Effect of an Educational Program on Nurses’ Level of Knowledge about Pain Assessment and Management: A Quasi Experimental

doi:10.21203/rs.3.rs-5231832/v1

Background

Pain is universally acknowledged as one of the most distressing experiences that individuals encounter, often leading to significant psychological and physical implications. Effective pain management is essential in healthcare, and it is imperative that nursing professionals possess the requisite knowledge and skills to assess and manage pain effectively.

Aim

This study aims to evaluate the impact of a structured educational program on the performance levels of nurses in the domains of pain assessment and management.

Design

A quasi-experimental, one-group pre- and post-test intervention design was employed to facilitate this investigation.

Setting

The research was conducted in the inpatient medical and surgical departments at Al-Zarqa Governmental Hospital, Jordan.

Subjects

A total of 106 nurses, both male and female, who provide direct nursing care in medical and surgical wards, voluntarily participated in the study.

Tools

Two instruments were utilized for data collection:

1. A questionnaire designed to assess nurses' knowledge regarding pain assessment and management.

2. An observational checklist to evaluate the practical application of pain management techniques by nurses.

Results

· The sample comprised predominantly female nurses, most of whom held a Bachelor of Science in Nursing and had 2–5 years of clinical experience.

· A significant 88.7% of participants had not previously attended any educational sessions focused on pain assessment and management.

· Statistical analysis revealed a significant improvement in mean knowledge scores post-educational intervention (P<0.001).

· All dimensions of nursing practices related to pain management showed statistically significant enhancement following the training, demonstrating a strong correlation between knowledge and practice levels before and after the educational program.

Conclusion

The implementation of the educational program resulted in over half of the participating nurses achieving a commendable level of knowledge and satisfactory practice in pain assessment and management. This underscores the program's effectiveness in enhancing both theoretical knowledge and practical skills.

Nursing

Pain Management Program (PMP)

Nursing Performance

Pain Assessment and Management

Pain is widely recognized as one of the most distressing experiences individuals encounter, often accompanied by significant fear and anxiety. According to the International Association for the Study of Pain (Raja, 2020), pain is defined as a distressing sensory and emotional experience associated with actual or potential tissue damage. Despite advancements in pharmacological therapies, global research indicates that pain remains inadequately managed, primarily due to a lack of knowledge regarding pain management strategies (Gustafsson & Shahriary, 2015).

Every patient possesses the fundamental right to be free from pain. Consequently, one of the major challenges in nursing practice is effectively managing and alleviating pain. Pain control is traditionally viewed as a core responsibility of nurses, making it one of the most critical aspects of nursing care (Brennan, 2019).

To provide high-quality care for patients experiencing pain, nurses must possess a thorough understanding of pain assessment and management techniques, including both pharmacological and non-pharmacological approaches. Given their continuous patient monitoring and care responsibilities, nurses play a pivotal role in pain management (Mazilu et al., 2018).

Effective educational techniques are crucial for successful learning outcomes (Shirani Bidabadi, 2016). The incorporation of simulation in educational programs has been shown to enhance learning experiences, leading to increased self-efficacy, satisfaction, and confidence among learners (Cameron ID, 2018). Simulations are particularly beneficial for improving healthcare providers' diagnostic and technical skills (Chernikova O, 2020).

Thus, it is essential for nurses to be equipped with the knowledge and skills necessary for effective pain assessment and management, fostering competence and confidence in their practice (Alqahtani M, 2015).

The study was executed according to the following steps as follows:

Written approval

· An Approval from the Research Ethics Committee in AL-Zarqa Governmental Hospital, Jordan was obtained.

· Approval from the authors of the tools to use in present research was obtained.

· All the staff nurses (137) in AL-Zarqa Governmental Hospital inpatient medical and surgical units were invited to participate in the research, sent thru official hospital organizational email by their respected head nurses with the inclusion of the informed consent.

