The knowledge and practices of nurses are determinant factors of pediatric pain management, but there are no pooled results concerning prevalence and associated factors. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of good knowledge, good practices, and associated factors for pediatric pain management in Ethiopia.
Methods
PubMed, Cochrane, Scopus, CINAHL, Google Scholar, and university repositories in Ethiopia were searched. It was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and Newcastle–Ottawa Scale was used to assess the quality. Cross-sectional studies conducted any time were included. STATA 17 was used to analyze the data after extraction. Heterogeneity was assessed via I2 statistics, Galbraith plot and meta-regression. A random effects model was used in the presence of heterogeneity. Funnel plots and Egger’s regression were used to assess publication bias. Subgroup analyses were conducted by the study period and sample size. Sensitivity analysis was also performed.
Results
Nine studies with a total of 2355 nurses were included. The pooled prevalence of good knowledge and practices for pediatric pain management among nurses was 60% and 42%, respectively. The percentages were higher from 2015–2021 than from 2022–2024. Education, training, pain management protocols, and tools were the main variables analyzed. Hence, pre-service training (OR: 3.1, CI: 2.21–4.36), in-service training (OR: 3.04, CI: 1.78–5.18), and pain management protocol (OR: 2.53, CI: 1.59–4.03) were associated with good knowledge. MSc degrees (OR: 7.45, CI: 2.74–20.21), pre-service training (OR: 2.26, CI: 1.53–3.34), in-service training (OR: 3.27, CI: 1.72–6.25), presence of protocol (OR: 2.68, CI: 1.79–3.99), presence of tool (OR: 2.74, CI: 1.96–3.83), presence of policy (OR: 6.2, CI: 2.98, 12.91), knowledge of nurses (OR: 4.47, CI: 3.24, 6.18) and child cooperativeness (OR: 1.98, CI: 1.46, 2.67) were associated with good practices of pediatric pain management.
Conclusion
The pooled prevalence of good knowledge and good practices was low. Education, training, and the availability of pain management protocols were the most important factors. Therefore, education and training provisions should focus on nurses working in pediatric wards.
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Abkürzungen
BSc
Bachelor’s of Science
CI
Confidence Interval
CINAHL
Cumulative Index to Nursing and Allied Health Literature
EBPs
Evidence-Based Practices
MSc
Master’s of Science
NOS
Newcastle–Ottawa Scale
OR
Odds Ratio
PRISMA
Preferred Reporting Items for Systematic Review and Meta-analysis
PROSPERO
Prospective Register of Systematic Reviews
Background
Pain is considered an unpleasant subjective sensory and emotional perception that occurs because of actual or potential tissue damage. It is the outcome of various physical, psychological, and spiritual reactions that lead to healthcare seeking by patients [1, 2].
Pain assessment and management in children are challenging, as they do not express their feelings as desired [3]. Pain management helps to resolve pain symptoms in children to improve their prognosis, quality of life, and safety for parents and even health care providers [4, 5].
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Pain is unrecognized and undermanaged due to different factors in children [5]. Children experience pain during routine medical procedures, such as injection, suctioning, or the effect of the disease process [5]. The nursing profession is responsible for assessing, planning, implementing, and evaluating pain [6]. Nurses’ knowledge and practices can therefore affect pain assessment and management among children. The unique nature of children can affect the knowledge and practice of nurses for pain management, such as medication contraindications and dosage limitations [7, 8].
Currently, the minister of health in Ethiopia has developed a national pain-free hospital initiative policy and guidelines incorporating protocols for pediatric pain assessment and management. Pain assessment and management have also been incorporated into nursing courses in higher education curricula. Pain has been registered as a fifth vital sign and documented in the nursing vital sign register [9‐11].
According to previous primary studies conducted in Ethiopia on pediatric pain management knowledge and practices, there is an inconsistency in the prevalence and associated factors among nurses. The prevalence of good pediatric pain management knowledge ranges from 42 to 68% [12, 13], and the prevalence of good pediatric pain management practices widely ranges from 16 to 59% [14, 15].
Different factors affect the knowledge and practice of pediatric pain management among nurses. The factors that determine the knowledge of pediatric pain management among nurses are educational status, training, attitudes of nurses, and the presence of pain management protocols [12‐14, 16, 17], and the factors that determine the practice of pediatric pain management include the educational and work experience of nurses, training opportunities, the presence of pediatric pain management protocols, tools, and policies, and the knowledge and attitudes of nurses [14‐16, 18, 19].
