Fatuma A Affey


Introduction: Nursing care models allow concept application of not only the physical treatment of pain but also synthesis the significance of social-cultural practices, psychological and spiritual pain relief. Cancer pain has high prevalence and negative impact on the quality of life of patients at Garissa County due to limited access to healthcare facilities and unique pastoral lifestyle of the community. This necessitated the development of Xannun model of nursing care for holistic pain management that is clinically proficient and culturally competent. The word ‘Xannun’ means Pain in Somali Language.  The name ‘Xannun’ nursing model was adopted because the model was developed based on the needs of Garissa resident, predominately with high population of Somali ethnic origin.  

Methods: Phase one of the utilised triangulation method approach to recruit 94 cancer patients, 84 clinical nurses and 15 key informants, while phase two was the actual development and testing of Xannun nursing care model. Various sampling procedures that included random, purposive and snowball and recruit participants voluntarily was done. Modified Brief Pain Inventory (MBPI) tool combined with focus group discussion and Eastern Cooperative Oncology Group (ECOG) performance status was used to obtain data from participants. The sample population was 188 participants. Phase two of this study utilised Delphi survey to gain expert opinion before the development and utilization the model.

Results: Cancer patients had a mean age of 51 years, with prevalence of pain at 78 % (73) that ranged from moderate to severe. A total of 78 % (66) of clinical nurses had no tool for pain assessment, 83.2 % (70) of them did not know how to utilise WHO analgesic ladder.  Majority of patients 82 % (78) were on incorrect WHO analgesic ladder with negative PMI (p-value < 0.05) of under treatment. Majority of patients considered alternative treatment for cancer pain such as Quran recitation and Somali herbs accounting for 65% (61) and 77.6% (73) respectively. Almost all KI 93% (14) indicated the inadequate availability of pain medication. In phase two of the study, experts’ opinion of 80% of respondents agreed that the ‘Xannun’ nursing model captured the challenges of cancer pain management and 60% of them predicted that the model could be utilised. However, 100% of the experts suggested that the model will bring a positive change, though 90% of them upheld that there will be potential challenges of implementing such a model.

Conclusion: This study found high prevalence of cancer pain, suboptimal pain care, Knowledge deficit among nurses and inaccessibility of pain medication associated with the dynamic of a nomadic lifestyle.

Recommendation:  This study recommends the implementation of “Xannun” Nursing Care model at GCRH, for a better approach of cancer pain management.


prevalence, cancer pain, ‘Xannun, nursing model

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Affey et al, (2018) Clinical Nurses’ Perspective of Cancer Pain Management of Adult Patients at Garissa County, Kenya. Journal of Health, Medicine and Nursing, Vol.3, Issue 3 No.5, pp 61- 68, 2018

Affey,F and Mwenda C (2019) Cancer pain management at Garissa County Referral Hospital.

International Journal of Scientific and Research Publications, Volume 9, Issue 8, Pg. 2250-3153

Bartoszczyk D and Gilbertson-White S (2015) Interventions to nurse-related barriers in cancer pain management. Oncol Nurs Forum. 1; 42(6): 634–641. https://www.ncbi.nlm.nih.gov/pubmed/26488832

Dzau, V.J. and Pizzo, P.A., 2014. Relieving pain in America: insights from an Institute of Medicine committee. Jama, 312(15), pp.1507-1508.

Fahey, K.F., Rao, S.M., Douglas, M.K., Thomas, M.L., Elliott, J.E. and Miaskowski, C., 2008, March. Nurse coaching to explore and modify patient attitudinal barriers interfering with effective cancer pain management. In Oncology nursing forum (Vol. 35, No. 2).

Habibi,A. ,Sarafrazi, A & Izadyar,S. (2014).Delphi Technique Theoretical Framework in Qualitative Research. The International Journal of Engineering And Science 3(4) 2319-1805

Hassan, A.H., Shariff, M. and Mohammed, M., 2014. P0052 Newly diagnosed cancers in Garissa Referral General Hospital, Kenya. European Journal of Cancer, 50, pp.22-23.

Huang, K.T., Owino, C., Gramelspacher, G.P., Monahan, P.O., Tabbey, R., Hagembe, M., Strother, R.M., Njuguna, F. and Vreeman, R.C., 2013. Prevalence and correlates of pain and pain treatment in a western Kenya referral hospital. Journal of palliative medicine, 16(10), pp.1260-1267.

Knudsenl, A.K., Brunellil, C., Kaasal, S., Apolonel, G., Corlil, O., Montanaril, M., Fainsingerl, R., Aassl, N., Fayersl, P., Caracenil, A. and Klepstadl, P., 2011. Which variables are associated with pain intensity and treatment response in advanced cancer patients? —Implications for a future classification system for cancer pain. European Journal of Pain, 15(3), pp.320-327.

Namukwaya, E., Leng, M., Downing, J.,and Katabira, E. 2011. Cancer Pain Management Resource Limited Setttings: A practice Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3236429/

Ndegwa, J. 2013. Prevalence and management of cancer pain in ambulatory patients at Kenyatta National Hospital. Retrieved November 1, 2014, from http://erepository.uonbi.ac.ke/handle/11295/62864

Senthil P Kumar, Krishna Prasad, Vijaya K Kumar, Kamalaksha Shenoy and Vaishali Sisodia (2013) Mechanism-based Classification and Physical Therapy Management of Persons with Cancer Pain: A Prospective Case Series. Indian J Palliat Care.2013 Jan-Apr; 19(1): 27–33.

Vallerand, A.H., Musto, S. and Polomano, R.C., 2011. Nursing’s role in cancer pain management. Current pain and headache reports, 15(4), pp.250-262.

Van den Beuken-van Everdingen MH1, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, and Janssen DJ (2016) Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis. J Pain Symptom Manage: 51(6):1070-1090

Waweru, S.M., Reynolds, A. and Buckner, E.B., 2008. Perceptions of children with HIV/AIDS from the USA and Kenya: self-concept and emotional indicators. Pediatric nursing, 34(2), p.117.

Wells, N, Pasero, C. and McCaffery, M., 2008. Improving the quality of care through pain assessment and management: chapter 17, Patient safety and quality: an evidenced based hand book for nurses 1-339

WHO(2014, November). Cancer. Retrieved December 2nd, 2014, from http://www.who.int/cancer/palliative/en/.

World Health Organization. 1990. Cancer Pain Relief and Palliative Care. http://www.who.int/cancer/ palliative/en/


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