# Exploring post-operative pain management practices for improved outcomes among nurses in public hospitals in West Shewa, Ethiopia: a multicenter observational study

## TL;DR

This study finds that only a quarter of nurses in Ethiopia's West Shewa zone manage post-operative pain effectively, with factors like training and hospital policies playing a key role.

## Contribution

The study introduces a mixed-method observational approach to assess nurses' post-operative pain management practices, reducing bias from self-reported data.

## Key findings

- Only 25.72% of observed nurses demonstrated good postoperative pain management practices.
- Use of standardized tools and hospital policies were strongly associated with better pain management practices.
- Training and working in surgical units also significantly improved pain management practices.

## Abstract

Effective postoperative pain (POP) management is crucial to enhance satisfaction and recovery. Nurses play a significant role in providing effective pain management, making it crucial to assess their practices. However, most prior research in Ethiopia relied on self-administered tools to evaluate nurses' POP management, potentially introducing bias. This observational study addressed this gap by exploring POP management practices and associated factors among nurses in public hospitals in the West Shewa zone.

A facility-based cross-sectional study incorporating both self-reported and observed quantitative measures was conducted among 377 randomly selected nurses in public hospitals in the West Shewa zone, Ethiopia, from June 1 to August 30, 2020. Data were collected using a standardized interviewer-administered questionnaire and an observational checklist. Non-participant observation was done three times by trained BSc degree nurses. Data quality was ensured, and analysis was done using SPSS version 26. The logistic regression analyses were done to identify factors independently associated with nurses' POP management practice. Adjusted odds ratio (AOR) with 95% CI was estimated to measure the strength of the association. The level of statistical significance was set at a p value <0.05.

Only 25.72% (95% CI: 23.4–32.6) of observed nurses demonstrated good postoperative pain management practices. Factors significantly associated with good practice included being female [AOR: 2.56, 95% CI: 1.78–4.79], using standardized pain assessment tools [AOR: 2.94, 95% CI: 1.65–5.86], working in hospitals with pain management policies [AOR: 3.10, 95% CI: 1.65–5.86], employment in surgical units [AOR: 2.93, 95% CI: 1.27–6.80], and having received relevant training [AOR: 2.28, 95% CI: 1.46–7.40].

Only a quarter of nurses demonstrated good postoperative pain management practices. Female nurses, use of standardized pain assessment tools, presence of formal hospital pain management policies, work in surgical units, and prior training were key enablers. To improve practice, hospitals should provide regular in-service training focused on evidence-based postoperative pain assessment and intervention, implement standardized pain assessment tools, and enforce comprehensive institutional policies guiding pain management across all wards.