الفهرس 
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Abstract
Pain is the most disturbing and annoying symptom experienced by surgical patients, especially post laminectomy, yet it is poorly managed. Despite having many types of research and scientific advancement in pain management over the years, inadequate knowledge and skills remains a major barrier to achieving effective pain management. Therefore, knowledge and attitudes of nurses towards pain management influence how pain is managed effectively.
To assure the quality of care, effective pain management protocol must be established to control the practice of nursing care delivered for post-laminectomy patients. Effective pain management post-laminectomy requires accurate knowledge, attitudes, and skills. Major knowledge deficits and inaccurate beliefs among nurses may impede the management of post-laminectomy pain skills. So, this study emphasized that educational programs are a potential method of improving nurses’ knowledge of post-laminectomy pain management and provide an opportunity to address negative attitudes and beliefs.
Therefore the current research aims to:
Assess nurses’ competence in pain management concerning their actual knowledge, attitude, skills and self-efficacy of nurses for post-laminectomy patients
A descriptive design was utilized to conduct this research to explore nurses’ competence in pain management for post-laminectomy patients.
The study was carried out at the inpatient neurological department in the Main University Hospital at Alexandria, Egypt.
The subjects of this study consisted of all the available nurses (32 nurses), who were working for at least six months at the above-mentioned settings, and responsible for providing nursing care among post-laminectomy patients.
To fulfil the objectives of the study, three tools were used to collect the necessary data for this study.
Tool I: Nurse’s knowledge and attitude of pain management post-laminectomy: (Structured Interview Schedule); (Appendix II);
This tool was developed by Ram (2013) and was adapted by the researcher to elicit nurse’s knowledge and attitudes regarding post-laminectomy pain management at the post-operative stage.
Tool II: The nurse’s skills observation checklist regarding pain management among post laminectomy patients. (Appendix III).
It was developed by (Erniyati, 2002; Kizza, 2012; Ram, 2013) and was adapted by the researcher and used to assess the actual performance of nurses who were providing care for patients post laminectomy.
Tool III: The nurse’s self-efficacy in post-operative pain management questionnaire for post-laminectomy patients. (Appendix IV).
It was developed by (Manworren, 2000). This tool was used to measure nurses’ self-efficacy in post-laminectomy pain management.
Additionally: Nurses Socio-demographic Data tool was attached:
The Nurses’ socio-demographic data was adapted from (Basak, 2010). It was used to measure nurse’s demographic characteristics concerning nurses; age, gender, marital status, level of education, experience in post-laminectomy words, personal experience of pain and pain in-service education (whether the participants had attended pain management training or not).
Research Methods:
Written approval to carry out the study was obtained from the faculty of nursing, Alexandria University to the hospital directors and head nurse of the department for conducting the study after explanation of the aim of the study.
Oral approval was obtained from the participants of the study.
Tool I and tool III has been translated into Arabic and then revised by a team of a jury composed of five specialized professors from the Faculty of Nursing, Alexandria University in the field of Medical-Surgical Nursing. The necessary adjustments were done by the researcher.
The reliability of the modified tools was done using Cronbach Alpha Test to measure the internal consistency of the tool. The tools of the study were applied to 5 nurses. Reliability coefficient for tool 1 (nurses knowledge was (r=0.958), and for nurses attitude was (r=0.810), for tool II nurses skills, was (r=0.785), and for tool III nurses self-efficacy, validity of the instrument was 1 and the reliability was (r=0.87) (Manworren, 2000), which means all tools were reliable.
The pilot study was conducted with 5 nurses. They were excluded from the study subjects to determine the feasibility, reliability, and applicability of the translated tool and to detect any problem peculiar to the sequence and the clarity of the tool.
A structured interview was conducted once for all nurses for 30-45 minutes by the researcher to assess their knowledge, attitude using tool I and self-efficacy using tool III for evaluating their competence concerning pain management post laminectomy.
Every nurse in the sample was observed using tool II to assess his/ her competence with pain management post laminectomy and observations were conducted in the morning and evening shifts about two hours per shift. Each nurse was observed twice, 2-hour for each observation.
Data were collected in four months starting on the 5th of February and ending on the 30th of May 2019.
Statistical analysis:
Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. (Armonk, NY: IBM Corp) Qualitative data were described using the number and percent. Quantitative data were described using range (minimum and maximum), arithmetic means, standard deviation, and median. The significance of the obtained results was judged at the 5% level.
The following points were the most important results encountered by the present study:
The vast majority of studied nurses were, females, married and held a diploma degree in nursing.
