SCHOOL OF ANESTHESIA AND CRITICAL CARE

RIDGE HOSPITAL
ACCRA

ASSESSMENT ON THE KNOWLEDGE OF

NURSES ON POST-OPERATIVE PAIN
ASSESSMENT AT ACHIMOTA HOSPITAL IN
GREATER ACCRA

BY

PATRICIA LARBI

MAY, 2018

i
 SCHOOL OF ANESTHESIA AND CRITICAL CARE

RIDGE HOSPITAL

ACCRA

ASSESSMENT ON THE KNOWLEDGE OF NURSES ON POST-

OPERATIVE PAIN ASSESSMENT AT ACHIMOTA HOSPITAL IN

GREATER ACCRA

A Thesis Submitted to the School of Anaesthesia and Critical Care, Ridge

hospital in Partial Fulfillment of the Requirement for the Award of a Degree
of
Bachelor of Science in Anaesthesia

BY

PATRICIA LARBI

MAY, 2018

ii
 DECLARATION

I hereby declare that this piece of work is the outcome of my own research, carried

out under the supervision of Mr. Haruna Salifu towards the award of Bsc in

Anesthesia. With the exception of references made to other literature which have been

duly acknowledged, no part of this research has ever been presented anywhere, fully

or partly for the award of a degree.

(Student Name and Index No.)

Patricia Larbi ...................…………… ………………………..

( AR20160029 ) Signature Date

Certified by:
Mr. Haruna Salifu ……………………… ……………………..
(Supervisor) Signature Date

Dr. Jerry Agudogo .........………........... …………………..

(Head of Academics) Signature Date

Dr. Evans Atito Narh .........………........... …………………..

(School Principal) Signature Date

i
 DEDICATION

I dedicate this work to my husband and children.

ii
 ACKNOWLEDGEMENT

First of all I will like to thank the Almighty God for seeing through this thesis.

Many thanks also goes to my supervisor, Mr. Haruna Salifu for his direction and his

patience throughout the supervision of this thesis. May the Almighty God richly bless

him.

Then finally to my parents and the rest of my family members, I want to thank all of

you for your kindness and prayer support.

iii
 ABSTRACT

The study aimed at assessing a post-operative pain assessment among nurses at the

Achimota Hospital. In this study, 51 respondents were targeted for the data collection

exercise by the use of questionnaire.

The study employed convenience and purposive sampling methods which at the end

yield an expected result by use of SPSS for the data analysis. Data was collected from

both primary and secondary sources.

It came out from the analysis generally that, some nurses are aware of pain assessment

tools but do not know the use of them. Others also revealed that, though they know

the use of these tools there are no protocols governing its use for quality health care

delivery. It was again revealed that, though these nurses are aware of the fact that,

though pain assessment methods exist, no education has been provided to aid them in

their daily activities.

The study therefore concluded that, postoperative pain relief must reflect the needs of

each patient since the final determinant of the adequacy of pain relief will be the

patient’s own estimation.

In recommendation, Pain management and control should be addressed as a public

health issue and all stakeholders in the help delivery system should come on board to

help in its management.

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 TABLE OF CONTENTS

DECLARATION........................................................................................................... i

DEDICATION ...............................................................................................................ii

ACKNOWLEDGEMENT ........................................................................................... iii

ABSTRACT .................................................................................................................. iv

TABLE OF CONTENTS ............................................................................................... v

LIST OF TABLES ..................................................................................................... viii

CHAPTER ONE ............................................................................................................ 1

INTRODUCTION ......................................................................................................... 1

1.1 Background ........................................................................................................... 1

1.2 Problem Statement ................................................................................................ 2

1.3 Objective ............................................................................................................... 4

1.3.1 Specific Objectives ............................................................................................ 4

1.4 Research Questions ............................................................................................... 4

1.5 Scope of the Study ................................................................................................ 4

1.6 Significance of the Study ...................................................................................... 5

1.7 Organization of the Study ..................................................................................... 5

CHAPTER TWO ........................................................................................................... 6

LITERATURE REVIEW .............................................................................................. 6

2.0 Introduction........................................................................................................... 6

2.1 The Concept of Postoperative Pain Management ....................... 6_Toc518768743

v
 2.2 Types of Postoperative Pain ................................................................................. 8

2.3 Consequences of Unrelieved Post-Operative Pain ............................................... 8

2.4 Knowledge related to Postoperative Pain Management among patients ............ 10

2.5 Challenges Contributing to the Post-Operative Pain Management .................... 11

2.6 Measures to ensure effective Post-Operative Pain Management ....................... 13

CHAPTER THREE ..................................................................................................... 16

METHODOLOGY ...................................................................................................... 16

3.0 Introduction......................................................................................................... 16