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Few systematic reviews and meta-analyses studies have focused on knowledge of pain management among nurses outside Ethiopia, and no reviews have focused on the prevalence of pediatric pain management practices elsewhere [20‐22]. In addition, systematic reviews and meta-analyses studies have not been conducted on the pooled prevalence and associated factors for knowledge and practice of pediatric pain management in Ethiopia.
Therefore, this systematic review and meta-analysis aimed to pool the prevalence of good knowledge and practices for pediatric pain management and associated factors among nurses in Ethiopia. To the best of our knowledge, this is the first systematic review and meta-analysis of knowledge and practices related to pediatric pain management among nurses in Ethiopia. Pooled results that show the national prevalence and factors associated with the knowledge and practice of pediatric pain management among nurses are needed. This may provide useful information for policymakers and health care leaders in planning future activities. This finding also helps improve pediatric nursing care provision through the implementation of evidence-based practices (EBPs) to meet the needs of the pediatric population and their caregivers.
Methods
Registration and reporting
The search strategy was started by checking the registration of protocol at the international Prospective Register of Systematic Reviews (PROSPERO) database. Hence, there was no protocol registered at the PROSPERO database on the prevalence of knowledge and practices for pediatric pain management and associated factors among nurses in Ethiopia. We then registered our protocol in the PROSPERO database with a registration number of CRD42024572462 [23]. It was reported on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, 2020) guidelines [24] (S1 File: PRISMA 2020 Checklist).
Search strategies
The PubMed, Cochrane Library, Scopus, CINAHL, Google Scholar, and university online repositories in Ethiopia were searched from 26/07/2024 to 10/08/2024. The references of the identified articles were also searched for inclusion. Knowledge, practice, pediatrics, pain, nurses, and Ethiopia were combined with Boolean operators AND/OR. Medical subject heading (MeSH) terms were used to search for articles. The search strategies with boolean operators are provided in the supporting files (S2 File: Search strategy).
The research questions were constructed using population, intervention, comparison group, outcome, type of study (PICOT) strategy.
Population
Nurses working with pediatric patients.
Intervention or exposure
The knowledge and practice of pediatric pain management among nurses.
Comparator
Poor knowledge and practice of pediatric pain management among nurses.
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Outcomes
The primary outcomes are knowledge and practice of pediatric pain management among nurses, and the secondary outcomes are factors associated with knowledge and practice of pediatric pain management among nurses.
Study design
Systematic review and meta-analysis.
Study setting
Ethiopia.
Operational definitions
Knowledge
Good knowledge versus poor knowledge. Different articles have used different algorithms to classify knowledge. Some articles used above and below the mean [12, 13, 18, 25], and others used below and above 80% to classify knowledge level [14, 17].
Practice
Good practices versus poor practices, and different articles have used different algorithms to classify them. Some articles also used above and below the mean [15, 18], and others used below and above 80% to classify the practice level [14, 17].
Pain management protocol
These are national or international guidelines used to manage pain [17].
Pain management tool
These are items of protocols that are usually posted on the wall or dispensed as brushers [17].
Pre-service training
These are trainings that are provided during educational programs before job appointments as part of the curriculum.
In-service training
This training is provided after a job appointment as part of continued professional development.
Pediatrics
A child less than 18 years of age.
Inclusion criteria
Cross-sectional studies that reported the prevalence of or factors associated with either knowledge or practices or both of pediatric pain management among nurses in Ethiopia were included. All nurses working with either male or female pediatric patients were included. Both published and unpublished articles conducted at any time in Ethiopia were considered.
Exclusion criteria
Studies that reported knowledge and practices related to pain management in adults were excluded. Studies involving health professionals other than nurses were also excluded. Studies that were not fully accessible; studies that were not conducted in English; and studies that did not measure the outcome of interest on the prevalence of pediatric pain management knowledge, practice and associated factors in Ethiopia were excluded.
Study selection and critical appraisal
The articles retrieved from the databases were exported to EndNote citation managers to remove duplicates. Two authors (Moges Tadesse and Yideg Abinew) independently screened the titles and abstracts of the articles, and any discrepancy between the two reviewers was resolved through discussion with a third reviewer (Jemberu Chanie).