More than one-third of the studied nurses lie in the age groups between 40-50 years, while about (18.8%) of them were in the age group of 50 to >60 years and (15.6%) their age ranged from 20 to 30 years.
More than half (62.6%) of the studied nurses’ working experience was more than 20 years old, (15.6%) of them their working experience ranged from 5 to less than 15 and from 15 to less than 20 years old. While only (3.1%) of them their working experience was less than 5 years old.
Almost all studied nurses had previous pain experience. Nearly less than half (46.8%) of the subjects complained of low back pain at some point in their life, and (15.6%) of them complained of stomach pain, while, (9.4%, 9.4%, 6.3%, 3.1, 3.1,) of them felt pain secondary to surgical operation, renal pain, lumbar disk, medical disease, and labor, respectively. On the other hand, 6.3% of the studied nurses stated that they didn’t get pain
The higher percentage (87.5%) of the studied nurses stated that they didn’t attend pain management training or workshops, where, (39.3% of them stated that there were no available workshops to attend and (60.7%) of them reported that they had never been asked to attend any pain management workshops. At the same point more than half (65.6%) of nurses stated that they want to attend pain management training/ workshops.
The level of knowledge, attitude and skills of nurses participating in this study was very low, on the other hand nurse’s self-efficacy level in this study was high regarding post-laminectomy pain management.
The majority of the studied nurses had very low competence levels regarding post-laminectomy pain management.
A statistically significant difference was found between nurses’ general pain knowledge and nurses’ documentation skills in first observation. As well as a statistically significant difference was found between nurses’ attitude toward post laminectomy pain evaluation and nurses’ evaluation skills in first observation.
No statistically significant differences were found between patients’ area of residence and the timeline –acute/chronic and consequences of renal stones.
No statistically significant relationship was found between the knowledge of nurses and overall self-efficacy in post-laminectomy pain management. While, a statistically significant relationship between nurses’ overall attitude and their self-efficacy toward post-laminectomy pain management assessment, evaluation, documentation subscales, and overall attitude and self-efficacy. Moreover, no statistically significant relationship between both scale overall score
No statistically significant relationships were found between nurses’ socio-demographic data and their knowledge regarding post-operative pain management, except in relation to nurses educational level; where a statistically significant relationship in the area of knowledge documentation and gender and between nurses’ general knowledge, assessment, intervention, dimensions (overall knowledge mean percent score and their education level
A significant relation in the area of knowledge evaluation in previous pain experience, moreover a statistically significant relation was found in the area of knowledge intervention in attendance of pain management training or workshops, and the area of knowledge assessment and overall knowledge in the need for pain management workshops.
A statistically significant relationship between nurse attitude evaluation and their age, between nurse attitude documentation and marital status, between their educational level and attitude (assessment, intervention and overall attitude) dimensions regarding post-laminectomy pain management and their socio-demographic characteristics.
A statistically significant relationship between nurses’ age and their intervention skills in first observation and their documentation skills in second observation as well as their overall skills in second observation.
A statistically significant relationship between nurses’ gender and their assessment and overall skills in second observation. A statistically significant relationship between nurses’ experience in surgical wards and their assessment and overall skills in second observation.
Additionally, a statistically significant relationship between nurses’ attendance in pain management workshops and their assessment, intervention, evaluation and overall skills in second observation, was noticed.
The main recommendations of this study:
1. Nurses should be a good listener, help post laminectomy patients to express their concerns and expectation related to post-laminectomy pain.
2. Nursing care should be based on psychological, social and spiritual concerns of the patients not only on physical concerns as well as accepting patients’ pain postoperatively.
3. Provide enough time to post laminectomy patients to express and discuss freely their perception about pain, and their fears post laminectomy.
4. Nurses who work in the surgical ward, especially those who work with post-laminectomy patients should update their knowledge and skills through participating in educational programs, attending seminars, workshops, lectures and reviewing pain management researches.
5. Develop manuals about ”post-laminectomy pain management”.
6. An initiative of implementing systematic pain assessment using pain scales should be reinforced. Hence it is important to equip nurses to develop attitudes that they have to believe in what their patients tell them.
7. Develop educational booklets, handouts and audiovisual materials that should be provided for teaching patients and their families.
8. A replication study to include more male nurses and nurses working in different surgical wards.
9. Nurse administrators can use the findings of this study to request to policymakers for allocating budgets for training nurses regarding post laminectomy pain management to improve the quality of nursing care in this area.