Development of the Nursing Practice Guidelines for Pain Management among Cancer Patients in Maharaj Nakorn Chiang Mai Hospital

Abstract

Introduction Pain is a significant problem experienced by cancer patients, affecting both the patients and their caregivers. Evidence-based clinical nursing guidelines are necessary for effective pain management. 

Objective To develop nursing practice guidelines (CNPGs) for pain management in cancer patients.

Design Operational research 

Methodology The development of the Nursing Practice Guidelines based on the ADAPTE Collaboration (version 2.0) consisted of three distinct phases: 1) the set up phase, 2) the adaptation phase, and 3) the finalization phase. Participants comprised three groups: 1) five healthcare professionals as the guideline development team, 2) three cancer patients in a private ward at Maharaj Nakorn Chiang Mai Hospital, who received care according to the guidelines, and 3) four healthcare personnel who implemented the Clinical Nursing Practice Guidelines (CNPGs) and adhered to all recommendations. The research instruments included 1) a guideline screening tool, 2) the Thai version of the Appraisal of the Guideline for Research & Evaluation II (AGREE II), 3) a cancer patient screening form, and 4) a clinical outcome and process evaluation form. These instruments were quality-checked before use. Data were analyzed using descriptive statistics, including frequency and percentage. 

Results The CNPGs comprised five key components: 1) protecting patient rights and ethics, 2) conducting pain assessment, 3) implementing pain management, 4) educating patients on pain self-management, and 5) monitoring adherence to the CNPGs and ensuring continuous quality improvement. Experts evaluated the quality of these guidelines, with all AGREE II components scoring above 80%, indicating their clinical appropriateness. The patient handbooks on pain self-management were also considered appropriate, providing comprehensive and easy-to-understand information. The guidelines were considered feasible, as patients reported pain relief each time pain occurred (21 times). Patient satisfaction with the care provided using these guidelines was highest, and healthcare personnel reported satisfaction to highest satisfaction with their use. 

Recommendation This study recommends implementing nursing guidelines for managing pain among cancer patients in clinical settings. Further research should focus on evaluating the effectiveness of these guidelines, considering both clinical outcomes, and process evaluation.