3.2 Population and Sampling of the Study ............................................................... 16

3.2.1 Target Population............................................................................................. 16

3.2.2 Sample size and Frame .................................................................................... 17

3.3 Sampling Techniques.......................................................................................... 17

3.4 Instrumentation ................................................................................................... 18

3.5 Data Collection Procedures ................................................................................ 18

3.6 Data Analysis Technique .................................................................................... 18

CHAPTER FOUR ........................................................................................................ 19

RESULTS AND DISCUSSION .................................................................................. 19

4.0 Introduction......................................................................................................... 19

CHAPTER FIVE ......................................................................................................... 36

SUMMARY, CONCLUSION AND RECOMMENDATIONS .................................. 36

5.0 Summary of findings .......................................................................................... 36

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 5.1 Conclusion .......................................................................................................... 37

5.2 Recommendations............................................................................................... 37

REFERENCES ............................................................................................................ 38

APPENDIX .................................................................................................................. 39

QUESTIONNAIRES ................................................................................................... 39

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 LIST OF TABLES

Table 1: Gender of respondents ................................................................................... 19

Table 2: Age of respondents ........................................................................................ 20

Table 3:Educational status ........................................................................................... 20

Table 4:Marital Status .................................................................................................. 21

Table 5: What is your current job title/rank? ............................................................... 22

Table 6:How long have you been working as a nurse?................................................ 23

Table 7: Pain can affect mood and emotions of patients ............................................. 23

Table 8:Pain can cause nausea ..................................................................................... 24

Table 9: Pain can affect patients’ communication ....................................................... 24

Table 10: Pain can affect patients sleep pattern? ......................................................... 25

Table 11: Patients are usually satisfied with post-operative pain management? ......... 25

Table 12: What pain assessment tools do you use in assessing post-operative pain

among patients? ........................................................................................................... 26

Table 13: How often do you use pain assessment tools in assessing post-.................. 27

Table 14:Are pain assessment tools effective in assessing pain .................................. 28

Table 15:Is pain assessment tools important? .............................................................. 29

Table 16: Do you always agree with patient’s statement about their pain? .............. 30

Table 17:In your opinion, who provides the accurate rating of post-operative pain? . 30

Table 18:Lack of familiarity with assessment tools .................................................... 31

Table 19: Lack of protocols for pain assessment ......................................................... 32

Table 20:Poor documentation of pain assessment and management ........................... 32

Table 21: Lack of education on assessment tools ........................................................ 33

viii
 CHAPTER ONE

INTRODUCTION

1.1 Background

Pain is a sensory and emotional experience associated with actual or potential damage

or described in terms of such damage (Kizza, 2012).Research have proven that pain is

the most typical reason for individuals to seek medical attention, as well as being the

most frequently reported complaint made by patients (Abdalrahim et al., 2008;

Smeltzer and Bare 2004; Aslan et al., 2003). Therefore, effective pain management is

a vital component to quality patient care.

Charlton (2005) underscored the importance of recognizing that pain is a

biopsychosocial experience with important cognitive, behavioural, sensory and

affective constituents. The biopsychosocial model which originated in the late 1970’s,

contested the traditional biomedical model of illness, based on biological indices, as

the sole determinants of defining illness or disease. American psychiatrist, George

Engel established the biopsychosocial model of illness in the 1970’s, to contest the

traditional biomedical model of illness, the latter being based exclusively on

biological indices as the sole determinants of defining illness or disease

The findings of a study on nurses’ pain practices for pain assessment for critically ill

patients unable to verbally communicate their pain in Turkey showed that of the 91

nurses, 85.7% stated that the most correct pain assessment would be made by the

patients themselves. However, only 29.7% based their assessment on the patient’s

own communication (Aslan, Badir, and Selimen, 2003). The authors felt that this

finding clearly indicated inadequate knowledge of pain assessment management

1
principles. In addition, 57.1% of the nurses failed to administer the analgesics

immediately but waited until after verification of the extent of pain in cases where the

patients made their pain known to the nurses. This shows how knowledge was not

translated into practice. In the same study, only 14.3% of the subjects had received

pain management education and this was during student training (Aslan, et al., 2003).

There are a number of factors that are capable of making pain assessment and

management challenging including patient, clinician and organizational related factors

(Rose et al., 2011). The most cited challenges to optimal pain assessment and

management include busy units, inadequate staffing, limited time, inappropriate

attitude or focus on other imperatives, inadequate knowledge of pain management

principles, poor communication, lack of accountability, inadequate staff training,

reluctance to prescribe opioid and to take medication, patients’ attitude and health

status among others (Taylor and Stanbury, 2009).

