6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION:-

“Pain is such an uncomfortable feeling that even a tiny amount of it is enough to ruin every enjoyment."

-Will Rogers

Pain is a common problem in all age groups and it offers associated with significant physical disabilities and psycho-social problems. Pain is one of the major reasons that people seek health care.1 A thorough understanding of the physiological and psycho-social dimension of pain is important for effective assessment and management of patients with pain. Pain is not synonymous with suffering, pain can also occur with or without suffering. The main dimensions of pain and pain process are physiological, sensory, affective, behavioural and cognitive dimensions2

Only the patient can accurately describe and assess his or her pain.Therefor number of pain assessment instruments have been developed to assist in the assessment of patient’s perception of pain. Such instruments used to document the need for interventions, to evaluate the effectiveness of the intervention in terms of mild, moderate or severe. They can be also set base lines and tends for your pain making it easier to find appropriate treatments.3

The main scales are numerical rating scales, Wong Baker scales, verbal rating scales, visual analogue scales, Rupee rating scales, face pain scales and observer scales. These scales have been investigated for use in a variety of patient population including young children and older adults. Results indicate that they provide valid and reliable assessment data.4

6.1 Need for the Study

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It occurs with many disorders diagnostic tests and treatment.5 Pain is categorized according to duration, location and aetiology. The basic categories of pain are generally classified as acute pain, chronic pain or non-malignant pain and malignant pain only the patient can accurately describe his /her pain.6

Pain assessment is a multidimensional approach to evaluate pain attributes. These attributes includes intensity, duration and location of pain, its somatosensory qualities, and accompanying emotions of the pain experience. The measurement of pain is difficult because of the variations in individual’s responses to painful stimuli. The goal of a nursing pain assessment is to assessing the severity of pain. Pain scales are useful tools to help the patients to communicate the intensity of pain and to guide treatment. Numerous methods have been developed for the measurement of pain. When choosing a method one must consider the type of setting, the ease of administration and patient education level.7

Among the pain rating scales the main scales are numerical scales, verbal scales and visual analogue scales are selected for this study.8 Numerical scales are written scales to assess pain, on a scale of 0 to 10, 0 being no pain and 10 being no pain as bad patient can respond with out difficulty. The patient numerical rating is documented and is used to assess the effectiveness of pain relief intervention verbal rating scales are scales shows no pain , mild pain, moderate pain ,sever pain, worst pain . the visual analogue scales are one version of scales include a horizontal 10 cm line with ends indicating the extremes of pain . Left end represents no pain and right end represents worst pain.9

Pain management is considered such an important part of care that the American pain society coined the phrase “Pain the 5th vital sign (Cambell 1995) to emphasize its significance and to increase the awareness among health care professionals of the importance of effective pain management calling pain the fifth vital sign suggests that the assessment of pain should be as automatic as taking a patient’s blood pressure and pulse.

Nurses spent more time with the patients in pain than do other health care providers, nurses need to understand how to assess the pain and methods used to treat pain. Nurses encounter patient in pain in a Varity of settings including acute care, out patient care and long term care settings as well as in the home10.Fourth year BSc nursing students are the future nurses, so far the investigator felt need to assess the knowledge regarding pain rating scales among them .

6.2  Review of Literature

Cinzia Brunelli, Ernesto Zecca, Cinzia Martini, Tiziana Campa, Elena Fagnoni, Michela Bagnasco, et al. (2010) conducted a study on Comparison of Numerical and Verbal Rating Scales to Measure Pain Exacerbations in Patients with Chronic Cancer. Aim of the present study is to compare NRS and VRS performance in assessing breakthrough or episodic pain exacerbations. In a cross sectional multicentre study carried out on a sample of 240 advanced cancer patients with pain, background pain and BP-EP intensity in the last 24 hours were measured using both a 6-point VRS and a 0–10 NRS. In order to evaluate the reproducibility of the two scales, a subsample of 60 patients was randomly selected and the questionnaire was administered for a second time three to four hours later.NRS revealed higher discriminatory capability than VRS in distinguishing between background and peak pain intensity with a lower proportion of patients giving inconsistent evaluations. NRS also showed higher reproducibility when measuring pain exacerbations while the reproducibility of the two scales in evaluating background pain was similar .Our results suggest that, in the measurement of cancer pain exacerbations, patients use NRS more appropriately than VRS and as such NRS should be preferred to VRS in this patient's population11.