To assess the quality of the included studies, the Newcastle–Ottawa scale (NOS) critical appraisal checklist for cross-sectional studies was used [26]. Studies with scores of 7 or more of the 10 criteria were included in this review. Two reviewers independently appraised each article (Moges Tadesse and Yosef Aragaw). Disparities between the two reviewers were resolved by the appraisal of a third independent reviewer (Muluken Chanie) (S3 File: NOS Critical Appraisal).
Data extraction
A standardized Microsoft Excel 2010 data extraction spreadsheet was used to extract the data (S4 files: extracted data). The name of the first author, year of study, region, sample size, frequency of knowledge of pediatric pain management among nurses, frequency of practice of pediatric pain management among nurses, NOS scale, and response rate were extracted (Table 1). Two independent reviewers (Moges Tadesse and Dessie Alemnew) extracted the data and crosschecked their consistency. Any disagreement between the two reviewers was resolved with a third reviewer’s (Muluken Chanie) extraction and further discussion among the three reviewers.
Table 1
Characteristics of the included studies on knowledge and practices of pediatric pain management among nurses in Ethiopia
Serial number
Author (study year)
Region
Frequency of knowledge
Frequency of practice
Sample size
Prevalence of good knowledge
Prevalence of good practice
Response rate
NOS Scale
1
Birhanu et al. 2022
Amhara
233
216
421
55.3
51.3
95.7
10
2
Wari et al. 2020
Addis Ababa
79
41
119
66.4
34.5
96.6
7
3
Lulie et al. 2020
Amhara
267
-
393
67.9
-
95.4
9
4
Alemu et al. 2 2023
Amhara
-
185
314
-
58.9
88.2
8
5
Mekonen et al. 2022
Oromia
127
33
203
62.6
16.3
98.5
7
6
Miftah et al. 2015
Tigray
147
140
251
58.6
55.8
96.5
8
7
Tagele et al. 2021
Amhara
157
-
234
67.1
-
86.03
7
8
Tadesse et al. 2022
Addis Ababa
96
86
226
42.5
38.1
92.2
8
9
Jamie et al. 2023
Harar
122
-
194
62.9
-
97.9
8
Data analysis
STATA version 17 statistical software was used to analyze the data. The Galbraith plot, I-squared (I2) statistic, and meta-regression analysis were used to assess the heterogeneity among the included studies. The fixed effects model was used when the I2 value was less than 50%, and the random effects model was used when the I2 value was greater than 50%. Funnel plots and Egger’s-based regression tests with a p-value of 0.05 were used to assess publication bias. Sensitivity analysis was executed to determine the effect of a single study on the overall effect estimate by removing each study at a time. Subgroup analysis was conducted using the study period and sample size to identify the source of heterogeneity.
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Results
Selection results
Overall, 1563 articles were retrieved from online databases. After being exported to the EndNote citation manager, 566 duplicates were removed, and 681 were excluded after title and abstract screening. A total of 158 full articles were assessed for eligibility; 128 were excluded because of outcomes of interest, and 13 were excluded because of data inconsistency. Finally, 9 articles were included in this systematic review and meta-analysis (Fig. 1).
Fig. 1
PRISMA flow diagram of study selection for the systematic review and meta-analysis of knowledge and practices related to pediatric pain management among nurses
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Characteristics of the included studies
This systematic review and meta-analysis included 9 cross-sectional studies with a total of 2355 nurses. Among them, four studies were from the Amhara region [12, 13, 15, 18], two studies were from Addis Ababa [16, 17], one study was from the Oromia region [14], one study was from the Tigray region [25] and one study was from the Harar region [27]. All the studies were conducted since 2015, and most articles have been published since 2020. The smallest and largest sample sizes were 119 and 421, respectively (Table 1).
Prevalence of knowledge for pediatric pain management
The pooled prevalence of good knowledge of pediatric pain management among nurses according to the random effects model was 60% (CI: 55%-66%), I2 = 86.6%, p < 0.001 (Fig. 2).
Fig. 2
Forest plot showing the pooled prevalence of knowledge of pediatric pain management among nurses in Ethiopia
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Publication bias and heterogeneity test
Although the funnel plot revealed asymmetry, Egger’s regression test yielded a p-value of 0.76, which indicated the absence of significant publication bias between studies. As the Galbraith plot shows, all included studies had 95% of CIs of the plot, confirming the absence of significant outliers or heterogeneity (Fig. 3). Furthermore, to identify possible sources of heterogeneity, we conducted meta-regression analysis using the year of study and sample size as covariates. However, these factors did not significantly affect the heterogeneity of the studies (Table 2).