1.2 Problem Statement

Pain after surgery is distressing to patients and is a significant problem in post

anesthesia care unit (PACU) (Ho et al., 2013 and Gandhi, 2012). Recent data suggest

80 percent of patients’ experience pain post operatively (Wells et al., 2008). The lack

of appropriate pain management results in physiological and psychological harmful

effects on the patients including the risk of developing chronic pain (Abdalrahim et

al., 2011). Ineffective pain management in the immediate postoperative period can

prolong the patient’s length of stay in Post Anesthesia Care Unit (PACU) which may

lead to increased cost of care (Wells et al., 2008).

Achieving optimal pain-management practices in PACU continues to be a challenge

for administrators, nurses, physicians, and other health care providers (Samuels and

2
Fetzer, 2009). Advances have been made in the understanding of pathophysiology of

postoperative pain and development of new analgesics and delivery techniques,

regardless patients still suffer from moderate to severe postoperative pain (Ismail et

al., 2012). Insufficient knowledge about pain, inadequate assessment and evaluation

of pain and various attitudes on pain and its management are some of the possible

barriers to effective post-operative pain management (Dihle et al., 2006 and

Krenzischek et al., 2004).

Additionally, outdated attitudes, myths, and misconceptions about pain and its

treatment among nurses and patients contribute to unsafe, inadequate, and

inappropriate pain management (Dihle et al., 2006). Nurses, as important members of

the team, have a unique opportunity to assess and continuously evaluate pain and its

treatment. Accurate knowledge, appropriate attitudes and assessment skills,

communication and the ability to implement the appropriate intervention and also

evaluate and communicate the outcomes of the treatment in a timely manner can help

manage postoperative pain (Krenzischek et al., 2004). The implementation of a

multimodal, evidence-based, culturally competent educational and behavioral

intervention will improve the quality of pain assessment, and improve nurses’

knowledge and attitudes about pain assessment and management in the PACU (Clark

et al., 2006).

On daily basis, Surgeries are performed in the Achimota Hospital. Almost all the

patients do experience some degree of pain and hence the quality of pain management

of these patients is critical in the realization of their overall physical and emotional

well-being. The minimization and prevention of pain among these patients is a major

dependable indicator of full recovery from illness. This study seeks to to assess the

knowledge of nurses on postoperative pain assessment at Achimota Hospital in

3
Greater Accra.

1.3 Objective

The main objective of the study is to assess the knowledge of nurses on postoperative

pain assessment at Achimota Hospital in Greater Accra.

1.3.1 Specific Objectives

1. To evaluate factors that influence postoperative pain.

2. To identify methods used for postoperative pain assessment

3. To identify the challenges contributing to quality of postoperative pain

assessment.

1.4 Research Questions

1. What are the factors that influence postoperative pain?

2. What are the methods used for postoperative pain assessment?

3. What are the challenges contributing to quality post-operative pain

assessment?

1.5 Scope of the Study

The study will be conducted in the Achimota Hospital in Greater Accra. It will be

focused on postoperative pain management among surgical patients. The Hospital is

chosen because it is one it known for surgical practices since time memorial in the

country and therefore receives patients from all over the country. It is therefore

important to assess the quality of the postoperative pain management.

4
1.6 Significance of the Study

The outcome of the study will be of utmost importance to health unit and researchers.

It will aid health personnel in making informed decisions and policies involving pain.

The findings of this study will expose and contribute to the understanding of nurses’

knowledge of pain management. The findings of the study will also enhance

appropriate educational policies, strategies and initiatives to address knowledge

deficits in postoperative pain management. In academia, the outcome of this study

will add up to existing literature and therefore can be used as a source of reference for

researchers interested in this field.

1.7 Organization of the Study

The first chapter is about the introduction of the study and it deals with the

background of the study, the problem statement, the research objectives and

questions, significance, scope and organization of the study. Chapter two is the

literature review, which contains relevant literature related to the research. It

comprises of the theoretical and empirical review. The third chapter contains the

methodology which includes the research design, source of data, population and

sampling, data collection and data analysis. Chapter four presents the analysis of the

information gathered. Conclusion of the study, summary and recommendations was

covered in chapter five.

5
 CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This chapter is a review of similar works conducted by other researchers. It involves a

systematic review of literature from academic journals, text books, institutional and

statutory publications and conference papers.

2.1 The Concept of Postoperative Pain Management

Postoperative pain (POP) is a form of acute pain following surgery. It results from

tissue injury during surgical procedure like skin incision, tissue dissection,

manipulation and traction. The POP is one of the immediate postoperative

complications. Globally the prevalence of POP ranges from 50% to 75% of

postoperative patients (Philip & Schroeder, 2007).

Postoperative pain refers to the pain felt instantly due to surgery or a wound as a

consequence of the suffering to the tissue. Pain is a subjective experience because

individuals have different thresh-hold and different ways of expressing it.

