INTRODUCTION:

The word Pain is derived from a Greek word ‘Poine’ which means payment, penalty. Pain has been called as an ageless universal phenomenon; an unpleasant multidimensional sensory experience that delivers wide variations in intensity, quality, duration and persistence ^[1]. Pain is one of the most common reasons for which clients seek the medical help, and is a symptom that every health care provider will encounter.

The term “pain as the fifth vital sign” was initially promoted by the American Pain Society to elevate awareness of pain treatment among healthcare professionals. In the same was as any other vital sign, a positive pain score also should initiate further assessment of pain, timely intervention, and follow-up evaluation of pain and the effectiveness of treatment. Pain should be assessed with the same eagerness as other vital signs monitoring in order to have a better treatment experience for the patients ^[2].

Pain originating from intramuscular injection should not be considered less, because a painful injection might actuate severe dread of injection, which may detain a patient from seeking medical help ^[3]. Pain management is reflected on patient satisfaction. Improving patient satisfaction in hospitals is a high priority for organizations seeking to improve patient care. Morris et al. ^[4]stated that it is challenging to define patient satisfaction and it is multifaceted. Care expectations from patients and their attitudes contribute significantly to satisfaction. Patient satisfaction scores are also influenced by psychosocial factors which includes pain and depression.

Hanna et al. ^[5] conducted a study to determine the pain control perception by surgical patients and its relationship with the patient satisfaction. It was found that with the adequate pain control there was 4.86 times greater patient satisfaction and 9.92 times greater when the consideration of pain relief was promptly attempted by health care staff.

Pain management among patients admitted in Emergency department and its association with satisfaction was studied by Bhakta and Marco ^[6]. Out of 289 participants, 52% experienced a pain score reduction of 2 or more. Pain score reduction showed a significant association with higher number of medications. It also confirmed that there was a significant association with higher satisfaction and adequate assessment, response and treatment of pain.

Niebuhr and Whitfield ^[7] identified that the subjects who didn’t received any injection were highly satisfied than the subjects who received the injection. Hamilton et al. ^[8] assessed a cohort of 4709 patients following lower limb joint replacement. Various determinants were analysed such as expectations meeting, pain relief, ability to perform activity, perform exercise and rating of hospital experience. It was found to have a significant strong positive correlation (r= 0.72) with the pain relief and the overall satisfaction of the patient (p<0.001).

Frequently the pain originating from intramuscular injection is not given due consideration but which can affect the satisfaction in a remarkable way. As pain and satisfaction are related in various studies and instances, researcher was interested to identify the relationship of pain and satisfaction in patients receiving intramuscular injection. It also studied the association of satisfaction with the demographic and clinical profile of subjects receiving intramuscular injection. The formulated hypothesis for the present study is

H1: There is a significant relationship between pain and satisfaction of patients receiving intramuscular injection

H2: There is a significant association between satisfaction and demographic and clinical variables of subjects receiving intramuscular injection

MATERIALS AND METHODS:

Using Quantitative approach, a descriptive design was undertaken for this study. Subjects receiving intramuscular injection in the injection room of a tertiary care centre were selected. A total of 102 samples were collected using consecutive sampling technique. Based on the previous study findings, sample size was calculated. Subjects with infectious skin diseases, bleeding disorder, trauma and injury, cognitive impairment were excluded from the study.

Subjects fulfilling the inclusion criteria were given an information sheet containing the study details. An informed consent was obtained from the subject after clarifying their doubts. Data was collected using demographic and clinical profile, Numerical rating scale and satisfaction questionnaire. Demographic and clinical profile included age, gender, literacy, occupation, number of injection in the past 3 months, height and weight, the drugs used, site of injection and volume of the drug used.

Satisfaction Questionnaire was developed by the researcher. Five experts from medical and nursing field validated the tool. Content Validity Index (CVI) was found to be 1. The reliability of the tool was calculated statistically. The Cronbach's Alpha was found to be r = 0.86 and the reliability coefficient was r = 0.749 (p<0.01) which shows that it was a reliable tool. Translation was done by experts and back translation was also done. The tool had eight items with five point likert scale ranging from highly satisfactory to highly unsatisfactory. The maximum score was 40 and the minimum score was 8. The obtained score total was converted to percentage. The scores were summed up and interpreted as follows:

