Knowledge and perspectives of nurses and clinical officers on morphine use at Chiradzulu District Hospital

Mbewe, Emily; Misenje, Thomas; Chitani, Enoch; Uladi, Allan

Knowledge and perspectives of nurses and clinical officers on morphine use at Chiradzulu District Hospital

Date

2020-11-16

Authors

Publisher

Kamuzu University of Health Sciences

Abstract

This is a qualitative interview study that aims to explore perspectives of nurses and clinical officers on use of morphine in palliative care patients. The broad objective is to explore perception of nurses and clinical officers on clinical use of morphine. This study will be conducted at Chiradzulu District Hospital. A sample size of 10 participants disaggregated into categories of 5 Nurses and 5 Clinical officers will be selected using convenient sampling technique. Data collection will employ semi-structured in-depth interviews. Some patients do not get complete relief from pain owing to unfounded fears regarding use of morphine despite that it is the drug of choice in Malawi for management of severe pain. This study expects to understand challenges around morphine use in palliative care by service providers. Conversely, these results will significantly contribute towards planning for in-service training aimed at addressing the identified bottlenecks in morphine use thereby making the service accessible to those in need at Chiradzulu District Hospital. Study findings will be disseminated through a variety of channels including College of Medicine Research Dissemination Conference, Chiradzulu District Hospital research committee, COMREC and College of Medicine Library. 3.0 Background Morphine is one of the strong analgesics in a group of opioids. It is primarily used for pain relief. Morphine is a gold standard in palliative care because it is the baseline by which other opioids are measured. Morphine is a potent opioid analgesic widely used for the treatment of acute pain and for long‐term treatment of severe pain. World Health Organization (WHO) rates morphine on level three of the analgesic ladder, it is given to patients who present with severe pain that might be acute or chronic [1]. Morphine is widely being used for almost any condition that causes physical pain for example; active cancer treatment and vaso-occlusive pain during sickle cell [2]. A study done in Kenya revealed that Nurses and clinical officers have had unfounded fears surrounding morphine use, due to inadequate knowledge [3]. This study further revealed that such fears were linked to concerns about addiction, respiratory depression and sedation. Nurses and Clinicians had myths which include morphine will shorten life, morphine use will make my patient an addict, morphine is offered to patient only when death is eminent and it has worse side effect than other drugs [4]. Nurses and clinical officers play an important role in pain management and lack of knowledge creates barriers for them to be able to provide optimal pain management [3]. Nurses and clinical officers who are giving morphine to patients should follow the precaution measures. Some of the precautions include monitoring of mental status, blood pressure, respiratory drive, abuse/overuse and monitoring of other medications the patient is taking. The medications include other opioids that could lead to respiratory depression, alcohol, benzodiazepines and barbiturates [5]. Patients can become apneic study design will be qualitative using phenomenological approach. This analysis is based on discussion and reflection of direct sense perception and experience of the researched phenomenon [9]. The researcher will explore the perception of Nurses and Clinical officers on clinical use of morphine in palliative care patient at Chiradzulu District Hospital. The approach will use semi-structured In-depth interviews with prospective participants. This approach uses open- ended question and probing that give participants the opportunity to respond in their own words rather than forcing them to choose from fixed response [10]. This will help investigators understand perspectives of nurses and clinical officers on the clinical use of morphine in palliative care patients. 7.2 Study place This study will be conducted at Chiradzulu District Hospital. This site was chosen because Chiradzulu is one of the districts that used less amount of morphine as compared to other districts according to Malawi Health Management Information System data of July 2019 to June 2020 [11]. This can be due to several factors, for example, poor perception of nurses and clinical officer on morphine use, poor supply of morphine at the district hospital, lack of knowledge on morphine use among health workers, lack of knowledge on palliative care by the community that led to poor access to palliative care services, 7.3 Study population The study population are nurses and clinical officers because they are the core and frontline providers of palliative care services in Malawi. 7.4 Study period The estimated period for the whole study is 12 months which runs between March 2020 and May 2021. Activities within this period include; proposal development, data collection and analysis and presentation and dissemination of results. 7.5 Sample size We will have a sample size of 10 participants spread out into groups of 5 nurses and 5 clinical officers respectively using non probability convenient sampling technique. This sampling technique is applicable to our study because it will enable us to gather information from people that can be easily accessed. This sample size is ideal as it will help us uncover a variety of views and perspectives from the two cadres in question.