Pain assessment practice and associated factors among nurses working at adult care units in public hospitals in Wolaita Zone, Southern Ethiopia, 2021

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage [1, 2]. The evidence shows that pain is one of the main reasons patients seek medical care [3‐6]. Untreated pain has an impact on patients' clinical and psychological well-being, as well as hastens their risk of mortality and has a slew of other negative repercussions, such as raising treatment expenses, lengthening hospital stays, and lowering their quality of life [2, 7‐11].

Pain is regarded as the fifth vital sign [12‐14] and as important as the other vital signs [15]. Assessment of pain is the first and most important step in pain management [4, 16‐19]. It is notable that assessing pain decreases overtreatment and treatment-related adverse effects [16, 17, 20]. Pain assessment must be considered on admission, after a change in medical status, prior to, during, and after procedures [17]. A comprehensive assessment of pain requires subjective and objective data, self-reports, and assessment tools [17]. Actually, a patient’s self-report of pain is the most valid method of assessing pain in a patient who can communicate [6, 21, 22]. Moreover, patients' vital signs are part of a comprehensive pain assessment [16, 22‐24]. Because the vital signs cannot distinguish pain from other types of suffering, they are utilized as a complement in pain assessment [22]. Additionally, during pain assessment, health care providers should also pay attention to patients’ behavior, such as facial expressions and gestures [25, 26]. Furthermore, assessment results must be documented and disseminated to all those involved in a patient's care [12, 17].

Nurses are in a unique position to support patients who are experiencing pain [4, 10, 27, 28]. Nurses play a vital role in providing pain assessment and management [16]. Besides, in order to effectively manage pain, a nurse must accurately measure the patient's experience of pain [8, 17, 18]. In addition, nurses should use a consistent and methodical approach to pain exploration [17]. Furthermore, nurses should consider pain assessment principles while using assessment techniques and instruments [25].

In many clinical contexts, pain is not assessed in a standardized manner [29]. Implementing the principles of pain assessment remains a challenge for many nurses [30, 31]. Several studies from developed countries pointed out that nurses’ pain assessments vary across regions, with some reports suggesting poor compliance among nurses in recording and reporting pain assessment findings [31‐35]. On the other hand, problems of applying the standard of pain assessment were shown to be more prominent in low-income countries [36]. Moreover, African patients are less likely to verbalize their pain because expressing pain is seen as an act of weakness [37]. Thus, African regions suffer from a double burden of pain assessment from nurses’ and patients’ sides. Furthermore, similar results were reported from studies of African countries [15, 25, 38, 39], indicating poor adherence to the principles of pain assessment. Besides, the previous few and inconsistent studies in Ethiopia showed that pain assessment practice among nurses was from 24.4% to 55.9% [39‐41].

Being a male nurse, having low work experience, a lower educational level, lack of training on pain management, lack of organizational support, and absence of pain management guidelines were associated with nurses’ poor pain assessment practice [39‐42].

Previous studies in Ethiopia have mainly focused on pain management, other than pain assessment practice. Thus, there is very limited and inconsistent evidence on pain assessment practice among nurses in Ethiopia. Therefore, this study aimed to identify pain assessment practice and associated factors among nurses working at adult care units in the Wolaita Zone, Southern Ethiopia.

The majority of the nurses in this study, 73.8%, reported that they assessed pain for their patients. The result was higher than the findings of previous studies in Ethiopia [39, 41]. However, a higher magnitude was reported from other African countries [44, 45]. The discrepancy could be explained by the small sample size in the previous study in Ethiopia, and the study nurses from other African countries were from critical care units, so they may have had training and clinical skills in pain assessment.

The present study showed that 53.2% of nurses in the study used pain assessment tools. The finding was congruent with a study from Rwanda [45]. Nevertheless, the magnitude of this study was higher than several reports from Ethiopia and other African countries [15, 25, 39, 41]. These disparities could be attributable to the small sample size of the previous studies and differences in the instruments used for pain assessment.

In the current study, less than half (47.2%) of the study nurses documented pain assessment scores. The result was in accordance with findings reported by [31, 41, 45]. Contrary to the finding, studies from Africa and Asia [42‐44] demonstrated lower results. The differences might be clarified by small sample sizes, and a non-probability purposive sampling technique was used in the previous studies.

According to this study, less than one-fourth (23.6%) of the study nurses discussed pain assessment scores during a nurse-to-nurse report. This suggests that the majority of nurses failed to report pain assessment scores. Several reports from other countries, including Ethiopia [15, 25, 40, 41] pointed out higher results than this study. It is by now generally accepted that discussing a patient’s pain assessment findings with a health care team is critical to advancing a patient's care.

In this study, the proportion of nurses with good pain assessment practice was found to be 38.2%. The result ties well with a previous study in Ethiopia [41]. Contrary to the findings, studies [33, 34, 39] and [40] reported a lower and higher magnitude, respectively. The possible reasons for the discrepancy could be due to some of the previous studies with smaller sample sizes and differences in a tool used for pain assessment practice. Moreover, the study [40] was conducted among nurses working in critical care units that might have better pain assessment skills.

The odds of having good pain assessment practice among nurses who received training on pain management was two times higher than its counterpart. This was consistent with what has been found in other African countries [25, 45]. However, having training on pain management was not associated with pain assessment practice, according to the study [40]. A similar conclusion was reached by previous studies wherein a lack of training on pain management leads to poor pain assessment practice [6, 46‐49].

Finally, this study found a connection between nurses' pain assessment practice and perceived organizational support [AOR (1.9(1.2–3.23)]. This indicates that nurses who perceived organizational support were twice more likely to assess pain than those who did not. The finding was verified by previous studies [30, 43, 47]. Furthermore, providing organizational assistance allows nurses to improve their pain assessment skills [25, 50].

Nurses’ pain assessment practice was found to be low. Moreover, most nurses did not discuss pain assessment scores during a nurse-to-nurse report. The problem of reporting pain is magnified by low documentation practice, which was below half. Continuous professional development through in-service training and education, and improving organizational support through good leadership are crucial to ameliorating nurses’ pain assessment practice. The management of the hospitals should continually support nurses through a supportive working environment and supervision. Future studies should address organizational and health service-related barriers in pain assessment. And reviewing records from patients’ charts to get a complete picture of pain assessment should be considered.