Highly Satisfactory- 90% and above

Moderately Satisfactory- 50-89.9%

Unsatisfactory- 0-49.9%

Following the injection procedure, subjects were given numerical rating scale and satisfaction questionnaire to answer. Questionnaire was administered based on the preferred languages of subjects. Demographic and clinical profiles were obtained. Subjects were seated in a closed room and the researcher was present to clarify any doubts while answering. Pilot study was conducted to check the feasibility of the study. Institutional research and ethics committee approval was sought before the commencement of the study. Subjects’ confidentiality and anonymity was maintained throughout the study. The data was stored in a password protected system. Data were analysed using SPSS version 21. Frequency and percentage were used to describe the data. Spearman correlation test was used to identify the relationship between pain response and satisfaction. Chi square test was used to find the association between satisfaction and demographic and clinical variables of subjects receiving intramuscular injection.

RESULTS:

Table 1 Distribution of Subjects Based on Demographic Variables (N= 102)

S. No

Subject Characteristics

Total (n=102)

Gender

Male

Female

63.7

36.3

Age Group

16-30 yrs

31-50 yrs

51-65 yrs

18.6

47.1

34.3

Literacy

Primary

Secondary

Graduate

10.8

38.2

Occupation

Unemployed

Unskilled

Skilled

Professional

Others

45.1

2.9

8.8

27.5

15.7

Injections in the past 3 months

1-5

68.6

28.4

2.9

Table 2 Distribution of Subjects Based on Clinical Variables (N=102)

S. No

Particulars

Total (n=102)

BMI

Underweight

Normal

Overweight

Obese

8.8

27.5

28.4

35.3

Drugs Used

Vitamin

Antibiotic

Hormone

Vaccine

39.2

14.7

10.8

35.5

Site of Injection

Gluteal

Deltoid

65.7

34.3

Volume of Drug

0.5-1ml

1.1-2ml

2.1-5ml

54.9

24.5

20.6

Figure1. Mean Pain Scores of Subjects Receiving Intramuscular Injection (N= 102)

Figure 2. Satisfaction of Subjects Receiving Intramuscular Injection (N= 102)

Figure 3. Relationship between Pain Response and Satisfaction among Subjects Receiving Intramuscular Injection

DISCUSSION:

The researcher found that most of the subjects were male (63.7 %) and majority belonged to the age group of 31-50 years (47.1%). Half of them were graduate (51%) and 68.6% haven’t had injection in the past three months. Most of the subjects (65.7%) received injection in the gluteal site and more than half of them (54.9%) received 0.1-1ml of injection (see table 1 and 2).

In the current study, the researcher found that the mean pain score was 3.15±1.44 among the subjects who received intramuscular injection (see figure 1). Similar findings were noted by Chung, Ng and Wong ^[9], where the pain score among the subjects received intramuscular injection was 2.87±0.18. Even an Iranian study conducted by Nasiry et al. ^[10] also affirms the above finding that the mean pain scores of subjects receiving intramuscular injection were found to be 3.50±.96.

Majority of the subjects (58.8%) were highly satisfied with the intramuscular injection procedure and 41.2% were moderately satisfied, none of the subjects expressed dissatisfaction (see figure 2). Similar findings were noted by Villarruz-Sulit, Dans and Javelosa ^[11]stating that 57.8% of patients were highly satisfied with the overall evaluation of care. Contrary to the findings, study done by Philips et al ^[12]. found that 6.6% were highly dissatisfied, 2.6% were dissatisfied, 5.3% were slightly satisfied, 44.7% were satisfied and 40.8% were highly satisfied with the pain control provided.

The findings of the study clearly reflected that the subjects receiving intramuscular injections were well satisfied and surprisingly none of the subjects revealed dissatisfaction with injection procedure which was quiet a welcoming sign. This will motivate the nursing personnel to keep up the good work and provide the best possible care in the injection room.

A weak negative correlation was seen between pain response and satisfaction of subjects receiving intramuscular injection (ρ = -0.439) and it was found to be statistically significant (p<0.001) (see figure 3). Thus it signified that whenever pain increased, satisfaction decreased and vice versa. Likely, the observation done by Carlson et al. ^[13] also suggested that there was a weak negative correlation found between pain intensity and patient satisfaction (r= -0.24). Even Philips et al ^[12] also identified that there was a weak negative correlation (r= -0.31) between pain intensity and patient satisfaction score. Hence the current study supports the first hypothesis that there is a significant relationship between pain and satisfaction.