Although postoperative pain is one of the expected consequences of almost all

surgeries, ineffective controlled postoperative pain can lead to potentially serious

complications that have impact on recovery, rehabilitation and patients’ quality of

life. Inadequate management of pain may lead to path physiological complications

(Griffiths and Justin, 2006).

Preoperative phase is an important phase because most of the patients are vulnerable

in their needs both psychological and physiological. The important factor is anxiety

6
due to fear of the unknown of the outcome of the surgery, pain and even death. Hence,

the care should include physical, emotional preparation, guidance, assessment and

possible referral to experts to promote recovery and prevent postoperative

complications (Rosen, Svensson, & Nilsson, 2008). Also, patients should be evaluated

for their preparedness for the surgery, identify potential risk of the patients, advice the

patient about the surgical procedure and be prepared for postoperative experience and

possibly plan with the patients for home care (Pearson & Osbom, 2010).

Postoperative patients in many countries including Ghana continue to experience

moderate to severe pain after surgery (Qu, Sherwood, McNeill, and Zheng, 2008).

Studies have reported that nurses underestimate patients’ pain, do not believe patients

are in pain, and do not administer the prescribed dosage of analgesics due to fear of

addiction (Aziato & Adejumo, 2013). However, ineffective postoperative pain

management poses problems for patients such as pulmonary complications that retard

their recovery (Pasero & McCaffery, 2011).

Although postoperative pain has been studied in high income countries, minimal

research has been carried out in less developed countries, particularly in Africa

(Apfelbaum , Chen , Mehta and Gan,2003). In Eldoret, Kenya, 57% of healthcare

practitioners who work with patients in the preoperative period indicated that they

lacked the knowledge to manage postoperative pain.

Research in Nigeria demonstrated that postoperative pain was undertreated in patients

who underwent a Caesarean section (Kolavole and Fawole, 2003). Postoperative pain

was similarly undertreated following thoracic and abdominal surgery in Kenya. As of

yet, there are no published reports from Africa that have examined both patients’ and

healthcare practitioners’ perspectives regarding postoperative pain (Ocitti and,

Adwok).

7
2.2 Types of Postoperative Pain

Acute pain is defined by Duarte (1997), as pain that is temporarily related to injury

and that this pain resolves after the healing of the injury. Acute pain in most cases

responds well to analgesic medications and treatment of the precipitating factor.

Neuropathic pain can also come about as a result of changes to the peripheral nervous

system. This causes pain fibers to emit pain signals repeatedly and hence increase

sensitivity to stimulus. Neuroplasticity can also develop alongside and this is

characterised by unusual neuronal sprouting in the peripheral and also within the

dorsal horn of the spinal cord. This abnormal neuronal sprouting may also result in

the generation of additional and increase transmission of pain impulses (Farquhar-

Smith, 2007)

Mixed pain is a type of pain which is caused by a combination of neuropathic and

nociceptive factors. This is usually start with an injury or dysfunction of the nervous

system (central and peripheral) which is then followed by an inflammation response

leading to the release of inflammatory mediators and apparent neurogenic

inflammation. Myofascial and migraine headaches are examples of mixed pain.

(Cousins M J, 1988)

2.3 Consequences of Unrelieved Post-Operative Pain

Inadequately managed pain has major physiological, psychological, economic and

social ramifications for patients, their families and society (Brennan, et al., 2007).

Physiologically, unrelieved pain has been found to affect almost all the systems in the

body because it precipitates a generalized sympathetic response (Thomas, 2008). In

8
addition to what has been mentioned earlier , other physiological consequences

include; immune-suppression with increased susceptibility to disease and dependence

on medications ; tachycardia, increased myocardial oxygen demand with increased

cardiac ischemia in susceptible patients due to an imbalance between myocardial

oxygen demand and supply, blood pressure(hypertension) , decreased cerebro-

vascular auto-regulation, increased intracranial pressure and increased and prolonged

catabolic response (Thomas,2008) .

Unrelieved pain may result in lung collapse due to reduced movement of the

diaphragm and chest wall resulting in hypoxia, hypercarbia, decreased cough,

decreased vital capacity and functional residual capacity, pneumonia, ventilation-

perfussion mismatching and respiratory failure with prolonged mechanical ventilation

and ICU stay (Thomas, 2008). Complications in the gastrointestinal system include;

anorexia, nausea, vomiting and post- operative ileus (Thomas, 2008).

A key issue to remember is that adequate pain relief is unattainable without adequate

assessment. Findings of a study at Muhimbili Orthopedic Institute in Tanzania

showed that of the 156 patients who scored their pain as moderate to severe, 76.5%

rated their pain at the same level even after analgesic administration (Haonga et al.,

2009).

