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

doi:10.21203/rs.3.rs-5231832/v3

Background Pain is universally acknowledged as one of the most distressing experiences 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. This study aimed to evaluate the impact of a structured educational program on nurses' performance levels in pain assessment and management.

Methods A quasi-experimental, one-group pre- and post-test intervention design was used to facilitate this investigation. The research was conducted in the inpatient medical and surgical units in a main tertiary governmental hospital in Jordan. A total of 106 male and female nurses who provided direct nursing care in medical and surgical wards voluntarily participated in the study. Two instruments were utilised for data collection. A questionnaire was designed to assess nurses' knowledge regarding pain assessment and management, and an observational checklist was used to evaluate the practical application of pain management techniques by nurses.

Results The study focused on a sample predominantly comprising female nurses, most of whom held a Bachelor of Science in Nursing degree and had 2–5 years of clinical experience. Notably, 88.7% of participants had not previously attended educational sessions centred on pain assessment and management. Following an educational intervention, statistical analysis revealed a significant improvement in the mean knowledge scores (P<0.001). Furthermore, all dimensions of nursing practices related to pain management showed statistically substantial enhancement after the training, demonstrating a strong correlation between knowledge and practice levels before and after the educational program.

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

Nursing

Pain Management Program (PMP)

Nursing Performance

Pain Assessment and Management

Pain is commonly regarded as one of the most unpleasant experiences that people fear but will have to be addressed at some point in their lives, with variable intensity and duration. The International Association for the Study of Pain (Raja, 2020) defines pain as a distressing sensory and emotional experience caused by real or potential tissue damage. Despite pharmacological breakthroughs in pain therapy, research from throughout the world has demonstrated that pain is still undermanaged owing to a lack of information about pain and how to control it. (Gustafsson &Shahriary 2015).

Acute and chronic pain have different mechanisms and durations. Acute pain is a physiological response to tissue damage. (Pergolizzi, Raffa & Taylor, 2014). Poorly handled acute postoperative pain may reduce participation in rehabilitation treatments such as physiotherapy and deep breathing. (Francis & Fitzpatrick, 2013). It can progress to chronic pain; however, the transition from acute to chronic pain is poorly understood. (Voscopoulos & Lema, 2010). The presence of pain before surgery, the nature of the surgery, nerve injury, adjuvant radiation treatment, anxiety, and depression are all factors that increase the chance of chronic postsurgical pain. (VanDenKerkhof, Peters & Bruce, 2013).

Chronic pain was defined as pain that lasted longer than the 'normal' healing timetable or discomfort that lasted more than three months. (Cohen, Quinter & Buchanan, 2013). Chronic pain can begin in the nerves or be caused by nerve injury, illness, or disease. (Scholz, 2014). Various arthritic and inflammatory conditions (31%), low back or spinal conditions (21%), injury and postoperative sequelae (13%), migraines or headaches (11%), neuropathic or neurological problems (11%), and soft tissue pain (11%) are the most commonly reported causes of chronic pain (8%) (Boulanger, Clark, Squire, Cui & Horbay, 2007). Chronic pain can have a negative impact on one's quality of life, can be linked to depression and suicide, and can limit one's capacity to work. (Choiniere, 2010). Nurses must have sufficient pain assessment and management knowledge to provide quality care for patients with pain using pharmacological or nonpharmacological therapies. Nurses play a key role in pain treatment because they monitor patients and offer care 24 hours daily. (Lewthwaite, et al., 2011; Mazilu et al, 2018).

However, worldwide, nurses were found to lack expertise in pain assessment due to misunderstandings about pharmacologic therapy, notably fear of drug addiction, underdosing, and fear of opioid analgesic side effects. (Abdelrahim, 2011; Al-Shaer, 2011; Amponsah, 2019; Khalil & Mashaqbeh, 2019). The knowledge of a caregiver about the physiological repercussions of pain is crucial. Different pain treatment strategies are used, and their success requires frequent monitoring and evaluation. A person's knowledge reflects their views and thoughts, and it is mirrored in their actions and emotions. A nurse's performance about many caring issues, such as sensitivity to patients' pain and society's ideas, values, customs, and culture in general, are influenced by various circumstances. As a result, examining nurses' knowledge of and practices related to pain makes it possible to identify the factors that influence attitudes and changes. (Kamali and Mashayekhi, 2018).