Longo UG, Loppini M, Denaro L, Maffulli N, Denaro V(2010) conducted a study on Rating scales for low back pain.During the past decades several rating scales have been developed to assess the functional status of patients with low back pain. We performed a search using the keywords 'spine' in combination with 'scoring system', 'scale', 'scores', 'outcome assessment', 'low back pain' and 'clinical evaluation'.Twenty-eight scoring systems are currently available for the evaluation of low back pain. Each of them evaluates low back pain using specific variables. All these scoring systems are presented.Although many scoring systems have been used to evaluate the back function, we are still far from a single outcome evaluation system that is reliable, valid and sensitive to clinically relevant changes, taken into account both patients' and physicians' perspective and is short and practical to use. Further studies are required to evaluate the reliability, validity and sensitivity of the low back pain scoring systems used in the common clinical practice12.

E. Bondestam, K. Hovgren, F. Gaston Johansson, S. Jern, (2006) conducted a study on pain assessment by patients and nurses in the early phase of acute myocardial infarctionIn 47 patients admitted to the coronary care unit (CCU) at Sahlgren's Hospital in Göteborg, Sweden, due to acute myocardial infarction (MI) the intensity of pain independently assessed by the patient and by the nurse on duty was evaluated during the first 24 hours in CCU. Pain was assessed according to a modified numerical rating scale graded from 0-10, where 0 meant no pain and 10 meant the most severe pain. A positive correlation between the patients’ and nurses’ assessments was found .However, the nurses under-estimated the patients’ pain in 23% of the situations and over-estimated. Over-estimation was particularly found when heart rate and blood pressure increased. Many patients scoring their pain to fairly high degrees were not given pain-relieving treatment. Treatment with morphine did not cause substantial pain relief in a substantial number of patients. A significantly positive correlation was found between the patients’ and nurses’ assessments of pain, although underestimation as well as over-estimation occurred. A few patients with severe pain were not treated and when treatment was given it was often ineffective13.

Dihle, A., Bjølseth, G. and Helseth, S. (2006), conducted a discriptive study on The gap between saying and doing in postoperative pain management Postoperative pain is inadequately managed. Nurses play an important role in assessment, treatment and evaluation of postoperative pain in surgical wards, but combined observational and interview studies about how they approach these activities have rarely been undertaken.The study design is descriptive. Observations and in-depth interviews were conducted with nine nurses on three surgical wards at two hospitals. Each nurse was observed during five shifts, day and night, and interviewed after the final observation. The collection and analysis of data followed principles of qualitative research.One main theme emerged about the nurses’ approach to postoperative pain management: a discrepancy between what the nurses said they did and what they actually did.. The study revealed a gap between what nurses said and did in postoperative pain management, and this gap was smaller when the nurses took an active approach. An active approach towards patients about postoperative pain seemed to enhance pain alleviation.Nursing education and practice both need to promote knowledge of pain and pain management, as well as empathy and empathic communication in relation to pain. They need to collaborate in guiding nurses to act in accord with theoretical knowledge and so enhance competence in nursing actions related to postoperative pain management.14

S.JoséCloss, BridgetBarr, MichelleBriggs, KeithCash, KateSeers. (2003) conducted A comparison of five pain assessment scales for nursing home residents with varying degrees of cognitive impairment The aim of the study was to compare five different pain assessment scales for use with people with different levels of cognitive impairment who resided in nursing homes. The verbal rating scale, horizontal numeric rating scale, Faces pictorial scale, color analogue scale and mechanical visual analogue scale were presented in random order to 113 residents. Cognitive impairment was assessed using the Mini-Mental State Examination. The use of the verbal rating scale was the most successful with this group, y completed with severe cognitive impairment. Repeated explanation improved completion rates for all the scales. Consistency between scores on the five scales was good for those with none to moderate cognitive impairment and poor for those severely impaired. This study showed no difference in pain scores according to cognitive status15.