Only 18% received analgesia within 20min of admission. If pain is well assessed and

analgesics prescribed and administered according to the assessment scores of pain,

then complete relief can be attained and consequences prevented.

In summary, pain, the unnecessary discomfort, has debilitating effects that can affect

patients physically, emotionally and spiritually and can alter their quality of life. On

the other hand, good pain control is not only more pleasant for the patient but can also

9
lead to earlier mobilization, faster rehabilitation, improved patient satisfaction, and

earlier discharge from the hospital (Pronovost, and Pham, 2006).

2.4 Knowledge related to Postoperative Pain Management among patients

Knowledge deficits regarding pain assessment and management principles has been

cited as one of the clinician-related barriers to optimal pain management among

surgical patients, and surgical care nurses’ recognition that they have inadequate pain

assessment knowledge has been considered as a key step towards improvement of

pain management (Pasero et al., 2009).

Subramanian et al, (2014) conducted a study with the aim of assessing the pain

experiences and satisfaction with pain control among surgically treated clients in

which one hundred and seven (107) respondents were interviewed. Only clients who

had abdominal surgeries and were admitted to surgical wards of an urban hospital

were used for the study. The study revealed that post operative pain continues to be a

problem for clients are surgically treated and that good and effective pain

management and health education are required to help manage pain more efficiently

after surgery.

In another study that was designed to examine the relationship between nurses’

knowledge and beliefs about and patients’ outcomes related to pain and analgesic

intake, findings showed that among 80 nurses for cardiac postoperative patients, the

level of knowledge was moderate for majority. About 53% of the nurses scored 69%

or less with the Toronto Pain Management Inventory (TPMI) tool with only 15%

scoring 75% or greater (Watt-Watson, et al., 2001).

Apfelbaum et al, (2003), published a study on post operative experience. Two

10
hundred and fifty (250) adults who had undergone surgical procedure were used for

the study using telephone questionnaire. Patients were asked about the severity of post

surgical pain, treatment, satisfaction with pain medication, patient’s education and

perception about post operative pain and pain medication. 80% of the respondents

indicated that they experienced acute pain after surgery.

2.5 Challenges Contributing to the Post-Operative Pain Management

There are a number of factors that are capable of making pain assessment and

management challenging including patient, clinician and organizational related factors

(Rose et al., 2011). The most cited challenges to optimal pain assessment and

management include busy units, inadequate staffing, limited time, inappropriate

attitude or focus on other imperatives, inadequate knowledge of pain management

principles, poor communication, lack of accountability, inadequate staff training,

reluctance to prescribe opioid and to take medication, patients’ attitude and health

status among others (Taylor and Stanbury, 2009). The shortage of nurses and heavy

workload associated with managing post-operative pain can limit the interaction time

between patients and nurses for adequate pain assessment and management (Tunabe,

2000).

Others mentioned in the emergency situation include inability to administer

medication until a diagnosis is made, patients reluctance to report pain and use of

alcohol or other recreational drugs by patients (Tunabe et al, 2000). Patient related

factors like hemodynamic instability and inability to communicate have been reported

to specifically impact on practices related pain assessment and management (Rose et

al., 2011).

11
Social attitudes and cultural beliefs (of both the person in pain and practitioners)

prevail and can limit effective assessment and management of pain (Ashley, 2009).

Nurses have reported in some studies that taking pain medication is a sign of

weakness and that pain is a logical consequence of injury (Thiadens et al., 2011).

Also absence of protocols and guidelines on pain assessment and management has

been cited to hinder effective pain management (Kituyi et al, 2011). High workload

and subsequent time constraints have been identified as significant barriers to

assessment of pain in the critical care area. The critical care nurses frequently neglect

pain assessment whilst attending more urgent patient needs (Shannon and Bucknall,

2003). It has been urged that nurses need to view pain with the same degree of

urgency and importance as other changes in vital signs in order to improve patient

outcomes (Shannon and Bucknall, 2003).

Others include the increasing presence of technology and the rapidly changing

situations common in the critical care that place time constraints on nurse’s ability to

make pain assessment decision and implement them (Shannonand Bucknall,2003).

Some nurse variables have been associated with pain assessment and management

practices. These include years of experience, attendance of ongoing professional

education on pain and it assessment and management, nurse’s confidence with use of

tools or performing pain assessment and perception of the importance of pain

assessment and management (Kaasalainen et al., 2007; Rose et al, 2011).

Poorer concordance between patients’ and nurse’s ratings of pain has been associated

with lower confidence in the ability to accurately assess pain and time constraints

12
faced in completing nursing tasks (Kaasalainen et al., 2007). More years of

experiences nurses has been associated with more confident in the ability to assess

pain, but less use of pain assessment tools (Rose, et al, 2011).