· A list of 119 staff nurses from medical and surgical units consented to participate in the research that were sent by their respected head nurses.

· 106 staff nurses randomly selected from the consented participants’ list.

2. Contents Validity

All tools used were tested for content validity by five experts in medical- surgical nursing, Faculty of nursing- University of Alexandria to assure the content validity, clarity of items, comprehensiveness, appropriate translation and necessary modifications were introduced.

1. Reliability

Reliability of the tools were testing using the Cronbach's Alpha test was (0.92) to measure its internal consistency to evaluate how well the tools consistently measure what they were designed to measure.

2. Pilot study:

A pilot study was carried out on 10% of the subjects (N=11) nurses to test the clarity, feasibility, and applicability of the tools. The necessary modifications were done accordingly. Nurses included in the pilot study were excluded from the total number of study subjects.

3. Program development

The educational program on enhancing nurse’s performance about pain assessment and management in medical and surgical department in collaboration with pain management team and education department were developed based on review of literature (International Association for the Study of Pain, 2020; Wood, 2019; Gosselin, 2014 and Ferrell, 2014).

Objectives of educational program to:

A. Knowledge and understanding

1. Explain the complex, multidimensional and individual-specific nature of pain.

2. Define terminology for describing pain and associated conditions

3. Describe the impact of pain on society

4. Identify and understanding role of nurse during pain

5. Explain how cultural, institutional, societal and regulatory influences affect assessment and management of pain

B. Skills and practice

1. Assessment of the pain

2. Assess patient preferences and values to determine pain-related goals and priorities

3. Use valid and reliable tools for measuring pain and associated symptoms to assess and reassess related outcomes as appropriate for the clinical context and population.

4. Describe patient, provider and system factors that can facilitate or interfere with effective pain assessment and management

5. Identify the potential of pain

6. Describe patient behavior during pain occurrence

7. Apply pharmacological and non-pharmacological for pain

8. Assess Patient response to pain management

9. Describe and assess for any possibility of side effect of pain management or the pain itself.

10. Demonstrate empathic and compassionate communication during pain assessment

11. Demonstrate the inclusion of patient and others, as appropriate, in the education and shared decision-making process for pain care.

12. Explain how health promotion and self-management strategies are important to the management of pain.

13. Develop a pain treatment plan based on benefits and risks of available treatments.

14. Monitor effects of pain management approaches to adjust the plan of care as needed.

To fulfill the study aim, the actual study carried out in four phases:

Assessment, planning, implementation, and evaluation phase

Phases 1: Assessment phase:

· The study participants were interviewed individually; the researcher introduced himself, explained the aim of the study and obtained the verbal informed consent from studied subjects.

· Initial assessment of each study participants was carried out before beginning of the educational program using tools I and II to assess the existing nurses’ knowledge and practices regarding pain assessment and management (pre-test) as the following:

- Coordinate with the hospital administrator to utilize the conference room as the venue for the per-test questionnaires.

- For the purpose of observing the nurses’ practice, the researcher got approval from all medical and surgical unit directors and head nurses to observe the studied nurses’ practice regarding pain assessment and management for those who agreed to participate in the study with approximately 5 staff per day for 21 days.

Phases II: Planning Phase:

· Based on initial assessment the educational program on enhancing nurse’s performance about pain assessment and management in medical and surgical department in collaboration with pain management team and education department were developed based on review of literature (International Association for the Study of Pain, 2020; Wood, 2019; Gosselin, 2014 and Ferrell, 2014). The program was divided to theoretical and practical sessions, one hour each session.

· The sessions were covered two groups per day; each group attended one theoretical and one practical session.

· Each group consists of 11 nurses.

· The sessions were done five times per week to cover all nurses in the study (106). With total of 10 theoretical sessions and 10 practical sessions for each participant in the study.

Phases III: Implementation phase:

· The training sessions were implemented within their mandatory 2-hour education sessions, a total of 22 nurses per day were divided into two groups. Each group consists of 11 nurses.

