Barriers and solutions for improving pain management practices at regional hospitals in South Albania

Having access to pain management is a human right. We can’t assure a life without any kind of pain but we certainly can do much to reduce physical pain. Based on literature review, acute pain management in Albania differs from that of developed countries, in pharmacological and non-pharmacological management. Taking into account the entire Albanian background, this research had two objectives; first, Identification of barriers and solutions on the Albanian Health Care System in terms of Acute Pain Assessment and Non-pharmacological Management of Pain; second, experimentation of the Italian procedure “Procedura Monitoraggio del Dolore” for the acute pain management in the Surgery and OBGYN units. Methods This is a mixed cross-sectional and experimental, quantitative and qualitative study. It was developed in three phases. The first phase was observation, the second phase was training of nursing staff, and the third phase was the experimentation. The population of this study consisted of all nurses and all patients of Surgery and OBGYN Units in the public regional hospitals of Gjirokastër, Vlorë, and Fier. It wasn’t applied any filter of gender, age, ethnicity, or socio-economic factors on the target population of nurses. Meanwhile, the target population of patients was all adults, conscious and responsible, without any cognitive deficiency or impairment, and collaborative. In the first phase, the sample of the study consisted of 73 nurses and 453 patients. In the third phase, the sample of the study consisted of 68 nurses and 380 patients. The instruments used were interviews, observation, and a questionnaire. Data analysis The data were processed with the statistical program SPSS-23. For the qualitative data, a tabular method was used, as well as pie and column charts to better reflect the phenomena in the study. The Chi-square probability indicator was used to see the significant statistical differences between the qualitative variables. For the quantitative variables, the indicators of average, standard deviation, and confidence intervals were calculated. To verify the distribution of the values of the continuous variables, the Shapiro-Wilk test was used. For variables with normal distribution, the ANOVA method was used to verify the differences between groups with different evaluation points. For the variables, for which the values do not have a normal distribution, the non-parametric methods Mann-Whitney u test, and Kruskal-Wallis test were applied. The Hypothesis Control method was used to verify the hypotheses of this research. Linear Regression was used to analyze the relationship between the variables. Results Of the patients assisted by the trained group, to 89.3% of them the objective evaluation of pain was done, 98% of them used non-pharmacological methods for pain relief, and 96.7% of them received health education. The patients that were assisted by the trained group had a higher average of patient satisfaction, Mean=8.7; and a higher average of pain relief, Mean=83.7%. The patient satisfaction was higher in the regional hospital of Fier, Mean=8.92; and the regional Memorial Hospital of Fier, Mean=8.85. The lowest score for the patient’s satisfaction was at the regional hospital of Gjirokastër, Mean=7.24. Patient satisfaction was higher in the Surgery Unit, Mean=8.36. Patient’s perception of pain management quality was highest in the regional Memorial Hospital of Fier, Mean=5.748; and lowest at the regional hospital of Gjirokastër, Mean=4.827. It was also higher in the patients who received health education, Mean=5.653; higher in the patients who used non-pharmacological methods for pain relief, Mean=5.647; and higher in the patients who were assisted by the trained group, Mean=5.696. The number of days spent with pain was higher in the Surgery Unit, Mean=2.31; lower in the patients assisted by the trained group, Mean=2.07; higher in the regional hospital of Gjirokastër, Mean=2.3; lower in highly educated patients, Mean=1.73; lower in female patients, Mean=1.98, and lower in younger patients 18-29 years old, Mean=1.74. Conclusions Pain management improved after nursing staff was trained with an Italian procedure on pain assessment, and non-pharmacological methods for pain relief. The use of non-pharmacological methods for pain relief is strongly correlated to the improvement of patient’s quality of life during hospitalization, the increase of patient satisfaction, and the increase of pain relief from the pain management received. The barriers to improving non-pharmacological management of pain were identified and possible solutions were addressed. The first hypothesis was confirmed, the experimentation of an Italian procedure for pain evaluation and monitoration increased patient satisfaction. The second hypothesis was confirmed, applying non-pharmacological methods for pain relief improves the patient’s quality of life during hospitalization by reducing the impact of pain in the patient’s activities, and in the patient’s mood and emotions, but didn’t impact pain severity. The third hypothesis was not confirmed, applying non-pharmacological methods for pain relief didn’t decrease the number of days spent with pain. The training was successful and is statistically proven to be useful in improving the quality of health care, improving patient’s quality of life during hospitalization, and increasing patient’s satisfaction with the pain management received.