Similarly, the patient’s status or category may affect the perceived importance of pain

assessment. Nurses considered pain assessment equally important for surgical and

trauma as compared to medical patients but more important for critically ill patients

with burns injuries but less important for patients with Glasgow Coma Scale less than

8 (Rose et al, 2011). The inability of many patients to communicate adequately with

the health professionals providing their care strikes at one of the most basic tenets of

pain control, namely the need for patient input in pain control decisions given the

subjective nature of pain (Erstad et al., 2009).

2.6 Measures to ensure effective Post-Operative Pain Management

Nurses caring for surgical patients need expertise in pain management and the use of

advanced techniques of pain management such as patient-controlled analgesia,

epidural analgesia, and various contemporary pharmacological and non-

pharmacological measures used for postoperative pain management (Pasero &

McCaffery, 2011). It is noted, however, that in Ghana, there are no advanced

specialist nurses for pain management. Also, advanced techniques requiring

contemporary gadgets such as patient-controlled analgesia are not routinely employed

in clinical practice.

Some factors have been considered as enablers for nurses caring for surgical patients

to practice adequate pain assessment and management. These include; prioritization of

13
pain assessment and management by ICU team, working with an ICU team that is

motivated to provide effective pain relief, prescription of analgesia with adequate

dosing (Rose et al ,2011) and support from nurse and medical colleagues (Watt-

Watson et al ,2001). However, most times prescribers do not base the dosing on the

nurses’ rating of pain. In a study by Rose et al. (2011), most nurses (71.4%) reported

that analgesic prescribing by physicians targeted to a pain score occurred less than

50% of the time. This may be a de-motivator.

Providing appropriate support such as orientation of patients to ward environment and

advice that is easily accessible for those patients that need it are key areas for

improvement during preoperative period (Rachel, Davis, Charles, Ania, & Alison,

2011). Further studies indicated that allowing patients and their relatives to familiarize

themselves with the environment through orientation and to meet staff who will

provide perioperative care or a visit of nurses to ward may relieve patients ‘anxiety

and answer patients ‘questions relating to anaesthesia and surgical process (Crawford,

2012).

Health staffs like nurses are supposed to deliver analgesia to patients on time as

prescribed. The existing problems of shortage of health staff may result in delay in

giving analgesia to patient hence interfere with patient pain control. Poorly controlled

postoperative pain delays patient recovery therefore increase number of days of

hospital stay. Relatively small number of hospital bed capacity in surgical ward (35

beds) and prolonged hospital stay results in overcrowding of inpatient. The end result

of this vicious cycle is poor health care delivery. Adequately controlled POP

facilitates reduction of postoperative complications and hence quick recovery

(Chaturvedi & Chaturvedi, 2007).

14
Effective post operative pain management can be achieved if it is well planned and

delivered in a consistent and evidence based manner and this must be based on

client’s assessment of their own pain if possible. Due to the subjective nature of pain

and the many factors that cause pain, no two individuals will experience the same pain

even if they had same surgery. Healthcare professionals need to be aware of this so

that pain management can be tailored towards individual needs (White et al, 2007).

Studies have indicated that effective information delivery to surgical patients has an

empowering effect that enables them to take control over their health care and to

comply with treatment. It lets the patients understand whatever is expected of them

(Feeley, & Tierney, 2012). However, patients‘level of understanding is an important

factor that should be assessed before educating them. This will help nurses to manage

patient‘s stress and anxiety during education.

It will also help the nurses to find out ways of reducing risk such as pressure ulcer,

venous thromboembolism and malnutrition. Inadequate education and information

increases patient anxiety, inability to cope and planning for discharge (Rhodes, Gail,

& Alan, 2006)

15
 CHAPTER THREE

METHODOLOGY

3.0 Introduction

This chapter discusses the road map used for the study, and that is the methodology.

In this chapter all the methods and procedures that aided the successes of the study

were discussed.

3.1 Research design

Research design is of crucial importance because it determines the success or failure

of the research. The research design guides logical arrangements for the collection and

analysis of the data so that conclusions may be drawn. A research design is a blueprint

or detailed plan of how a research study is to be conducted operationalizing variables

so they can be measured, selecting a sample of interest to study, collecting data to be

used as a basis for testing hypothesis and analyzing the results (de Vos & Fouche,

1998). The quantitative method was adopted for this study; the purpose of this

approach is to employ prescribed procedures to ensure validity and reliability.

3.2 Population and Sampling of the Study

3.2.1 Target Population

Polit and Hungler, (1999) defined population as an aggregate or totality of all the

objects, subjects or members that conform to a set of specification. The population for

this study will be nurses in Achimota Hospital. The nurses in this sector will be the

population of interest.