· The training sessions were done five times per week covering morning shift.

· The education sessions of the program were covering one-hour theoretical and one-hour practical sessions.

· The duration of each session was 60 minutes.

· Each session started with the objectives of the session.

· The theoretical sessions; were conducted through group discussion using a very simple language, using power point suits the level of nurses. Sessions of nurses' education were carried out to provide them with new knowledge.

The duration of each group session was last 60 minutes to cover: Introduction of pain assessment and management, types of pain, pain assessment skills and pain management methods and pain reassessment.

· The practical sessions; were provided using demonstration techniques by using real materials, instruments, case scenario and informative workshop. Sessions of nurses' training were carried out to provide them with new skills and practices. The duration of each group session was last 60 minutes to cover: subjective assessment on management, objective assessment and intervention and reassessment.

Phases IV: Program evaluation:

· To evaluate program expected outcome. Post testing of nurses' knowledge and performance about pain assessment and management post educational program immediately and after one month from the end of the program using all the study tools were done.

· The appropriate statistical tests were used to analyze the obtained data. For statistical analysis and tabulation, the Statistical Package for Social Science SPSS will be utilized.

· Comparison between the findings of pre and posttest were carried out using appropriate statistical analysis (t test) in order to determine the difference in mean score and measure the impact of using an educational program on nurses' knowledge and practice about pain assessment and management.

4. Ethical Considerations:

· Informed consent was obtained from the nurses who participated in the study

· Witness consent was obtained from administrative personnel at the selected setting, then from the head nurse for nurse’s observation after explaining the aim of the study in Jordan.

· Confidentiality of the collected data was assured throughout the study. The subjects were assured that their participation is voluntary, and they had the right to withdraw from the study at any time.

5. Data processing and Statistical Analysis

After the data were collected, they were coded and transferred into special design formats, so as to be suitable for computer feeding. Following data entry, checking and verification processes were carried out to avoid errors during data entry. Data was computed and statistically analyzed using the Statistical Package for Social Sciences "SPSS" software version 20.

A. Descriptive statistics

• Quantitative data were described using range (minimum and maximum), means and standard deviation. Significance of the obtained results was judged at the 5% level.

B. Analytical statistics

v McNemar and Marginal Homogeneity Test: Used to analyze the significance between the different stages

v Paired t-test: For normally distributed quantitative variables, to compare between two periods

v ANOVA with repeated measures were used for normally distributed quantitative variables, to compare between more than two periods or stages

v Friedman test: used for abnormally distributed quantitative variables, to compare between more than two periods or stages

C. Graphical presentations

- Graphs were done for data visualization of study and control findings using Microsoft Excel.

The findings of this study will be presented under the following headings:

1. Distribution of the studied nurses’ according to their socio-demographic characteristics (Table I)

2. The relations between studied nurses' knowledge and their characteristics (Table II)

3. Differences in studied nurses’ according to their overall knowledge pre and post implementing the educational program regarding pain assessment and management (Table III).

4. Differences in studied nurses’ according to their overall means score for the observed nurses' practices pre, post, and after one month post implementing the educational program regarding pain assessment and management (Table IV).

5. The relations between studied observed nurses’ practice and their characteristics Table (V).

6. Differences in studied nurses’ according to their satisfactory level of practices in relation to pre, post, and one month post implementing educational program about pain assessment and management (Table VI)

7. The correlation between knowledge and practices in the studied nurses’ pre and post implementing the educational program regarding pain assessment and management (Table VII)

Table (I) shows the frequency distribution of the studied nurses to their personal characteristics.

Regarding the age, results show that almost half (43.4%) of the studied nurses were in the age group of 25 to less than 30, while almost one fourth (21.7%) were in the age group of 30 years and above with a mean age of (30± 1.23).

In relation to gender, it is noticeably dominated by the female that accounts to two-thirds (70.8%) of the participants.