For instance, a cross-sectional study in Taiwan utilising the Nurses' Knowledge and Attitudes Survey-Taiwanese version revealed that 53.4% of nurses working in intensive care units needed more pain management knowledge. (Wang & Tsai, 2010). The knowledge, attitudes, and beliefs of West African-born nurses working in the U.S. were compared to those of their American-born counterparts. In both groups of nurses, there was a lack of understanding about pain management. Moreover, only four nurses (1 percent of the entire sample) scored 80% or higher on the Nurses' Knowledge and Attitudes test in Jordan, according to a study of 417 nurses. The majority of people have unfavourable attitudes and beliefs about pain, according to a survey on the subject. (Khalil & Mashaqbeh, 2019).

The Department of Health and Human Services (HHS) has approved initiatives to increase pain management knowledge through research, prevention, and improved treatment options (Joint Commission statement on pain management, 2016). Each patient has the right to be pain-free. As a result, maintaining comfort and managing pain are key difficulties in nursing, and pain control has always been the responsibility of nurses. (Tilahun, Nasrabaid, Alamayehu, Teklu, Charania, 2016).

This study aimed to determine the effect of implementing an educational program on the performance of Jordanian nurses in the AL-Zarqa Governmental Hospital medical and surgical general wards in pain assessment and management.

Approval was obtained from the Research Ethics Committee of inpatient medical and surgical units in a main tertiary governmental hospital in Jordan. and from the authors of the tools used in the present research. The survey was modified based on the literature reviews (Kamali and Mashayekhi, 2018). The nurses were invited to participate in the study. Through official hospital organisational emails by their respected head nurses after providing informed consent. The total study sample (106) was estimated based on the Epi info 7 program statistical calculation using the following parameters: population size: 137 over three months, expected frequency: 50%, acceptable error: 5%, confidence coefficient: 95%.

Five experts in medical-surgical nursing at the Faculty of Nursing, University of Alexandria, tested all tools for content validity to assure content validity, clarity of items, comprehensiveness, appropriate translation, and necessary modifications. The reliability of the tools was tested using Cronbach's alpha test (0.92) to measure their internal consistency and evaluate how well the tools consistently measure what they were designed to measure. A pilot study was carried out on 10% of the participants (n=11) to test the tools' clarity, feasibility, and applicability. The necessary modifications were made accordingly. Nurses included in the pilot study were excluded from the total sample.

Program development

Based on a literature review, an educational program to enhance nurses’ performance in pain assessment and management in medical and surgical departments, in collaboration with pain management teams and education departments, was developed (International Association for the Study of Pain, 2020; Wood, 2019; Gosselin, 2014; and Ferrell, 2014).

The educational program aimed to enhance nursing skills in pain management by addressing the complex and individual-specific nature of pain. Key objectives included defining pain-related terminology, understanding the societal impact of pain, and recognising the nurse's role in assessment and management. Participants learned to use reliable assessment tools, incorporate patient preferences, and identify factors affecting pain management. The program covered pharmacological and nonpharmacological approaches, emphasised empathetic communication, and promoted patient involvement in decision-making. Nurses were trained to develop personalised treatment plans that consider the benefits and risks of therapies, focusing on continuous monitoring and adjustment based on patient outcomes.

To fulfil the study aim, the actual study was carried out in four phases: assessment, planning, implementation, and evaluation phase.

Phase 1: Assessment phase: The study involved individual interviews with participants, where the researcher introduced himself, explained the study's purpose, and obtained verbal informed consent. Before the educational program, participants underwent an initial assessment of their knowledge and practices regarding pain management using specific tools. The hospital administrator provided a conference room for this purpose. Additionally, the researcher obtained approval from unit directors and head nurses to observe the practices of approximately five nurses per day over 21 days for those who agreed to participate.

Phase II: Planning Phase: Based on initial assessments, educational programs were developed to enhance nurses' pain assessment and management skills in medical and surgical departments, collaborating with pain management teams and education departments. The program, informed by relevant literature (International Association for the Study of Pain, 2020; Wood, 2019; Gosselin, 2014; and Ferrell, 2014), included 10 theoretical and 10 practical sessions, each lasting one hour. Sessions were conducted in two groups of 11 nurses per day, five times a week, to accommodate all 106 participants in the study.

