An ethnographic exploration of postoperative pain experiences among Ghanaian surgical patients

The experience of pain associated with surgery has been a challenge for health care professionals for many years, and culture is said to influence pain. Purpose: This study focused on patients’ experiences of postoperative pain (POP) and factors that affect POP. Design: The study employed qualitative ethnographic principles. Method: Data were collected through individual face-to-face interviews. Data were saturated after analyzing data from 13 patients from two hospitals in Ghana. Findings: Themes that emerged were the subjective nature of pain, which described pain dimensions and communication; psycho-sociocultural factors, such as personal inclinations and sociocultural background; and health system factors, such as personnel attitudes and health financing. Implications for Future Research and Practice: Health professionals need to understand the sociocultural effects of pain in order to give effective care. Conclusion: The study highlighted the need for patient education and the importance that health care professionals understand context-specific factors that influence POP management.Department of HE and Training approved lis

The Ghanaian surgical nurse and postoperative pain management: a clinical ethnographic insight

This study aimed at illuminating the perceptions and responses of Ghanaian surgical nurses regarding their patients’ POP. It also identified the factors that influenced nurses’ pain responses. A focused ethnography was used, and data were collected through individual interviews. Sampling was performed purposively to include junior, senior, day, and night nurses who cared for surgical patients. Concurrent data analysis was performed and data were saturated with 12 individual interviews. The findings indicated that nurses perceived POP as an individual phenomenon, and nurses responded to patients’ pain by administering analgesics and by using nonpharmacologic measures. Factors that influenced the nurses’ response were individual factors, such as commitment, discretion, fear of addiction, and organizational factors, such as organizational laxity and challenges of teamwork. The study recommended that nurses should be educated, supported, and encouraged to ensure pain relief after surgery and that they should see pain relief as a priority postoperative care to avert the negative repercussions of poorly managed POP.Web of Scienc

An insight into the preoperative experiences of Ghanaian general surgical patients

The unknown outcome of surgery has always been a source of anxiety for patients and their relatives. However, the experiences of Ghanaian surgical patients have not been adequately explored. This study sought to have an in-depth exploration of the preoperative experiences of Ghanaian general surgical patients to inform effective preoperative care. The study employed an ethnographic design and was conducted at two hospitals in Accra. Thirteen general surgical patients were purposively recruited and interviewed. Data analysis occurred concurrently and themes that emerged included reaction to impending surgery with subthemes of inappropriate disclosure, fear of death, readiness for surgery, and effect of waiting in the theatre. Also, the theme information gap had subthemes of preoperative care, expectations at the theatre, and undue delays. The study emphasized the need for health professionals to provide effective education to the public and patients, on surgery and its effects, to curb negative perceptions about surgery.Web of Scienc

Psychosocial factors influencing Ghanaian family caregivers in the post -operative care of their hospitalised patients

This study explored the psychosocial factors influencing family caregivers during the care of patients who had undergone surgery and were in pain. Family caregivers play key roles in the care of post-surgical patients in different cultures. However, research has not adequately explored family caregivers’ experiences within the post-operative context in Ghana. An exploratory qualitative design was employed. Data collection involved individual interviews. Concurrent content analysis was undertaken and saturation of data was achieved with 12 family caregivers and 1 key informant. The participants were recruited from the surgical department of a tertiary health facility in Accra, the capital city of Ghana. The study revealed six themes that influenced family caregivers in the care of post-surgical patients: faith, fear, feeling of relief, empathy, commitment and inadequate knowledge. Health professionals should meaningfully integrate and educate family caregivers on patient care and pain management within the post surgical context.Department of HE and Training approved lis

Determinants of nurses’ knowledge gap on pain management in Ghana

There are concerns about adequacy of nurses’ knowledge and skill in effective pain management since effective pain management promotes early recovery after surgery. This study explores factors that accounted for Ghanaian nurses’ inadequate knowledge of postoperative pain management using a focused ethnographic design for data collection at a tertiary teaching hospital in Ghana. Fourteen nurses designated as key informants with different backgrounds as nurse educators and leaders were purposively sampled to participate. Data were collected through in-depth individual interviews; all interviews were conducted in English, audio-taped and transcribed verbatim. The study revealed that nurses’ inadequate pain management knowledge might have resulted from curriculum gaps during training; inadequate clinical supervision, study days, and workshops for practising nurses; lack of funding for organising regular workshops; and, negative attitudes of nurses whereby new information learned at workshops was not readily applied in clinical practice. It was concluded that nursing curricula at all levels of training in Ghana should incorporate credit-bearing courses on pain management, and appropriate pain management education programmes should be instituted for practising nurses. Regular monitoring and evaluation of the impact of such education programs is required.Web of Scienc

Perspectives of the surgeons, anaesthetists, and pharmacists on post-operative pain management roles in the Ghanaian context

Post-operative pain is best managed by a multi-disciplinary team approach. An extensive review of the literature indicated that little is known about the roles of surgeons, anaesthetists, and pharmacists regarding post-operative pain management in Ghana. Therefore, this study was undertaken in order to fully understand how health professionals perceive their roles and the challenges that influence their decisions about post-operative pain management. A qualitative approach with a focused ethnographic design was employed involving eleven in-depth individual interviews. Purposive sampling approach was employed. The study was conducted at a tertiary hospital in Accra, Ghana. The study revealed that surgeons and anaesthetists practised pre-emptive analgesia by administering intra-operative analgesia, giving nerve blocks, and infiltrating surgical wounds. Sometimes, epidural analgesia and perfusers were used for patients who could afford them, particularly if they were expected to experience severe post-operative pain. Challenges reported by all the participants related to inadequate personnel, opioid effect and availability, inadequate training and collaboration, and effects of organisational culture were identified. It was concluded that effective collaboration among health professionals could enhance post-operative pain management. There is a need for enhanced commitment, in order to provide more effective post-operative pain management.Department of HE and Training approved lis