Present study reveals that there was no evidence of statistically significant association between satisfaction and the demographic and clinical variables of the subjects receiving intramuscular injection. This could be because of the subjects recruited for the study was minimal and also less number of subjects in few categories. Similarly Niebuhr and Whitfield ^[7] also identified that there was no statistical difference between men and women in terms of satisfaction. In the current study findings, there is no significant association between pain and satisfaction. Hence the second hypothesis is not supported.

The concept of “Right to be free from pain” has to be imbibed by every health care team member. Nurses are legally and ethically responsible for alleviation of pain and it should be emphasized to nursing students. Apart from the injection procedure, there are various other invasive procedures where a nurse can explore and implement Non pharmacological measures for pain relief. The concept of alleviating procedural pain in improving patient satisfaction need to be reiterated during the In-service programme for the staff members. There are other factors which could influence procedural pain response such as viscosity of the drug, pH of the drug, speed of injection, etc which were not explored in the current study and gives an option for further planning of study.

CONCLUSION:

Pain is an unpleasant feeling and most often not given much importance in the context of procedural pain. Pain management is one of the ethical principles which the nurse should incorporate in the day to day practice. A statistically significant weak negative correlation was found between the pain response and satisfaction of patients receiving intramuscular injection. Hence it was clearly evident that the measures taken to alleviate the pain will obviously improve the satisfaction experienced by the patient. Nursing personnel, in specific who spend maximum time in coordination and providing care to patients, are highly responsible in providing a pain free and comfortable care.

REFERENCES:

1. DeLaune SC, Ladner PK. Fundamentals of Nursing: Standards and Practice. 3rd ed. New York: Thomson Delmar, 2007.

2. American Pain Society. Principles of analgesic use in the treatment of acute pain and cancer pain. 4th ed. Glenview, IL: American Pain Society; 1999.

3. Ozdemir L, Pιnarcι E, Akay BN, Akyol A. Effect of methylprednisolone injection speed on the perception of intramuscular injection pain. Pain Management Nursing. 2013; 14(1):3-10.

4. Morris BJ, Jahangir AA, Sethi MK. Patient satisfaction: an emerging health policy issue. AAOS Now. 2013 Jun;7(6):29.

5. Hanna MN, González-Fernández M, Barrett AD, Williams KA, Pronovost P. Does patient perception of pain control affect patient satisfaction across surgical units in a tertiary teaching hospital?. American Journal of Medical Quality. 2012 Sep;27(5):411-6.

6. Bhakta HC, Marco CA. Pain management: association with patient satisfaction among emergency department patients. The Journal of Emergency Medicine. 2014 Apr 1;46(4):456-64.

7. Niebuhr HF, Whitfield MJ. Injections and Patient Satisfaction in Zulu-Speaking Patients. South African Family Practice. 2002;25(6):9-11.

8. Hamilton DF, Lane JV, Gaston P, Patton JT, Macdonald D, Simpson AH, Howie CR. What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients following total joint replacement. BMJ Open. 2013 Jan 1;3(4):e002525.

9. Chung JW, Ng WM, Wong TK. An experimental study on the use of manual pressure to reduce pain in intramuscular injections. Journal of Clinical Nursing. 2002 Jul;11(4):457-61.

10. Nasiry H, Hesam M, Asayesh H, Rahmani Anaraki H, Shariati K, A Bathai S. The effect of manual pressure on intramuscular injection pain severity. J Urmia Nurs Midwifery Fac. 2013;11(2):113-8.

11. Villarruz-Sulit MV, Dans AL, Javelosa MA. Measuring satisfaction with nursing care of patients admitted in the medical wards of the philippine general hospital. Acta Medica Philippina. 2009 Dec 1;43(4):52-6.

12. Phillips S, Gift M, Gelot S, Duong M, Tapp H. Assessing the relationship between the level of pain control and patient satisfaction. Journal of Pain Research. 2013; 6:683.

13. Carlson J, Youngblood R, Dalton JA, Blau W, Lindley C. Is patient satisfaction a legitimate outcome of pain management?. Journal of Pain and Symptom Management. 2003 Mar 1;25(3):264-75

Received on 31.07.2019 Modified on 14.09.2019

Asian J. Nursing Education and Research. 2020; 10(2):171-174.

DOI: 10.5958/2349-2996.2020.00037.3