Cancer-Related Pain Assessment Practices among Nurses: A Focused Ethnography in a county Referral Hospital in Kenya

Lister Onsongo


Introduction: Up to 80% of cancer patients in Kenya continue to experience untreated moderate to severe pain. A key step for nurses in the management of cancer pain is conducting a comprehensive assessment. This study explored cancer-related pain assessment practices among nurses in Kenya.

Methods: A focused ethnographic approach, twenty-five (n=25) participants were recruited using purposive, snowballing sampling strategy from an oncology and private ward in a large teaching and referral hospital. Semi- structured interviews and observations were used to collect data. Content analysis was used to analyze the data.

Findings: Cancer-related pain assessments were not a routine practice in both wards. Assessments were triggered by patients’ behavior, patient’s verbal reports of pain, and during evaluation of the outcome of an intervention. Based on observations the ward culture influenced how nurses intervened. For instance, nurses in the oncology ward took patients verbal reports of pain into account unlike the nurses in the private ward who believed their observations were superior to patient’s verbal reports.

Conclusion: To an extent pain assessment practices were influenced by the ward culture, patient’s perspectives were not prominent. Tailored interventions taking into consideration the ward culture are needed to enhance pain assessment practices among nurses.


Cancer, Kenya, nurses, pain assessment, unit culture.

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Abed El-Rahman M., Al Kalaldeh, T., Muhbes, F.J., 2013. Knowledge and attitude towards pain management: a comparison between oncology and non-oncology nurses in Jordan. Int J Adv Nursing Studies 2(2),95–100

Ali, Z., Njuguna, E., Munyoro, E., Makumi, D., Vijay, K., & Kanja, J., 2013. Cancer Pain Management. National Guidelines for Cancer Management Kenya. Retrieved from

Al Qadire, M. & Al Khalaileh, M., 2014. Effectiveness of educational intervention on Jordanian nurses’ knowledge and attitude regarding pain management. British Journal of Medicine & Medical Research, 4(7), 1460–1472.

Aziato, L., & Adejumo, O., 2014. The Ghanaian surgical nurse and postoperative pain management: a clinical ethnographic insight. Pain Management Nursing, 15(1), 265-272. doi: 10.1016/j.pmn.2012.10.002

Baillie, L., 2015. Promoting and evaluating scientific rigour in qualitative research. Nursing Standard, 29(46), 36-42.

Bloch, C., 2017. Hispanic Nurses’ knowledge of and approach to pain assessment and management. Journal of Transcultural Nursing, 28(3), 251-258.

Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., & Jemal, A., 2018. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 68(6), 394-424.

Carlson, C. L., 2016. Effectiveness of

the World Health Organization cancer pain relief guidelines: an integrative review. Journal of Pain Research, 9, 515.

Caraceni, A., Hanks, G., Kaasa, S., Bennett, M.I., Brunelli, C., Cherny, N. et al., European Palliative Care Research Collaborative (EPCRC)., European Association for Palliative Care (EAPC) (2012) Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol 13:58–68

Chatchumni, M., Namvongprom, A., Eriksson, H., & Mazaheri, M., 2016. Thai nurses’ experiences of post-operative pain assessment and its influence on pain management decisions. BMC Nursing, 15, 1-8.

Coghill, R. C., 2010. Individual differences in the subjective experience of pain: new insights into mechanisms and models. Headache: The Journal of Head and Face Pain, 50(9), 1531-1535.

Creswell, J., 2013. Qualitative inquiry and research design: Choosing among five approaches third ed. Los Angeles, CA: Sage


De Silva, B. S., & Rolls, C., 2011. Attitudes, beliefs, and practices of Sri Lankan nurses toward cancer pain management: An ethnographic study. Nursing and Health Sciences, 13, 419-24.

Fink, R. M., & Brant, J. M., 2018. Complex cancer pain assessment. Hematology/Oncology Clinics. 32(3), 353-369.

Fink, R. M., & Gallagher, E., 2019. Cancer Pain Assessment and Measurement. In Seminars in oncology nursing. WB Saunders.

Gallagher, E., Rogers, B. B., & Brant, J. M., 2017. Cancer-Related Pain Assessment: Monitoring the effectiveness of interventions. Clinical journal of oncology nursing, 21(3). 8-12. doi: 10.1188/17.CJON.S3.8-12.