As regards to qualification, the result shows that about three-quarters (71.7%) of the studied nurses had received a Bachelor of Sciences in Nursing.

Concerning the years of experience, it was observed that almost one third (33.0 %) of the nurses had 2-5 years of experience. While only 14.2% has less than 2 years of experience about pain assessment and management.

In addition to educational program attendance, the result revealed that about 88.7% have not attended any educational sessions on pain assessment and management in the previous two years. Only about one eight of the studied nurses (11.3%) attended educational programs about pain assessment and management within the last 2 years.

Table (I): Distribution of the studied nurses’ according to their socio-demographic characteristics (n = 106).

Nurses’ socio-demographic characteristics	Studied nurses’ (n=106)
Nurses’ socio-demographic characteristics	No	%
Age (in years)
20-25 Years	37	34.9
25-30 Years	46	43.4
30> Years	23	21.7
Min-Max Mean ± SD	20-50 30± 1.23
Gender
Male	31	29.2
Female	75	70.8
Level of qualification
Diploma of nursing	23	21.7
Bachelor of Science in Nursing	76	71.7
Master of Science in Nursing	7	6.6
Year of Experience
Less than 2 Years	15	14.2
2- 5 Years	35	33.0
5- 10 Years	25	23.6
>10 years	31	29.2
Attended any educational programs about pain assessment and management within the last 2 years
No	94	88.7%
Yes	12	11.3%

SD: Standard deviation t: Student t-test χ²:Chi square test

p: p value for comparing between the studied groups

*: Statistically significant at p ≤ 0.05

Table (II): Illustrates relation between studied nurses’ according to their overall means score for the studied nurses' knowledge pre, post, and after one month post implementing the educational program regarding pain assessment and management and their socio-demographic characteristics.

The findings of this study showed that there is no statistically significant relationships between overall means score for the studied nurses' knowledge pre, post, and after one month post implementing the educational program regarding pain assessment and management and the participant’s socio-demographic characteristics as P values were > 0.05.

Table (II): Relation between studied nurses’ according to their overall means score for the studied nurses' knowledge pre, post, and after one month post implementing the educational program regarding pain assessment and management and their socio-demographic characteristics.(n = 106).

	Nurses' knowledge about pain assessment and management (total grade 37)
Nurses' Socio- demographic characteristics	Pre educational program	post educational program immediately	After one month post educational program
	Mean ± SD	Mean ± SD	Mean ± SD
Age (years)
20-25 Years	18.62±5.21	34.00±2.12	33.51±2.47
25-30 Years	18.35± 5.41	33.57±2.31	33.39±2.76
30> Years	18.59±5.58	33.93±2.24	33.57±2.83
F(p)	0.020(0.980)	0.301(0.741)	0.032(0.968)
Gender
Male	18.52±5.71	33.84±2.40	33.52±2.78
Female	18.56±5.26	33.89±2.13	33.51±2.64
t(p)	0.04(0.97)	0.12(0.91)	0.02(0.99)
Level of qualification
Diploma of nursing	19.09±5.85	34.22±2.28	33.83±2.81
Bachelor of Science in Nursing	18.37±5.32	33.78±2.21	33.42±2.68
Master of Science in Nursing	18.71±4.86	33.86±2.04	33.43±2.23
F(p)	0.159(0.853)	0.351(0.705)	0.204(0.816)
Year of experience
Less than 2 Years	18.33±5.21	33.47±2.42	33.27±2.66
2- 5 Years	17.83±5.49	33.60±2.17	33.14±2.69
5- 10 Years	19.88±4.93	34.56±1.98	34.16±2.32
>10 years	18.39±5.70	33.84±2.27	33.52±2.92
F(p)	0.735(0.534)	1.173(0.324)	0.753(0.523)
Attended any educational programs
No	16.25±5.15	32.75±2.09	32.33±2.39
Yes	18.84±5.35	34.02±2.18	33.66±2.67
t(p)	1.586(0.116)	1.910(0.059)	1.635(0.105)

SD: Standard deviation t: Student t-test F: F for One-Way ANOVA test

p: p value for the relation between studied observed nurses and their characteristics

*: Statistically significant at p ≤ 0.05

Table (III): shows the frequency distribution of the studied nurses according to their overall knowledge pre, post, and after one month post implementing the educational program regarding pain assessment and management.