Fig. 3
Galbraith plot showing heterogeneity for knowledge of pediatric pain management among nurses in Ethiopia
Table 2
Meta-regression analysis of between study heterogeneity of pediatric pain management knowledge among nurses in Ethiopia
Source of heterogeneity
Coefficients
Standard errors
p-values
Year of study
-0.0042
0.0149
0.79
Sample size
-0.000068
0.000366
0.86
×
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Subgroup analysis for knowledge of pediatric pain management
Subgroup analysis was conducted according to the study period and sample size. Hence, the percentage of good knowledge based on the study period was higher from 2015–2021 than from 2022–2025. In terms of sample size, the percentage of good knowledge was nearly the same between samples of below and above 250 (Fig. 4 and 5).
Fig. 4
Subgroup analysis of study period for knowledge of pediatric pain management among nurses in Ethiopia
Fig. 5
Subgroup analysis using sample size for knowledge of pediatric pain management among nurses in Ethiopia
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×
Sensitivity analysis
A step-by-step removal of each study to determine the effect of a single study on the overall effect size revealed that no single study exclusively influenced the pooled effect size of knowledge of pediatric pain management among nurses (Fig. 6).
Fig. 6
Sensitivity analysis for knowledge of pediatric pain management among nurses in Ethiopia
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Prevalence of pediatric pain management practices
The pooled prevalence of good practices for pediatric pain management among nurses according to the random effects model was 42% (CI: 28%-57%), I2 = 97.13%, p < 0.001 (Fig. 7).
Fig. 7
Pooled prevalence of practicing pediatric pain management among nurses in Ethiopia
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Publication bias and heterogeneity test
Although the funnel plot revealed asymmetry, the p-value of Egger’s test of 0.75 indicated the absence of significant publication bias. The Galbraith plot revealed an absence of heterogeneity (Fig. 8). The meta-regression analysis using the year of study and sample size as covariates did not significantly affect heterogeneity of the studies (Table 3).
Fig. 8
Galbraith plot showing heterogeneity for the practices of pediatric pain management among nurses in Ethiopia
Table 3
Meta-regression analysis of between study heterogeneity of pediatric pain management practice among nurses in Ethiopia
Source of heterogeneity
Coefficients
Standard error
p-value
Year of study
-0.023
0.027
0.456
Sample size
0.001
0.00078
0.254
×
Subgroup analysis for practice of pediatric pain management
Subgroup analysis was also conducted according to the study period and sample size. Hence; by study period, the percentage was higher from 2015–2021 than from 2022–2024. It was also greater when the sample size was greater than 250 than when it was less than 250 (Fig. 9 and 10).
Fig. 9
Subgroup analysis using study period for the practice of pediatric pain management among nurses in Ethiopia
Fig. 10
Subgroup analysis using sample size for the practice of pediatric pain management among nurses in Ethiopia
×
×
Sensitivity analysis
A step-by-step removal of each study to determine the effect of a single study on the overall effect size revealed that no single study exclusively influenced the pooled effect size of good practice of pediatric pain management among nurses (Fig. 11).
Fig. 11
Sensitivity analysis for the practices of pediatric pain management among nurses in Ethiopia
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Factors associated with knowledge of pediatric pain management among nurses
Pre-service training, in-service training and the presence of protocols were associated with good knowledge of pediatric pain management among nurses in Ethiopia (Table 4).
Table 4
Factors associated with knowledge of pediatric pain management among nurses in Ethiopia
Nurses who received pre-service training were 3 times more knowledgeable in managing pediatric pain than those who did not receive pre-service training (OR: 3.1, CI: 2.21, 4.36), I2 = 0.0%, p = 0.418, Egger’s test revealed no evidence of publication bias (p = 0.87). Similarly, nurses who received in-service training were nearly 3 times more knowledgeable than their counterparts were (OR: 3.04, CI: 1.78, 5.18), I2 = 68.3%, p = 0.013, Egger’s test revealed that there was no evidence of publication bias (p = 0.77).
