Effect of a teaching programme on knowledge of postoperative pain management among nurses at Lagos University Teaching Hospital, Nigeria

Abstract

Postoperative pain is a common, predictable and expected experience following surgery, and if not adequately managed leads to delayed postoperative recovery, poor prognosis, increased mortality and morbidity and increased risk for pain becoming chronic. [1] This can lead to a decline in the patient's functionality and productivity, and consequently have a negative effect on their quality of life. [2] The relief of pain has been and remains one of the major campaigns in the health sector, but regardless of this, studies continue to reveal poor and ineffective postoperative pain management by healthcare providers. [3] This problem has been identified in underdeveloped, developing and developed countries: it is a global challenge. The Institute of Medicine in 2010 described quality in healthcare as 'the degree of healthcare provided to patient populations sufficient to improve their desired health outcomes'. [4] They identified six basic steps to high-quality healthcare: care must be effective; safe and reliable; patient-centred; efficient; timely; and equitable. Adequate pain management has consequently been described as: conducting a detailed clinical assessment of pain, periodically reassessing the patient's responses to pain treatment, and developing a modality of care that is safe, involves the patient and his or her family members and is culturally consistent and developmentally appropriate. [5] Quality pain management training is important in ensuring effective patient care, and this can be achieved by empowering nurses with adequate knowledge and skills needed for the provision of quality postoperative pain management. [6] The drive to improve postoperative pain management has been in place for some time, but nurses continue to experience challenges in this area of practice. [7] Accreditation of healthcare organisations in 2000 specifically demands pain assessment and documentation, staff education in pain management and competency assessments, adequate pain control to allow functional rehabilitation, and education of patients and families on pain and symptom management. [7,8] The fact, however, remains that most professions have neglected the concept of pain in their curriculum at undergraduate level and even during clinical practice. [9] The reported undermanaged postoperative pain in different studies has affected institutions adversely, and contributes to decreased patient satisfaction and longer impaired mobility and hospital stay, increased morbidity and mortality and, consequently, poorer quality of life. [10-12] Poor management of postoperative acute pain can contribute to medical complications including pneumonia, deep vein thrombosis, infection and delayed healing, as well as the development of chronic pain. It is therefore important that all patients undergoing surgery should receive adequate pain management. However, evidence suggests this is not currently the case: between 10% and 50% of patients develop complications related to Background. Postoperative pain management is a way of reducing or e...