16
3.2.2 Sample size and Frame

A sampling frame is the source material from which a sample is drawn. It is a list of

all those within a population who can be sampled, and may include individual,

households or institutions (Wretman, 2013). A sampling frame includes a numerical

identifier for each individual, plus other identifying information about characteristics

of the individuals, to aid in analysis and allow for division into further frames for

more in-depth analysis.

The sample size and the way in which it is selected will certainly have an implication

on the confidence of the findings of the study and the extent to which the findings can

be generalized (Sanders et al., 2012). An undersized study can be a waste of resources

for not having the capability to produce useful results (Russell, 2009). The sample

size will be 51.

3.3 Sampling Techniques

According to Neuman (2016), with sampling, the primary goal of researcher is to get

a smaller collection of units from a larger collection or population, such that the

researcher can study the smaller group and produce accurate generalizations about the

larger group. Sampling is an important tool when conducting a research. Random

sampling refers to a technique in which the entire population of the study is known by

the researcher, and each individual within the population has an equal chance of being

selected for the study. This ensures that bias is not introduced regarding who is

included in the survey.

Sampling methods

The study employed purposive and convenience sampling methods during the study.

In order to realise the objectives of the study, the researcher gathered information

17
from nurses who had knowledge about the subject.

In a convenience approach also, data was collected at the expense of both the

researcher and the respondents own available time.The nature of the work schedules

for nurses are so demanding which therefore called for this method.

3.4 Instrumentation

For the purpose of this study, primary data will be collected using self-administered

questionnaires. A questionnaire is a printed self-report form designed to collect

information that can be obtained through the written responses of the subjects (Burns

& Grove, 1993). Questionnaires are suited for this study because it will aid in the

collection of a large amount of data from a large number of respondents within a short

period of time.

3.5 Data Collection Procedures

Data collection is the process of gathering data on targeted variables in a systematic

way which can help the researcher to analyze and evaluate results. The questionnaires

that will be used in this research will be categorized into three sections. The first

section will address the demographic profile of the respondents. It will comprise of

the gender, age and position held by respondents.

3.6 Data Analysis Technique

According to Rouse (1999), data analysis is the science of examining raw data with

the purpose of drawing conclusions about information. The data will be analyzed

using frequency distribution. Data received will be presented in the form of

frequencies and graph.

18
 CHAPTER FOUR

RESULTS AND DISCUSSION

4.0 Introduction

This chapter covers the analysis and interpretation of the various data collected with

the use of questionnaire. The set of questionnaires were administered to the

employees. The overall number of respondents picked was fifty-one (51).

Table 1: Gender of respondents

Responses Frequency Percentages

Males 20 38.2

Females 31 60.8

Total 51 100.0
Source: Field Survey, 2018

From the Table 1, 38.2% of the respondents are male whiles the remaining 60.8% are

females which corresponds to 20 and 31 persons respectively.

19
Table 2: Age of respondents

Response Frequency Percentage

20-30 26 51.0

31-40 23 45.1

41-50 2 3.9

Total 51 100.0

Source: Field Survey, 2018

Table 2 indicates that, 51% of the respondents fall within the ages of 20-30 years

whiles significant respondents representing 45.1% fall within 31-40 years.

Again, it was revealed that, 3.9% of the respondents are between 41-50 years

respectively.

Table 3:Educational status

Response Frequency Percent

Certificate 2 3.9

Diploma 30 58.8

Degree 19 37.3

Total 51 100

Source: Field Survey, 2018

On the educational background of the respondents sampled for the study, the Table 3

revealed that 3.9% of the respondents have obtained Certificate, 37.3% have Degree

20
as higher education. However, the majority 58.8% of the respondents declared that

they have obtained Diploma as their higher education.

Table 4:Marital Status

Response Frequency Percentage

Married 21 41.2

Single 29 56.9

Divorced 1 2.0

Total 51 100.0

Source: Field Survey, 2018

From table 4 above, out of the total respondents of 51, 29 constituting 56.9% are

single, 21 constituting about 41.2% are also married and the remaining 1constituting

2% have divorced.

21
Table 5: What is your current job title/rank?

Job title/rank Frequency Percent

Anaesthetist 1 2.0

Critical care nurse 3 5.9

Enrolled nurse 1 2.0

Nurse 4 7.8

Nursing officer 6 11.8

Principal Enrolled nurse 1 2.0

Registered nurse anaesthetist 1 2.0

Senior nursing officer 2 3.9

Senior staff nurse 14 27.5

SSN 2 3.9

Staff nurse 16 31.4

Total 51 100.0

Source: Field Survey, 2018

The table 5 above shows ranks of nurses interviewed for the assessment.

