Dying without pain: evaluating the impact of nurses prescribing morphine in Uganda

Background: Approx 27,000 new cases of cancer are reported in Uganda in each year affecting 1.5% of the population, of which it is estimated that 95% will experience pain in the terminal phase of their disease. However with a there is a severe shortage of Doctors coupled with a wide geographical distribution, and poor transport systems lead to many patients experiencing severe uncontrolled pain. Following policy changes in 2004 nurses who have completed a nine month Community Palliative Care Course at Hospice Africa Uganda are permitted to prescribe morphine. The aim of this study was to evaluate the impact of this extended prescribing. Methods: A qualitative methodology using focus group interviews was adopted for the study to enable group discussion and interaction to take place. A purposive sample of members from clinical and educational teams and current students from were invited to participate in the study. 24 volunteers and participated in three audio taped focus groups. Data was analysed for emerging themes using thematic analysis. Results and Discussion: There was a general consensus that nurses’ being allowed to prescribe morphine was having a positive effect of patients, their families and the clinical team. Benefits including pain relief and enhancing the patient’s quality of life were noted. Economic impacts of reduced travelling costs to obtain the morphine were stressed. Course students referred to their initial concerns surrounding prescribing morphine and the importance of the course in preparing them for the role. The ongoing problem of a limited supply of morphine was also noted. This paper discusses these findings and potential explanations given. Ongoing research to assess measurable clinical outcomes will be discussed.