Table IV revealed that before implementing the educational program, 79.3% of the studied nurses had poor knowledge, 20.7% had fair knowledge. Post educational program immediately, a significant improvement was presented in the findings of the study. A drastic decline of more than two thirds of the studied nurses who had poor knowledge to none (0%), those having fair knowledge remained relatively stable from one fifth to one sixth (15.1 %) while from none of the nurses had good knowledge before, now it greatly accelerates and dominates the majority (83.9%) of the studied nurses.

Table (III): Frequency distribution of the studied nurses according to their overall knowledge pre, post, and after one month post implementing the educational program regarding pain assessment and management (n=106).

Nurses' knowledge about pain assessment and management	Pre- educational program		post educational program immediately		After one month post educational program
Nurses' knowledge about pain assessment and management	No	%	No	%	No	%
Poor knowledge (Less than 60%)	84	79.3%	0	0	0	0
Fair knowledge (60- 85%)	22	20.7%	17	15.1 %	20	18.9%
Good knowledge (More than 85% )	0	0	89	83.9%	86	81.1%
Total	106	100	106	100	106	100

Table (IV): shows distribution of the studied nurses’ according to their overall means score for the observed nurses' practices pre, post, and after one month post implementing the educational program regarding pain assessment and management.

Table V depicts that there is a significant difference in the overall mean scores of all dimensions of the studied participants according to observed nurses' practices about pain assessment and management. It was found that the overall means score for the observed nurses' practices pre, post, and after one month from implementing the educational program regarding pain assessment and management was increased (25.68 ± 3.485, 60.21± 2.377, 59.96± 2.423 respectively). It appears from the results that there were statistically significant differences in the mean score of practice about pain assessment and management between the pre- & post educational program immediately and also, between Pre - and after one month in all items about pain assessment and management after receiving the pain educational program (p ≤ 0.001).

Table (IV): Distribution of the studied nurses’ according to their overall means score for the observed nurses' practices pre, post, and after one month post implementing the educational program regarding pain assessment and management (n = 106).

Nurses' practice about pain assessment and management	Pre- educational program	post educational program immediately	After one month post educational program	Test		Sig. bet. periods
Nurses' practice about pain assessment and management	Mean ± SD	Mean ± SD	Mean ± SD	F	p	p₁	p₂	p₃
Initial Assessment	5.43 ±0.805	9.08 ±1.061	9.02 ±1.087	371.75	*<.001	*<.001	*<.001	0.326
Try to obtain a self- reported assessment of pain	2.04 ±0.935	3.64 ±0.733	3.65 ±0.704	98.89	*<.001	*<.001	*<.001	1.000
investigate for potential of pain or discomfort	2.02 ±0.743	7.63 ±0.667	7.59 ±0.714	1964,08	*<.001	*<.001	*<.001	0.308
Observes the patient’s behaviors	7.72 ±1.766	19.57 ±1.441	19.53±1.468	1738.98	*<.001	*<.001	*<.001	0.308
Non- pharmacological interventions to alleviate pain	2.02 ±1.033	8.63 ±1.482	8.59 ±1.459	858.90	*<.001	*<.001	*<.001	1.000
Uses pharmacological to alleviate pain	2.45 ± 0.745	3.49 ±0.605	3.44 ±0.618	13.789	*<.001	*<.001	*<.001	0.074
Reassessment of pain	0.78 ± 0.414	1.82 ±0.385	1.79 ±0.407	213.19	*<.001	*<.001	*<.001	0.250
Assess possible side effects	2.28 ± 1.271	6.34 ±0.994	6.31 ±1.018	369.24	*<.001	*<.001	*<.001	0.250
Overall Practice (72)	25.68 ±3.485	60.21±2.377	59.96±2.423	4956.5	*<.001	*<.001	*<.001	0.081