The availability of pain management protocols is another determinant of knowledge of pediatric pain management among nurses. Hence, these nurses were 2.53 times more knowledgeable than nurses who did not have the protocol (OR: 2.53, CI: 1.59, 4.03), I2 = 60%, p = 0.082, Egger’s test revealed that there was no evidence of publication bias (p = 0.11).
Factors associated with the practice of pediatric pain management among nurses
Nurses with an educational level of MSc, nurses with good knowledge of pain management, nurses with pre-service and in-service training, the presence of pain management protocols and tools, and cooperative children were associated with the practice of pediatric pain management among nurses (Table 5).
Table 5
Factors associated with practices of pediatric pain management among nurses in Ethiopia
Nurses with MSc degrees were 7.45 times more likely to practice pain management than were nurses with educational levels of diploma (OR: 7.45, CI: 2.74–20.21), I2 = 0.0%, p = 0.633.
Training is another factor that affects the practice of pediatric pain management among nurses in Ethiopia. Nurses who received pre-service training were more likely to practice pediatric pain management than those without pre-service training (OR: 2.26, CI: 1.53–3.34), I2 = 0.0%, p = 0.656, Egger’s test revealed no evidence of publication bias (p = 0.31). In addition, nurses who received in-service training were also more likely to practice pediatric pain management than were those without in-service training (OR: 3.27, CI: 1.72–6.25), I2 = 72%, p = 0.013, Egger’s test revealed that there was no evidence of publication bias (p = 0.39).
Pain management protocols, tools and policy availability also affect the practice of pediatric pain management among nurses. Nurses practiced pediatric pain management when there was a pain management protocol rather than in the absence of it in the ward (OR: 2.68, CI: 1.79–3.99), I2 = 54.5%, p = 0.086. Egger’s test also revealed that there was no evidence of publication bias (p = 0.11). Similarly, the presence of pain assessment tools in the wards determined the practice of pediatric pain management among nurses (OR: 2.74, CI: 1.96–3.83), I2 = 0.0%, p = 0.464, Egger’s test revealed that there was no evidence of publication bias (p = 0.16). Finally, the availability of pain management policies in wards determines the practice of pediatric pain management among nurses (OR: 6.2, CI: 2.98–12.91), I2 = 0%, P = 0.854.
Nurses who were knowledgeable about pediatric pain management practiced more often than those with poor knowledge of pediatric pain management (OR: 4.47, CI: 3.24–6.18), I2 = 0.0%, p = 0.867, Egger’s test revealed that there was no evidence of publication bias (p = 0.98). Nurses also practiced pediatric pain management better when the child was cooperative (OR: 1.92, CI: 1.46–2.67), I2 = 0.0%, p = 0.987.
Discussion
This meta-analysis aimed to assess the prevalence of knowledge and practices related to pediatric pain management and associated factors among nurses in Ethiopia. The pooled prevalence for good knowledge of pediatric pain management was 60% and the pooled prevalence for good practice of pediatric pain management was 42%. This result was supported by systematic reviews and meta-analyses conducted previously [20, 21, 28]. The percentages of good knowledge and practices were higher from 2015–2021 than from 2022–2024. This may be because the first few years of the initiation of the pediatric pain management period provided training and materials such as protocols, tools and policies for nurses, which led to increased percentages. The factors associated with knowledge and practices related to pediatric pain management among nurses were described in this meta-analysis.
Among the multiple variables analyzed to determine factors affecting knowledge; pre-service training, in-service training and the availability of pain management protocols in the wards were associated with good knowledge of pediatric pain management among nurses. This might be because all these factors are sources of knowledge for nurses. This finding was supported by meta-analysis studies in which educational intervention improved nurses’ knowledge of pediatric management [20, 21, 29, 30].
Nurses who received pre-service or in-service training were threefold more knowledgeable in managing pediatric pain than those without training. The reason behind this could be that training provides knowledge for nurses [31]. Nurses who worked in wards where there was a pain management protocol had 2.53 times more knowledge of pediatric pain management than those who worked where there was no protocol. This might be because nurses can develop their knowledge by reading guidelines and protocols found in their working area, if available.
To identify factors associated with the practice of pediatric pain management among nurses, different variables were incorporated into the analysis. Nurses with MSc educational status, pre-service training, in-service training, availability of pain management protocols, policies and tools, pain management knowledge, and cooperative children were associated with good practices of pediatric pain management among nurses. These findings were also supported by a similar review [28].
