‘XANNUN’ NURSING CARE MODEL FOR CANCER PAIN MANAGEMENT AMONG ADULT PATIENTS AT GARISSA COUNTY REFERRAL HOSPITAL, KENYA

Abstract

Introduction: Nursing care models allow concept application of not only the physical treatment of pain but also synthesis the significance of social-cultural practices, psychological and spiritual pain relief. Cancer pain has high prevalence and negative impact on the quality of life of patients at Garissa County due to limited access to healthcare facilities and unique pastoral lifestyle of the community. This necessitated the development of Xannun model of nursing care for holistic pain management that is clinically proficient and culturally competent. The word ‘Xannun’ means Pain in Somali Language.  The name ‘Xannun’ nursing model was adopted because the model was developed based on the needs of Garissa resident, predominately with high population of Somali ethnic origin.  

Methods: Phase one of the utilised triangulation method approach to recruit 94 cancer patients, 84 clinical nurses and 15 key informants, while phase two was the actual development and testing of Xannun nursing care model. Various sampling procedures that included random, purposive and snowball and recruit participants voluntarily was done. Modified Brief Pain Inventory (MBPI) tool combined with focus group discussion and Eastern Cooperative Oncology Group (ECOG) performance status was used to obtain data from participants. The sample population was 188 participants. Phase two of this study utilised Delphi survey to gain expert opinion before the development and utilization the model.

Results: Cancer patients had a mean age of 51 years, with prevalence of pain at 78 % (73) that ranged from moderate to severe. A total of 78 % (66) of clinical nurses had no tool for pain assessment, 83.2 % (70) of them did not know how to utilise WHO analgesic ladder.  Majority of patients 82 % (78) were on incorrect WHO analgesic ladder with negative PMI (p-value < 0.05) of under treatment. Majority of patients considered alternative treatment for cancer pain such as Quran recitation and Somali herbs accounting for 65% (61) and 77.6% (73) respectively. Almost all KI 93% (14) indicated the inadequate availability of pain medication. In phase two of the study, experts’ opinion of 80% of respondents agreed that the ‘Xannun’ nursing model captured the challenges of cancer pain management and 60% of them predicted that the model could be utilised. However, 100% of the experts suggested that the model will bring a positive change, though 90% of them upheld that there will be potential challenges of implementing such a model.

Conclusion: This study found high prevalence of cancer pain, suboptimal pain care, Knowledge deficit among nurses and inaccessibility of pain medication associated with the dynamic of a nomadic lifestyle.

Recommendation:  This study recommends the implementation of “Xannun” Nursing Care model at GCRH, for a better approach of cancer pain management.