F: F test (ANOVA) with repeated measures, Sig. bet. Periods was done using Post Hoc Test Bonferroni

p: p value for comparing between the studied periods

p1: p value for comparing between Pre- educational program and post educational program immediately

p2: p value for comparing between Pre- educational program and after one month post educational program

p3: p value for comparing between post educational program immediately and after one month post educational program

*: Statistically significant at p ≤ 0.05.

Table(V): shows relation between studied nurses’ according to their overall means score for the observed nurses' practices pre, post, and after one month post implementing the educational program regarding pain assessment and management and their socio-demographic characteristics.

The findings of this study present that there is no statically significant differences in the practice of the participants in the pre –post or after one month post implementation of the educational program about pain assessment and management and the participant’s socio-demographic characteristics as P values were > 0.05.

Table (V): Relation between studied nurses’ according to their overall means score for the observed nurses' practices pre, post, and after one month post implementing the educational program regarding pain assessment and management and their socio-demographic characteristics.(n = 106).

	Nurses' practices (total grade 72)
Nurses' Socio- demographic characteristics	Pre- educational program	post educational program immediately	After one month post educational program
	Mean ± SD	Mean ± SD	Mean ± SD
Age (years)
20-25 Years	26.14±3.32	60.89±2.99	60.35±2.34
25-30 Years	26.00±3.67	60.70±2.77	60.00±3.02
30> Years	26.13±3.51	60.85±3.04	60.09±3.28
F(p)	0.013(0.987)	0.033(0.967)	0.107(0.899)
Gender
Male	26.19±3.62	60.84±3.13	59.97±3.41
Female	26.07±3.40	60.83±2.84	60.24±3.10
t(p)	0.17(0.86)	0.02(0.99)	0.40(0.69)
Level of qualification
Diploma of nursing	26.35±3.51	61.17±3.10	62.43±3.26
Bachelor of Science in Nursing	26.04±3.51	60.72±2.92	62.04±3.22
Master of Science in Nursing	26.00±2.94	60.86±2.41	62.57±2.70
F(p)	0.073(0.930)	0.208(0.813)	0.196(0.822)
Year of experience
Less than 2 Years	25.93±3.56	60.60±2.90	62.00±3.32
2- 5 Years	25.54±3.50	60.37±3.09	61.63±3.40
5- 10 Years	27.04±2.96	61.72±2.37	63.24±2.47
>10 years	26.06±3.70	60.74±3.09	61.97±3.29
F(p)	0.935(0.427)	1.111(0.348)	1.353(0.262)
Attended any educational programs
No	25.54±3.38	59.50±3.18	58.77±3.54
Yes	26.18±3.47	61.00±2.87	60.35±3.09
t(p)	0.629(0.530)	1.305(0.195)	1.700(0.092)

SD: Standard deviation t: Student t-test F: F for One-Way ANOVA test

p: p value for the relation between studied observed nurses and their characteristics

*: Statistically significant at p ≤ 0.05

Table (VI): shows distribution of observed studied nurses’ according to their satisfactory level of practices in relation to pre, post, and one month post implementing educational program about pain assessment and management.

Table VII revealed that 100%) of the studied nurses had unsatisfactory level of practices pre-educational program implementation. Post educational program immediately, 86% of the studied nurses achieved satisfactory level level and only 14% had unsatisfactory level level of practices. In addition, majority (83%) of the studied nurses relatively remained at satisfactory level level after one month from the educational program and only (17%) had unsatisfactory level.

Table (VI): Distribution of observed studied nurses’ according to their satisfactory level of practices in relation to pre, post, and one month post implementing educational program about pain assessment and management (n=106).

