Nursing at the forefront of pain management in Africa

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Published: 17 Nov 2017
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Prof Julia Downing - Makerere University, Kampala, Uganda

Prof Downing speaks with ecancer at AORTIC 2017 about the role of nurses in managing pain and palliative care in Africa

She notes the impact of nurse-managed assessment and management of pain, including the prescription opioid pain killers, and developing the support for inter-disciplinary support to expand delivery of care within the Ugandan health system and in neighbouring countries.

Prof Downing highlights this evaluation as the first in its setting, and considers how the benefits seen through this program could be rolled out to cover other healthcare systems and diseases, including HIV management.

I was talking about nurses being at the forefront of pain management here in sub-Saharan Africa and I was sharing some of the experience from the work we’ve been doing in Uganda over the past couple of decades, really from when palliative care started in Uganda and the role of nursing throughout that time with specific notice around the issue of nurse prescribing. Since 2004 in Uganda palliative care trained nurses have been able to prescribe morphine and other palliative care medications and the difference that that has made to getting pain management and palliative care out to people in the rural areas because many people don’t have access to a doctor, there are not that many palliative care trained doctors. So through expanding nurse prescribing to allow nurses to prescribe strong analgesics it means that people have access to those medications and we can control and manage their pain even in the rural settings.

So I was talking a bit about that and then we’ve just done a recent evaluation of nurse prescribing and that was a collaborative effort from most of the palliative care stakeholders in Uganda, the Ministry of Health and also involved initially the World Health Organisation. So we’ve just done that evaluation, we had twenty nurse leaders as part of their leadership fellowship programme undertaking this national level research. The results are exciting, we’ve been able to show that nurses are able to assess, manage individuals’ pain, to prescribe mediation appropriately and safely and we’ve been able to see a significant difference in terms of patients’ pain scores from the first visit to the third visit. Obviously there are some things that we’ve learnt from the evaluation, how the training can be improved, making sure that nurses have the appropriate support. We found that they can manage the pain symptoms until the issues become complex and then, understandably, they need a bit more of a multidisciplinary team. So we’re now looking at how we put that support in place so that when they need help they know who to contact and who to phone.

So we’re really excited by this evaluation, it’s been done by nurses, it’s nurses evaluating, and we’re sure that the results are going to be used not just in Uganda but regionally and internationally. That’s really what I’ve been talking about and sharing.

So there’s the potential for other countries to have nurses prescribing cancer drugs?

Yes, there has been a lot of talk about nurse prescribing. As I’m sure you’re aware, in many places there are not that many doctors, particularly in the sub-Saharan African countries. So trying to increase access to palliative care and particularly pain management is reliant on nurse prescribing. In other settings such as in HIV there has been task shifting to allow nurses to prescribe ARVs or refill ARVs etc., so looking at expanding the nurses’ role. But one of the challenges has been that there’s not been a fully scale evaluation of nurse prescribing. So by doing this evaluation that will enable the lessons learned to be used in other countries; as it shows that nurses are able to do it safely and well then that enables others to follow in similar suit. Other countries are beginning to do it, which is great, but this evaluation just really helps in promoting that further.