This study was carried out to determine the home management of pain in adult sickle cell patients aged 15-50 years who attend on the sickle cell clinic UNTH, Enugu State at the period of this study: determine pain experiences in sickle cell patients, determine immediate actions taken when patients have pains at home, identify home remedies used, determine their knowledge on predisposing factors of pain and in relation to use of home treatment. Literature review from relevant texts and journals was made. The research design for the study was the descriptive survey. The population for the study was 45 sickle cell patients attending sickle cell clinic in UNTH. Questionnaire was the only instrument for data collection. Frequencies and percentage were used in data analysis and presentation was done by the use of tables and bar charts. The major finding of the study were as follows: All patients experience crisis but at different frequencies; most of them resort to taking analgesics as their immediate action against crisis at home; some are not well informed about all predisposing factors to pain. Based on these findings conclusions were drawn and recommendations were made on ways to improve home management of pain among sickle cell patients.
TABLE OF CONTENTS
CHAPTER ONE: INTRODUCTION
Background of Study 1
Statement of problem 6
Purpose of the study 6
Objective of the Study 7
Research Questions 7
Significance of the study 8
Scope of the study 8
Operational definitions 9
CHAPTER TWO: LITERATURE REVIEW
An overview of sickle cell disease 10
The concept of pain 13
Theories of pain 14
Pain and sickle cell disease 18
Types of sickle cell pain 20
Factors that bring about crisis 21
Immediate home management of pain 23
Empirical review 24
Summary of literature review 30
CHAPTER THREE: RESEARCH METHODS
Research design 32
Area of the study 33
Population of the study 34
Sample of the study 34
Instrument for data collection 34
Validation of instrument 34
Procedure for data collection 35
Method of data analysis 36
CHAPTER FOUR
Data Analysis and Presentation of Results 37
CHAPTER FIVE: DISCUSSION OF FINDINGS
Discussion of findings 48
Limitations to the study 52
Implication of findings 53
Summary of findings 54
Recommendation 55
Suggestions for further studies 56
Questionnaire 67
REFERENCES
LIST OF TABLE
Table 1: Demographic Data of Respondents 37
Table 2: Pain Experience of Respondents 39
Table 4: Reasons for their actions 43
Table 5: Knowledge on Predisposing Factors to pain 47
LIST OF FIGURES
Figure1: Frequency of Pain Crisis 40
Figure 2: Immediate Action at Home During Pain
Crises 42
Figure 3: Strategies Patient Employs To Alleviate
Pain At Home 45
CHAPTER ONE
INTRODUCTION
BACKGROUND OF STUDY
Sickle cell disease is a long term (chronic) blood disorder that causes the bone marrow to produce red blood cells with defective hemoglobin (hemoglobin S). Normally, red blood cells are round; hemoglobin S causes red blood cells to become curved, or sickle-shaped, when they lose oxygen.
The most common symptoms of sickle cell disease are either related to long-term (chronic anemia or blood vessels blocked by sickled cells which include pain weakness, tiredness (fatigue), pale appearance, yellowing of the skin and the white of the eyes (jaundice) and shortness of breath, especially with exertion.
Sickle cell disease has a worldwide distribution but it occurs more frequently in the negroid race. It is common in Africa especially the West African Sub region such as Ghana and Nigeria. It is found in Asia especially India. However, there are pockets of it in Europe. In the West African sub-region, it is estimated that 25% of the population have the sickle cell trait. Also in the United States black population the incidence is about 10% Godwin(1997). In Nigeria about 30,000 – 50,000 children are born with sickle cell disease every year (Godwin, 1997). The epidemiology of sickle cell disorder is complex and poorly understood and its marked geographic variability implies that lessons on the disorder learnt elsewhere may be inappropriate and irrelevant to the management of the disorder in Africa. A major factor in this difference is falciparum malaria, which is a prominent cause of morbidity and mortality.
Sickle cell disease occurs where a person inherits one defective hemoglobin S gene from each parent. Similar sickle cell disorders occur when a person inherits a hemoglobin S gene from one parent and another type of defective hemoglobin gene from the other parent.
Pain is the insignia of sickle cell disease and the acute painful crisis is the number one cause of hospital admissions. Pain in sickle cell disease presents unique challenges for patients, families and health care professionals. It profoundly affects comfort, function in work, play, psychology, school and social relationships. Pain in sickle cell disease ranges from acute to chronic. Some patients only have occasional episodes of acute pain; if it is managed, it is considered to be chronic. Pain is distressing and if the causes, prevention and treatment are known, there are better chances of a near recovery. Patient experiences pain from mild, moderate to severe and should therefore be assessed and managed properly according to severity.
Pain and sickle cell disease are lifelong problems that affect quality of life and according to the American pain society (APS) guideline (1999), the goals of pain assessment are to characterize patient’s pain status and related experiences over time, to provide a basis on which treatment decisions can be made and to document the effectiveness of pain management strategies. Pain is a subjective experience and as such its assessment relies heavily on self-reports of patients and use of valid and reliable clinical measurement instruments.
Sickle cell disease has remained a major public health issue affecting children and adult. The traditional names ascribed to the disease all give vivid onomatopoeic descriptions of a condition that causes severe body pain. Many barriers impede the humane and competent assessment of sickle cell disease related pain. First, access to health care is problematic for many sickle cell patients, example non-pharmacologic treatments for chronic pain may be unavailable, unaffordable or not covered by health –insures. Secondly, risk of addiction to analgesic medications is overstated. Thirdly, the variability and unpredictability of pain in sickle cell disease make effective coping difficult and thus contribute to an adversarial relationship between health care professionals.
Nigeria besieged by myriads of socioeconomic problems though with potentials as engraved in her enormous human and material resources have not had ease in her health sector services. Health services procurement have been elusive due to aforementioned problems, coupled with low literacy level. Some mothers and other care givers do not know how to manage the patient at home while waiting for the time patient will get to the hospital. Also due to increase morbidity and mortality rates.
Inadequate funding and poor maintenance of the health services have led to high national burden of disease while focus are being directed on critical health issues like HIV/AIDS thereby making sickle disease a less critical disease, yet it is a common disease of the developing countries and African ancestry as a whole. In addition, illiteracy is a factor militating against awareness. As sickle cell disease can become life-threatening, home prevention measures and home management of pain are very important. This has prompted the researcher to engage in this study.
Sickle cell disease is a debilitating disease and the reseacher having observed the effects and problems on a friend and roomate in alleviation of pain prior hospital admission and the complications that arise as a result of poor home management, the researcher is prompted to seek to understand the home management of sickle cell crisis among adult patients with sickle cell disease.
The purpose of this study is to explore home management of pain in sickle cell patients attending sickle cell clinic in UNTH.
Specifically the objectives are to:
RESEARCH QUESTIONS
The findings from this study will help to highlight various ways by which sickle cell crisis can be managed during its acute onset at home. It will also evaluate the immediate action taken and why. Finally, it will help enlighten patients and care-givers on factors that predispose to crisis, thereby decreasing their chances of ignorantly exposing themselves to dangers of risk factors. This will enhance preventive management and cut down on the frequencies of crisis.
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