Nurses' practices observation about pain assessment and management	Pre- educational program		post educational program immediately		After one month post educational program
	No	%	No	%	No	%
Unsatisfactory level (Less than 85%)	106	100%	15	14%	18	17%
Satisfactory level (> 85%)	0	0%	91	86%	88	83%
Total	106	100	106	100	106	100

Table VII: The correlation between overall knowledge and overall practices in the studied nurses’

The table shows that; there was a positive statistically significant correlation between nurses’ overall knowledge and overall practices at (p<0.001^*).

		overall Practices
		Pre- educational program	post educational program immediately	After one month post educational program
overall Knowledge	R	0.956^**	0.969^**	0.954^**
overall Knowledge	P	<.001	<.001	<.001

Table VII: The correlation between overall knowledge and overall practices in the studied nurses’ pre and post implementing the educational program regarding pain assessment and management (n=106)

r: Pearson coefficient

*: Statistically significant at p ≤ 0.01

Background

Pain is widely recognized as one of the most distressing experiences individuals encounter, often accompanied by significant fear and anxiety. According to the International Association for the Study of Pain (Raja, 2020), pain is defined as a distressing sensory and emotional experience associated with actual or potential tissue damage. Despite advancements in pharmacological therapies, global research indicates that pain remains inadequately managed, primarily due to a lack of knowledge regarding pain management strategies (Gustafsson & Shahriary, 2015).

Every patient possesses the fundamental right to be free from pain. Consequently, one of the major challenges in nursing practice is effectively managing and alleviating pain. Pain control is traditionally viewed as a core responsibility of nurses, making it one of the most critical aspects of nursing care (Brennan, 2019).

To provide high-quality care for patients experiencing pain, nurses must possess a thorough understanding of pain assessment and management techniques, including both pharmacological and non-pharmacological approaches. Given their continuous patient monitoring and care responsibilities, nurses play a pivotal role in pain management (Mazilu et al., 2018).

Effective educational techniques are crucial for successful learning outcomes (Shirani Bidabadi, 2016). The incorporation of simulation in educational programs has been shown to enhance learning experiences, leading to increased self-efficacy, satisfaction, and confidence among learners (Cameron ID, 2018). Simulations are particularly beneficial for improving healthcare providers' diagnostic and technical skills (Chernikova O, 2020).

Thus, it is essential for nurses to be equipped with the knowledge and skills necessary for effective pain assessment and management, fostering competence and confidence in their practice (Alqahtani M, 2015).

Purpose of the Study

The primary aim of this study was to assess the impact of an educational program on nurses’ performance regarding pain assessment and management. The quasi-experimental research design was employed to test the following hypotheses:

Nurses who participated in the educational program will exhibit higher knowledge scores about pain assessment and management post-program compared to pre-program scores.

Nurses who attended the educational program will demonstrate improved practice scores in pain assessment and management after the program.

Results

The findings from this study demonstrate the effectiveness of a well-structured educational program on the performance levels of nurses in pain assessment and management. More than half of the participating nurses displayed a good overall knowledge level regarding pain management, and a significant proportion achieved satisfactory practice levels in caring for patients experiencing pain.

Socio-Demographic Characteristics

The majority of the participating nurses were aged between 25 and 30 years, with only a small percentage over 30. This demographic trend may be influenced by increased responsibilities and financial pressures that contribute to higher turnover rates among older nurses (Alreshidi, 2016). Furthermore, the low recruitment levels from the government amidst a nursing shortage likely explain the prevalence of younger nurses in hospital settings.

The study found that approximately two-thirds of the participants were female, reflecting a trend noted in Jordanian nursing, where the profession is predominantly female (Saleh, 2020). This gender distribution may be attributed to socio-economic factors that lead many male nurses to seek employment opportunities abroad (Samarkandi, 2021).