Akinpelu A , Olowe O (2002) conducted a Correlative study of 3 pain rating scales among obstetric patients. The relationship between pain scores obtained on the Visual Analog Scale , Numerical Scale and Verbal Rating Scale was studied. The subjects were 35 volunteer female patients who had their babies through caesarian section 1-3 days prior to the study. Demographic data and pain scores were collected through a questionnaire, which was available in both English and Yoruba, the two most commonly spoken languages in Ibadan where the study was carried out. Results indicated that there was no significant difference between the pain scores obtained on the 3 pain rating scales. High educational attainment improved correlation between the scales in this study. It was concluded that the three pain rating scales measure the same construct, and could be used for pain measurement in obstetrically related conditions in this environment.16

WCrawford Clarka, Joseph CYangb, Siu-LunTsuic, Kwok-FuNgb, SusanneBennett Clarkd (2001) conducted a study on Unidimensional pain rating scales: a multidimensional affect and pain survey (MAPS) analysis of what they really measure Bottom of FormPain is now regarded as ‘the fifth vital sign’ and patients are frequently asked to score the intensity of their pain on a numerical pain rating scale. We used a Chinese translation of the 101 descriptor multidimensional affect and pain survey (MAPS) questionnaire to determine the relative contributions of various dimensions of postoperative pain to a patient's score on a unidimensional NPRS. MAPS and NPRS were administered postoperatively to 69 patients with descending colon carcinoma who were recovering from left hemi-colectom It may be concluded that patient scores on unidimensional pain intensity scales reflect the emotional qualities of pain much more than its sensory intensity or other qualities. Accordingly such scales are poor indicators of analgesic requirement. The results also suggest that patients' postoperative anxiety and depression are inadequately treated. Based on our findings we present six unidimensional scales that should yield a more accurate assessment of the sources of a patient's pain.17

Breivik, Else Kristine, Björnsson, Gudmundur A, Skovlund, (2000) conducted a Comparison study on Pain Rating Scales by Sampling From Clinical Trial Data.The goals of this study were to examine agreement and estimate differences in sensitivity between pain assessment scales.Multiple simultaneous pain assessments by patients in acute pain after oral surgery were used to compare a four-category verbal rating scale ( and an 11-point numeric rating scale with a 100-mm visual analog scale. The sensitivity of the scales was compared in a simulation model by sampling from true pairs of observations using varying treatment differences of predetermined size.: There was considerable variability in VAS scores within each category both between patients and for repeated measures from the same patient. Simulation experiments showed that the VAS was systematically more powerful than the VRS-4 in all simulations performed. The sensitivity of the VAS and NRS-11 was approximately equal. In this acute pain model, the VRS-4 was less sensitive than the VAS. The simulation results demonstrated similar sensitivity of the NRSand VAS when comparing acute postoperative pain intensity. The choice between the VAS and NRS can thus be based on subjective preferences.18

Statement of the Problem

“A study to evaluate the effectiveness of structured teaching programme on knowledge regarding selected pain rating scales among 4th year BSc nursing students in selected nursing colleges in Bangalore.”

6.3 Objectives of the Study

(i)  To assess the knowledge regarding selected pain rating scales among 4th year BSc Nursing students.

(ii)  To evaluate the effectiveness of structured teaching programme on selected pain rating scales among 4th year BSc Nursing students.

(iii)  To determine the association between knowledge regarding selected pain rating scales among 4th year BSc nursing students and their selected demographic variables.

6.4 Hypothesis

H1 There will be significant difference in the knowledge scores regarding selected pain Rating scales among 4th year BSc Nursing students before and after the administration of the structured teaching programme..

H2 There will be significant relationship between knowledge on pain rating scales Among 4th year BSc nursing students and their selected demographic variables.