Phase III: Implementation phase: The training sessions were incorporated into mandatory 2-hour education periods for 22 nurses, divided into two groups. Held five times a week during the morning shift, each session included one hour of theoretical instruction and one hour of practical training. Theoretical sessions featured group discussions and PowerPoint presentations on pain assessment, management, types of pain, and reassessment. Practical sessions utilised demonstrations with real materials and case scenarios, focusing on developing skills in subjective and objective assessments, interventions, and reassessment. Each session lasted 60 minutes.

Phase IV: Program evaluation: To evaluate the expected outcome of the program. All the study tools were used to test nurses' knowledge and performance related to pain assessment and management post-educational program immediately and one month after the end of the program. The appropriate statistical tests were used to analyse the obtained data. The Statistical Package for Social Science (SPSS) will be utilised for statistical analysis and tabulation. Comparisons between the pre-and postintervention findings were carried out using appropriate statistical analysis (t-test) to determine the difference in the mean score and to measure the impact of using an educational program on nurses' knowledge and practices related to pain assessment and management.

Data processing and Statistical analysis

After the data were collected, they were coded and transferred into special design formats suitable for computer feeding. Following the data entry, checking and verification processes were carried out to avoid errors during the data entry. The data were computed and statistically analysed using the Statistical Package for Social Sciences (SPSS) software version 20.

Descriptive statistics: Quantitative data are presented in the range (minimum and maximum), mean, and standard deviation. The significance of the obtained results was judged at the 5% level.

Analytical statistics: McNemar and Marginal Homogeneity Tests: Used to analyse the significance of differences between the different stages; paired t test: For normally distributed quantitative variables, two periods were compared, ANOVA with repeated measures was used for normally distributed quantitative variables to compare more than two periods or stages, The Friedman test was used for nonnormally distributed quantitative variables to compare more than two periods or stages.

Table 1 shows the frequency distribution of the studied nurses according to their characteristics. The study's demographic findings indicated that nearly half (43.4%) of the nurses were aged 25 to less than 30 years, while about one-fourth (21.7%) were 30 or older, with a mean age of 30 ± 1.23 years. Most participants (70.8%) were female, and approximately three-quarters (71.7%) held a Bachelor of Science in Nursing degree. In terms of experience, nearly one-third (33.0%) had 2-5 years of clinical experience, while only 14.2% had less than 2 years of experience in pain assessment and management. Notably, about 88.7% of participants had not attended any educational sessions on pain assessment and management in the past two years, with only around one-eighth (11.3%) having participated in such programs during that time.

Table 1 Distribution of the studied nurses according to their sociodemographic characteristics (n = 106).

Nurses’ sociodemographic characteristics	Studied nurses’ (n=106)
Nurses’ sociodemographic 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%

Table (2): Illustration of the relationships between the studied nurses according to their overall mean scores for their knowledge before, after, and after one-month post-implantation of the educational program.

The findings of this study showed that there was no statistically significant relationship between the overall mean score for the studied nurses' knowledge before, after, or after one-month post-implantation of the educational program regarding pain assessment and management and the participants’ sociodemographic characteristics, as P values > 0.05.

Table 2: Relationships between the overall mean scores of the studied nurses' knowledge before, after, and after one-month post-implantation of the educational program

	Nurses' knowledge of pain assessment and management (total grade 37)
Nurses' Socio-demographic characteristics	Pre educational program	post educational program immediately	After one-month post of the 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)

Table (3) shows the frequency distribution of the studied nurses according to their overall knowledge before, after, and one month after the implantation of the educational program regarding pain assessment and management. It revealed that 79.3% of the nurses studied had poor knowledge before implementing the educational program, and 20.7% had fair knowledge. Immediately after the academic program, a significant improvement was observed. A drastic decline occurred; more than two-thirds of the studied nurses had poor knowledge compared to those without knowledge (0%). Additionally, those with fair knowledge remained relatively stable from one-fifth to one-sixth (15.1%), while none of the nurses had good knowledge before. This change greatly accelerates and dominates the majority (83.9%) of the studied nurses.