Regarding educational qualifications, the majority of nurses held a Bachelor of Science in Nursing (B.S.N.). As the nursing profession evolves and demands for qualified nurses increase globally, this trend aligns with findings from previous studies that similarly noted a predominance of B.S.N.-qualified nurses in clinical settings (Abdul-Jaleel, 2020).

Most participants reported having between 2 to 5 years of experience, with fewer having less than 2 years. Hospitals typically prefer hiring experienced nurses to ensure quality patient care with minimal supervision, which may explain this finding (Nimer & Ghrayeb, 2017).

Educational Program Effectiveness

The results indicated that prior to the educational program, nurses exhibited limited knowledge regarding pain assessment and management. However, significant improvements were observed in mean scores for pain assessment techniques following the program (mean rank = 0.63) and the application of pain education (mean rank = 0.92). Standardized procedures for pain evaluation and management are vital for closing knowledge gaps (Tobis, 2019).

Furthermore, a notable increase in knowledge about the effective duration of opioid analgesics was documented (mean rank = 0.85), reflecting an area of previous deficiency among participants (Saifan, 2018). The study underscores that many nurses lack adequate training in sedation assessment for patients undergoing opioid pain management, a finding that is consistent with literature highlighting education as a critical barrier to effective pain management (Rabba, 2021).

The implementation of the educational program resulted in approximately 84% of participants demonstrating good knowledge immediately following the intervention, with 81.2% retaining this knowledge one month later. This retention indicates that educational initiatives can successfully foster long-term learning in nursing practice (Michael, 2023).

Practice Improvement

Post-intervention assessments indicated a significant improvement in nurses' practices regarding pain assessment and management. Approximately two-thirds of nurses achieved satisfactory practice levels immediately after the educational program and maintained this level one month later. This enhancement reflects the successful application of acquired knowledge into clinical practice, as indicated by increased mean scores for pain reassessment techniques (mean = 1.82) following the program (Mahmoud, 2020).

Relationship Between Knowledge and Practice

A strong correlation was established between knowledge and practice regarding pain assessment and management (P < .001) after the educational intervention. This underscores the importance of integrating knowledge and practical skills through comprehensive educational programs, as emphasized in the literature (Rahman, 2021; Issa, 2019).

Recommendations

It is recommended that nursing professionals engage in ongoing training and educational opportunities focused on pain assessment and management to further refine their competencies and improve patient outcomes.

The findings of this study support the hypotheses, demonstrating that the educational program significantly enhanced nurses’ knowledge and practice regarding pain assessment and management. Continuous evaluation and competency development in pain management should be prioritized to improve patient outcomes and alleviate suffering. The successful implementation of this educational initiative has positively impacted the nursing workforce and, consequently, patient care.

Conflict of interest

- Hussein Alomari (no actual or potential conflicts of interest).

- Nabeel F. Allobaney (no actual or potential conflicts of interest).

- Raya Yousef Al-Husban (no actual or potential conflicts of interest).

- Esmat Swallmeh (no actual or potential conflicts of interest).

- Rosario A. Macaaly (no actual or potential conflicts of interest).

Author Contributions:

1. Hussein Alomari: Conceptualization; Data curation, Investigation, Methodology.

2. Nabeel F. Allobaney: Methodology, Writing - original draft.

3. Raya Yousef Al-Husban: Supervision.

4. Esmat Swallmeh: Software, Validation; Visualization.

5. Rosario A. Macaaly: Formal analysis, Visualization.

Funding: This research received no external funding.

Institutional Review Board Statement: Before the study started, ethical approval was obtained from the healthcare facility's research ethics committee.

Informed Consent Statement: Informed consent was obtained from all the subjects involved in the study.

Data Availability Statement: Not applicable.

Conflicts of Interest: The authors declare no conflicts of interest.

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The authors declare no competing interests.

Effect of an Educational Program on Nurses’ Level of Knowledge about Pain Assessment and Management: A Quasi Experimental

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