Development of clinical guidelines for the management of post-operative pain within the medico-socio-cultural context of Ghana

Philosophiae Doctor - PhDLiterature on post-operative pain indicates that post-operative pain is inadequately managed in many countries including Ghana. Little was also known about post-operative pain (POP) response and management in Ghana. This study sought to describe post-operative pain response and management among Ghanaian surgical nurses and post-operative patients within the medico-socio-cultural context. It also explored factors that influenced POP response and management and subsequently aimed to develop clinical guidelines within which post-operative pain could be managed in the medico-socio-cultural context. Research questions answered included: „what are the factors influencing post-operative pain responses among surgical patients and nurses; what clinical guidelines would be appropriate to guide post-operative pain management within the medico-socio-cultural context of Ghana?‟The study was designed as a multi-step focused ethnography which allowed the exploration of a specific sub-culture such as the surgical environment. The philosophical underpinnings of ethnography permit the investigator to use different data collection methods to fully understand the phenomenon investigated. Data collection during the ethnographic exploration phase involved individual interviews, clinical observations, and review of patients‟ clinical charts. At the stage of guideline development, data was collected through participant/expert review, systematic literature review, and consensus forum. Participants were sampled purposively and included 53 interview participants, 27 expert reviewers, and 29 consensus panel members. Also, there were 16 sections of clinical observation and review of 44 charts. The participants included nurses, patients and their relatives, the multidisciplinary team, key informants, experts, and stakeholders. The study was conducted at the Korle-Bu Teaching Hospital (KBTH) and Ridge Hospital, in Accra, Ghana. Appropriate ethical clearance was sought and individual informed consent was obtained.Concurrent analysis of data was done applying the principles of thematic content analysis and data was managed with NVivo 9. Themes that emerged from the patients‟ data were subjectivism which described pain dimensions and expressions and factors that influenced patients‟ pain experience were psycho-socio-cultural factors such as personal inclinations and socio-cultural background; and health system factors such as personnel attitude and health financing.The study also found that nurses perceived POP as an individual phenomenon and responded to pain by administering analgesics and by employing non-pharmacologic measures such as positioning and reassurance. Factors that influenced the nurses‟ pain response were individual factors such as commitment, discretion, and fear of addiction; and organizational factors such as organizational laxity and challenges of teamwork. Patients‟ relatives were also influenced by empathy, faith, and commitment to care for their post-operative patients. The multidisciplinary team and key informants were influenced by knowledge and experience in their respective specialty areas. Subsequently, the clinical guideline developed had four dimensions which highlighted patient and family education,effective teamwork, effective leadership and monitoring, and use of contemporary evidence for POP management.The study recommended that health professionals should be conscious of the subjectivenature of pain and they should educate and involve the patient on pain management decisions. Also, hospital leadership and the multidisciplinary team should be actively involved in pain management

Influence of Educational Level on Knowledge and Practice of Breast Self‑examination Among Women in Sokoto, Nigeria

Background: Breast cancer is the leading cause of cancer death among women worldwide. Breast self‑examination (BSE) remains the most effective means of early detection of breast cancer among women in middle‑ and low‑income countries where mammography is neither available nor affordable.Aim: This study explored the influence of educational level on knowledge and practice of BSE among women in Sokoto, Nigeria.Subjects and Methods: A quantitative cross‑sectional design was employed using structured questionnaire. A sample of 400 participants was selected for the study using multistage sampling technique among educated women in Sokoto. Statistical Package for Social Sciences (SPSS version 20.0, IBM Corp, New York) was used for data analysis. Chi‑square was used to establish significant relationships.Results: Findings showed that 75% (294/392) of women had average knowledge of BSE, but only 34.4% (135/392) practiced BSE regularly. Moreover, there was a significant relationship between educational level and the knowledge and practice of BSE.Conclusion: Findings of this study suggest that though women may have knowledge about BSE, the practice of BSE is sporadic.Therefore, there is a need for health care practitioners to provide women with BSE education and emphasize on the need for regular practice of BSE.KEY WORDS: Breast cancer, breast self‑examination, educational level, knowledge, practic

Keeping pace : understanding youth engagement in rural America through family structure lenses

With rapid shifts in the family economy, various family structures have continually emerged. Understanding the impact these changes have on youth engagement is foundational to developing interventions that will encourage participation in community life. Factors including rural-urban migration, the great recession, lower fertility rates, marrying at older ages and influx of women into professional employment have contributed to the emergence of new and more complex family types such as single parent and blended families. Youth growing up in these evolving settings (changing family structures) are vested with uncommon challenges. With less than 46% of children born into intact families, understanding the impact these challenges have on the ability of youth to stay engaged in family and community life is foundational to the building of appropriate interventions. Poverty, low educational attainment and lack of employment opportunities, increase the likelihood of breakdown and inadvertently disturb the emotional equilibrium of the home environment. These factors increase the likelihood of breakdown within resource-limited rural communities placing them at a disadvantage compared to families resident in urban areas