Table (3): Frequency distribution of the studied nurses according to their overall knowledge before, after, and after one-month post-implantation of the educational program regarding pain assessment and management

Nurses' knowledge of pain assessment and management	Pre- educational program		Post-educational program immediately		After one-month post of the post-educational program
Nurses' knowledge of 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 4 shows a significant difference in the overall mean scores for all dimensions of the studied participants according to the nurses’ practices related to pain assessment and management.

The overall mean pain assessment and management scores increased before, after, and one month after the implementation of the educational program (25.68 ± 3.485, 60.21± 2.377, and 59.96± 2.423, respectively). The results show statistically significant differences in the mean pain assessment and management scores immediately between the pre-and post-educational program groups and between the pre-and post-educational program groups for all the items about pain assessment and management after receiving the pain.

education program (p ≤ 0.001).

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
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
Nonpharmacological 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

Table 4: Distribution of the studied nurses according to their overall mean score for the observed nurses' practices before, after, and after one-month post-implantation of the educational program regarding pain assessment and management

Table 5 shows the relationships between the studied nurses according to their overall mean scores for the observed nurses' practices before, after, and after one month post-implantation of the educational program regarding pain assessment and management and their sociodemographic characteristics. The findings of this study revealed that there were no statistically significant differences in the participants' practices before or after one-month post-implantation of the educational program for pain assessment and management or in their sociodemographic characteristics, as P values were > 0.05.

Table 5: Relationships between the scores of the nurses according to their overall mean scores for the observed nurses' practices before, after, and one month after the educational program was implemented regarding pain assessment and management and t.

	Nurses' practices (total grade 72)
Nurses' Socio-demographic characteristics	Pre- educational program	post educational program immediately	After one-month post of the 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)

Table 6 explores the distribution of observed nurses according to their satisfaction level of practice before, after, and one month after implementing the educational program for pain assessment and management. It reveals that 100% of the studied nurses had unsatisfactory levels of pre-educational program implementation. Immediately after the educational program, 86% of the studied nurses achieved a satisfactory level, and only 14% had an unsatisfactory level. In addition, the majority (83%) of the studied nurses had relatively satisfactory outcomes after one month of education, and only 17% had unsatisfactory outcomes.

Table 6: Distribution of observed nurses according to their level of satisfaction with their practices in relation to before, after, and one month after the implementation of the educational program about pain assessment and management

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 7 reveals the correlation between overall knowledge and overall practices among the studied nurses. The table shows that there was a statistically significant positive correlation between nurses’ overall knowledge and overall practices (p<0.001^*).

Table 7: The correlation between overall knowledge and overall practices in the studied nurses’ pre- and post-educational program regarding pain assessment and management.

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

Pain is widely recognised as one of the most distressing experiences individuals encounter and is 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 nonpharmacological 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). Incorporating simulation in educational programs has enhanced 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 and to foster competence and confidence in their practice (Alqahtani M, 2015).

The findings from this study demonstrated the effectiveness of a well-structured educational program on nurses' pain assessment and management performance. 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.

The majority of the participating nurses were aged between 25 and 30, with only a small percentage over 30. This demographic trend may be influenced by increased responsibilities and financial pressures contributing 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.

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 socioeconomic 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 (BSN). 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 and 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). The results indicated that before the educational program, nurses exhibited limited knowledge regarding pain assessment and management. However, significant improvements were observed in the mean scores for pain assessment techniques following the program (mean rank = 0.63) and in the use of pain education (mean rank = 0.92). Standardised 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 receiving opioid pain management. This finding is consistent with the literature highlighting education as a critical barrier to effective pain management (Rabba, 2021). Implementing 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).

Postintervention assessments indicated a significant improvement in nurses' practices regarding pain assessment and management. Approximately two-thirds of the 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 in clinical practice, as indicated by increased mean scores for pain reassessment techniques (mean = 1.82) following the program (Mahmoud, 2020).

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 emphasised in the literature (Rahman, 2021; Issa, 2019).

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

Author Contributions:

Hussein Alomari: conceptualisation, data curation, investigation, methodology,Nabeel F. Allobaney; Methodology, Writing - original draft, Raya Yousef Al-Husban; Supervision., Rosario A. Macaaly; Formal analysis, Visualization, Esmat Swallmeh; Software, Validation; 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 Study

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Version 3

Abstract

Introduction

Methods and Method

Results

Discussion

Conclusion

Declarations

References

Additional Declarations

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Version 3