Effect of pain assessment scale integration and nurse training on knowledge, attitudes, and practices in postoperative pain management at a low-resource facility quantitative quasi-cross-sectional study.

Betty Musisi Nabiwande; Dr. Faith  Sebuliba; Oromcan Benjamin  Wathum

doi:10.51168/sjhrafrica.v6i12.2208

Authors

Betty Nabiwande Musisi Mengo Hospital School of Nursing and Midwifery.
Dr. Faith Sebuliba Head of Nursing Faculty, Uganda Christiaan University, Mukono.
Oromcan Benjamin Wathum Mengo Hospital School of Nursing and Midwifery.

DOI:

https://doi.org/10.51168/sjhrafrica.v6i12.2208

Keywords:

Postoperative Pain Management, Knowledge, KAP, Pain Assessment, Clinical Intervention, Quasi-experimental Study

Abstract

Background

Post-operative pain remains one of the greatest concerns for patients following surgery. Failure to promptly assess and manage pain may result in postoperative complications like hypertension, depression, and overall poor health outcomes.

Objective

To describe the effect of integrating the pain assessment scale on the nurse’s knowledge, attitude, and practice toward post-operative pain management in the surgical ward in a low-resource facility.

Method

This was a quasi-experimental study using pre- and post-intervention evaluation carried out from June to November 2022. The nurses included were educated on post-operative pain management using a numeric pain assessment scale during a CME. They completed a pre- and post-test to assess their knowledge and attitude towards post-operative pain management. Data was analyzed using SPSS version 20. A student paired t-test was performed to assess for change in knowledge, attitude, and practice.

Results

The researcher surveyed 60 participants, and the majority (70%) were aged between 24 and 33 years. In the pretest and posttest, the mean total knowledge scores about post-operative pain treatment were (M= 62.83, SD= 9.583, t = -59, P=0.01), pretest attitude (M = 60.72, SD=7.095) and the posttest (M=71.65.SD= 7.688, t =-7.479, dt= 59, p=.000). Majority of respondents had their post-operative practices (POP) management practices improved (87%) and were able to use the PQRST to evaluate POP, more than seventy-three percent (73.3%) used the PAS to manage POP and 75% of the respondents gave POP patients direct nursing care.

Conclusion

The results revealed a great improvement, which was statistically significant in the nurses’ knowledge, attitude, and practice towards post-operative pain management.

Recommendations

Create educational initiatives that emphasize pain evaluation and management, put in place standardized instruments for pain assessment, and create quality improvement initiatives in addition to procedures for efficient pain management and documentation.

Author Biography

Betty Nabiwande Musisi, Mengo Hospital School of Nursing and Midwifery.

is a dedicated Health Tutor at Mengo Hospital Training Institute, serving in the Department of Nursing. She holds qualifications in PGDME, MNS, BScN, and is a Registered Nurse. Her professional and research interests lie in Medical-Surgical Nursing and Obstetrics, with a strong focus on enhancing clinical practice through education and evidence-based interventions. Betty has led initiatives in continuous medical education, particularly in postoperative pain management, and has contributed to the development and implementation of pain assessment tools aimed at improving patient outcomes in low-resource settings.

References

Abu, P., Tornu, E., & Aziato, L. (2024). Exploring post-surgical pain experiences and determinants: A qualitative analysis among Ghanaian abdominal surgery patients. International Journal of Africa Nursing Sciences, 20, 100741. https://doi.org/10.1016/j.ijans.2024.100741

Choi, S., Yoon, S.-H., & Lee, H.-J. (2024). Beyond measurement: A deep dive into the commonly used pain scales for postoperative pain assessment. The Korean Journal of Pain, 37(3), 188-200. https://doi.org/10.3344/kjp.24069

Chow, K. M., & Chan, J. C. (2015). Pain knowledge and attitudes of nursing students: A literature review. Nurse Education Today, 35(2), 366-372. https://doi.org/10.1016/j.nedt.2014.10.019

Dessie, M., Asichale, A., Belayneh, T., Enyew, H., & Hailekiros, A. (2019). Knowledge and Attitudes of Ethiopian Nursing Staff Regarding Post-Operative Pain Management: A Cross-Sectional Multicenter Study. Patient Related Outcome Measures, Volume 10, 395-403. https://doi.org/10.2147/PROM.S234521

Fatma, A., & Serife, K. (2017). Experience of pain in patients undergoing abdominal surgery and nursing approaches to pain control. International Journal of Caring Sciences, 10(3), 1456.

Kiwanuka, F., & Masaba, R. (2018). Nurses' knowledge, attitude, and practices regarding pain assessment among patients with cancer at Uganda Cancer Institute. Journal of Research in Clinical Medicine, 6(2), 72-79. https://doi.org/10.15171/jarcm.2018.011

Kizza, I. B., Muliira, J. K., Kohi, T. W., & Nabirye, R. C. (2016). Nurses' knowledge of the principles of acute pain assessment in critically ill adult patients who can self-report. International Journal of Africa Nursing Sciences, 4, 20-27. https://doi.org/10.1016/j.ijans.2016.02.001

Meissner, W., Coluzzi, F., Fletcher, D., Huygen, F., Morlion, B., Neugebauer, E., Pérez, A. M., & Pergolizzi, J. (2015). Improving the management of post-operative acute pain: Priorities for change. Current Medical Research and Opinion, 31(11), 2131-2143. https://doi.org/10.1185/03007995.2015.1092122

Myles, P. S., Myles, D. B., Gallagher, W., Boyd, D., Chew, C., MacDonald, N., & Dennis, A. (2017). Measuring acute postoperative pain using the visual analog scale: The minimal clinically important difference and patient acceptable symptom state. BJA: British Journal of Anaesthesia, 118(3), 424-429. https://doi.org/10.1093/bja/aew466

Omotosho, T. O. A., Sey-Sawo, J., Omotosho, O. F., & Njie, Y. (2023). Knowledge and attitudes of nurses towards pain management at Edward Francis Small Teaching Hospital, Banjul. International Journal of Africa Nursing Sciences, 18, 100534. https://doi.org/10.1016/j.ijans.2023.100534

Pereira, M. P., & Pogatzki-Zahn, E. (2015). Gender aspects in postoperative pain. Current Opinion in Anesthesiology, 28(5), 546-558. https://doi.org/10.1097/ACO.0000000000000226

Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., Keefe, F. J., Mogil, J. S., Ringkamp, M., & Sluka, K. A. (2020). The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain, 161(9), 1976-1982. https://doi.org/10.1097/j.pain.0000000000001939

Samarkandi, O. A. (2018). Knowledge and attitudes of nurses toward pain management. Saudi Journal of Anaesthesia, 12(2), 220-226. https://doi.org/10.4103/sja.SJA_587_17

Sigakis, M. J., & Bittner, E. A. (2015). Ten myths and misconceptions regarding pain management in the ICU. Critical Care Medicine, 43(11), 2468-2478. https://doi.org/10.1097/CCM.0000000000001256

Xu, X., Chen, H., Xu, J., Zhang, Y., Gong, R., & Hu, X. (2025). The status and challenges of pain assessment in hospitalized patients: A cross-sectional study. Pain Management Nursing, 26(2), e124-e130. https://doi.org/10.1016/j.pmn.2024.11.003