Graneheim, U. H., & Lundman, B., 2004. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24(2), 105-112.

Greco, M.T., Roberto, A., Corli, O., et al. 2014. Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Clin Oncol, 32:4149–4154.

Hamieh, N. M., Akel, R., Anouti, B., Traboulsi, C., Makki, I., Hamieh, L., et al., 2018. Cancer-Related Pain: Prevalence, Severity and Management in a Tertiary Care Center in the Middle East. Asian Pacific journal of cancer prevention, APJCP, 19(3), 769-775. https://doi-org./10.22034/APJCP.2018.19.3.769.

Haumann, J., Joosten, E.A., Everdingen, M.H., 2017. Pain prevalence in cancer patients: status quo or opportunities for improvement? Curr Opin Support Palliat Care,11:99–104.

Hemingway, S., & Snowden, A., 2012. Debating mental health nurses role on medicines management. British Journal of Nursing, 21(20), 1219-1223. doi: 10.12968/bjon. 2012.21.20.1219

Hickey, S., 2011. Achieving concordance with inhaled therapy. Practice Nursing, 22(3), 155-158. doi:10.12968/pnur.2011.22.3.155

Kasasbeh, M. A. M., McCabe, C., & Payne, S., 2016. Cancer‐related pain management: A review of knowledge and attitudes of healthcare professionals. European Journal of Cancer Care. doi: 10.1111/ecc.12625.

LeBaron, V., Beck, S. L., Maurer, M., Black, F., & Palat, G., 2014. An ethnographic study of barriers to cancer pain management and opioid availability in India. The oncologist, 19(5), 515-522.

Li, Z., Aninditha, T., Griene, B., Francis, J., Renato, P., Serrie, A., et al., 2018. Burden of cancer pain in developing countries: a narrative literature review. ClinicoEconomics and outcomes research: CEOR, 10, 675-691. doi: 10.2147/CEOR.S181192.

Magnusson, J. E., & Fennell, J. A., 2011. Understanding the role of culture in pain: Ma"ori practitioner perspectives relating to the experience of pain. New Zealand Medical Journal, 124(1328), 41-51.

McKinnon, J., 2013. The case for concordance: Value and application in nursing practice. British Journal of Nursing, 22(13), 766-771. doi: 10.12968/bjon.2013.22.13.766

Neufeld, N. J., Elnahal, S. M., & Alvarez, R. H., 2017. Cancer pain: A review of epidemiology, clinical quality and value impact. Future Oncology, 13, 833-841.

Nurayan, M. C., 2010. Culture’s effects on pain assessment and management. American Journal of Nursing, 110(4), 38–47


O’Brien, M., Schwartz, A., & Plattner, L., 2018. Treat the pain program. Journal of Pain and Symptom Management, 55(2S), S135.

Onsongo,L., 2019. Barriers to Cancer Pain Management Among Nurses in Kenya: A Focused Ethnography, Pain Management Nursing,

Pasero, C., Quinlan-Colwell, A., Rae, D., et al., 2016. American Society for Pain Management Nursing Position Statement: prescribing and administering opioid doses based solely on pain intensity. Pain Manag Nurs;17(3):170–80.

Paice, J. A., & Von Roenn, J. H., 2014. Under-or overtreatment of pain in the patient with cancer: How to achieve proper balance. Journal of Clinical Oncology, 32(16), 1721-1726.

Portenoy, R. K., & Ahmed, E., 2018. Cancer pain syndromes. Hematology/Oncology Clinics, 32(3), 371-386.

Snowden, A., & Marland, G., 2012. No decision about me without me: Concordance operationalized. Journal of Clinical Nursing, 22, 1353-1360. doi: 10.111/j.1365- 2702.2012.04337.x

Swarm, R. A., Paice, J. A., Anghelescu, D. L., Are, M., Bruce, J. Y., Buga, S., et al., 2019. Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network, 17(8), 977-1007.

van Dijk, J. F. M., Schuurmans, M. J., Alblas, E. E., Kalkman, C. J., & van Wijck, A. J. M., 2017. Postoperative pain: knowledge and beliefs of patients and nurses. Journal of Clinical Nursing, 26(21-22), 3500-3510.

World Health Organization., 2019. WHO’s cancer pain ladder for adults. (accessed 20 November 2019).


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