Nurses with MSc degrees were 7.45 times more likely to practice pediatric pain management than nurses with diplomas were. This occurred because MSc nurses had better knowledge of pediatric pain management than diploma nurses did, which they acquired from their education. The other reason could be the job description variation, where MSc nurses are able to prescribe and manage the pain a child encounters, but diploma nurses do not participate in direct patient care in hospitals. Nurses who received pediatric pain management pre-service training were 2.26 times more likely to practice pain management than those who did not receive pre-service training. In addition, nurses who received pediatric pain management in-service training were 3.27 times more likely to practice pediatric pain management than those who did not receive the training. These three findings strongly implied the need for the provision of pediatric pain management education and training for nurses working in pediatric wards and were supported by the idea of meta-analyses conducted previously [29, 30].
The availability of a pediatric pain management protocol in the ward led to 2.68 times more practice for pediatric pain management among nurses. In addition, the availability of pain management tools in the ward also provided 2.74 times more practice for pediatric pain management among nurses. Policy availability also yielded a sixfold increase in the practice of pediatric pain management among nurses. Hence, pain assessment protocols, tools and policies are sources of information and knowledge that provide confidence in practicing pediatric pain management among nurses [32]. In addition to education and training, fulfilling pediatric pain management protocols, tools and policies in pediatric wards are key strategies for providing good knowledge and practice of pediatric pain management among nurses in hospitals [33].
The knowledge of nurses determines the practice of pediatric pain management. The likelihood of pediatric pain management practice was 4.47 times greater among those with good knowledge of pediatric pain management than among those with poor knowledge. This was because knowledge provided them with confidence in how to practice pediatric pain management appropriately. Knowledge is acquired through education and training, which is the reason that pre-service and in-service training are associated with the practice of pediatric pain management in addition to good knowledge [34].
Nurses had nearly two times more good practices of pediatric pain management when the child was cooperative. The challenge faced by pediatric nurses is the cooperativeness of a child. This might affect the practice of medication administration, such as pain management in children. Hence, the nurse should have better approaches for the child to cooperate [35].
The limitations of this review were that some of the studies lacked outcomes of interest, including factors. There was difficulty in data extraction because of the mismatch of variable categorization among some of the studies. Since the studies included were from only 5 regions of the country, the results may lack country representativeness. The presence of high heterogeneity was also a limitation that could be due to differences in the study period, sample size and study setting. The inclusion of only English language literature was another limitation.
Implications of the study
This systematic review and meta-analysis has various scientific implications that can enhance healthcare delivery, improve child health outcomes, inform policies, and foster EBPs that address the unique needs of the pediatric population. Through this review, the healthcare system can develop and implement strategies to improve pediatric pain management protocols, tools and policies tailored to the Ethiopian context. It also benefits the local healthcare system and contributes to the global body of knowledge and practices related to pediatric pain management among nurses. It also provides valuable insight that may be applicable in other low-resource settings by documenting the unique challenges and solutions found here in Ethiopia.
This review indicated the gaps that will be filled by nurses to provide appropriate pain management in children. By addressing the shortcomings identified in this review, there can be notable advancements in pediatric pain management and enhanced nursing practices. It also indicates the area of research, particularly the need for exploring the association between education and training of nurses with pain management knowledge and practices. It will also enable researchers to conduct studies on pediatric pain management among nurses out of the regions included in this review. This review can inform authors the need for advancing pediatric pain management guidelines, policies, and textbooks of nursing sciences used for nursing professional development.
Conclusions
The pooled prevalence of both good knowledge and good practices for pediatric pain management among nurses was low. Education and training were the most important factors for good knowledge and practice of pediatric pain management among nurses in Ethiopia. Furthermore, the availability of pain management protocols, tools and policies were other enablers of good practices for pediatric pain management.
Recommendations
Health service leaders should consider providing pain management training for nurses working in pediatric wards. In addition, they have to provide master’s degree educational opportunities for pediatric nurses to equip them with the best knowledge and practices of pediatric pain management. Pain management protocols, tools and policies must be available in all the pediatric units of health facilities. Research should be conducted on the knowledge and practice of pediatric pain management among physicians since these practices may affect child health and nurses’ practices as well. Additionally, the practice of Ethiopian nurses to use pediatric pain management protocols, tools and policies need to be investigated.
Acknowledgements
We would like to thank all the authors of the studies included in this systematic review and meta-analysis.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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