTRH, in Kenya in order to inform policy. Methods: This was a descriptive cross-sectional study design. The study was done at the newborn unit at MTRH, Eldoret. A semi –structured questionnaire and observation check-list was used to collect data. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0 program and presented in tables, graphs, frequencies and content analysis. Statistical techniques including logistic regression and correlation statistical procedures were employed in analysis. Results: Data from 45 health care providers were collected. The mean years of practice were 9 years, while the mean score for the assessment was 3.7. There was a negative correlation (r = - 0.058) between professional years of practice and assessment scores though it was not significant 0.703. There was a positive correlation between the intervention scores and professional years of practice (r = 0.028, p > 0.05) hence not significant. There was a positive correlation between the intervention scores and assessment scores (r = 0.546) and it was statistically significant p < 0.001. The mean score between doctors and the nurses differed and was slightly higher on assessment as compared to intervention. All health care providers cited that there were no written guidelines and pain assessment scale for use at NBU. Majority of the doctors and nurses had adequate knowledge on assessment of postoperative pain in neonates and the subsequent intervention to alleviate pain although none of them had attended any course on the same. Conclusion and Recommendations: From the study, there was lack of provision of objective tools to assess neonatal pain. Postoperative pain management was influenced by the knowledge base and personal decision of the health care provider. The study recommends the need for evidence-based guidelines for postoperative pain management at the newborn unit of MTRH. In addition, there is need for Continuing Professional Development for professional staff working at the newborn unit on the systematic assessment and management of postoperative pain in neonates.