Out of 51 respondents which included anaesthetist, critical care nurses, enrolled nurse,

nurses, nursing officers, principal enrolled nurse, registered nurse anaesthetist, senior

nursing officers, senior staff nurses, SSNs, staff nurses. In this study, Staff nurses

were in majority being 16(31.4%).

22
Table 6:How long have you been working as a nurse?

Period Frequency Percent

1-4 years 28 54.9

5-8 years 20 39.2

Above 8 years 2 3.9

Less than a year 1 2.0

Total 51 100.0

Source: Field Survey, 2018

The table 6 above shows the working time frame of 51 nurses for the assessment. The

ranges 1-4 years were 28 (54.9%),5-8 were 20 (39.2%), above 8 years were 2 (3.9%)

and less than a year was 1(2%).

Table 7: Pain can affect mood and emotions of patients

Response Frequency Percent

Neutral 2 3.9

Agree 17 33.3

Strongly agree 32 62.7

Total 51 100

Source: Field Survey, 2018

Table 7 indicates that majority representing (62.7%) confirmed that pain can affect

mood and emotions of patients, (33.3%) claimed they agree whiles (3.9%) indicated

neutral. Physiologically, unrelieved pain has been found to affect almost all the

systems in the body because it precipitates a generalized sympathetic response

(Thomas, 2008).

23
Table 8:Pain can cause nausea

Response Frequency Percent

Strongly Agree 14 27.5

Disagree 9 17.6

Agree 19 37.3

Neutral 9 17.6

Total 51 100

Source: Field Survey, 2018

According to table 8, 27.5% of the respondents strongly agree that pain can cause

nausea due to the medication given whiles (17.6%) were indifferent. However, 17.6%

neither agreed nor disagreed.

Table 9: Pain can affect patients’ communication

Response Frequency Percent

Neutral 1 3.9

Agree 15 29.4

Strongly agree 35 68.6

Total 51 100

Source: Field Survey, 2018

Respondents representing 68.6% strongly agree that pain can affect communication of

patients. Another 29.4% of the respondents also agreed whilst 2% neither agreed nor

24
disagreed. The results is shown in table 9 above.

Table 10: Pain can affect patients sleep pattern?

Response Frequency Percent

Agree 7 13.7

Strongly agree 44 86.3

Source: Field Survey, 2018

Respondent were asked if pain can affect patient’s sleep pattern. (86.7%) said it can

since when the pain begins at an odd hour one cannot sleep soundly whilst (20%)

strongly agreed to the notion.

Table 11: Patients are usually satisfied with post-operative pain management?

Response Frequency Percent

Agree 12 23.5

Disagree 22 43.1

Neutral 14 27.5

Strongly disagree 3 5.9

Total 51 100.0

Source: Field Survey, 2018

The table 11 shows how satisfactory post-operative pain management is. Out of 51

patients interviewed 12(23.5%) Agreed, 22(43.1%) Disagreed, 14(27.5%) were

Neutral and 3(5.9%) Strongly agreed. This indicates that the majority of patients are

not given adequate health delivery by nurses after surgery.

25
Table 12: What pain assessment tools do you use in assessing post-operative pain
among patients?
Response Frequency Percent
None 1 2.0
Numerical Rating scale
9 17.6
(NRS)
Patients facial
4 7.8
expression
Verbal descriptor
32 62.7
scale(VDS)
Visual analogue scale
4 7.8
(VAS)
We look at patients
1 2.0
facial expression
Total 51 100.0
Source: Field Survey, 2018

The table 12 above shows the tools used in assessing post-operative pain which

includes Numerical Rating Scale, Patients facial look, Verbal Descriptor Scale and

Visual Analogue Scale. Out 51 nurses interviewed, 32 (62.7%) being in majority used

Verbal Descriptor Scale. The study revealed Verbal Descriptor Scale (VDS) is a

major and a commonly tool which is adopted by most of the nurses for providing

health support.

26
Table 13: How often do you use pain assessment tools in assessing post-
operative pain among patients?

Responses
Frequency Percent
Always 3 5.9
Rarely 10 19.6
Never 1 2.0
Often 9 17.6
Sometimes
28 54.9

Total 51 100
Source: Field Data Survey, 2018

Among the 51 respondents interviewed, it was revealed that, respondents makes use

of tools available all the time, 1 which represents 2% have never applied such tools

before, 9 representing 17.6% says they often use it, for rarely use of these tools was

also represented by 10(19.6%) and 28 representing 54.9% said they sometimes makes

use of these tools. The details of this are shown in table 13 above.

In a working environment though some of these responses may be known, it is

advisable that, the designated tools applied on patients be used for the actual purpose.

27
Table 14:Are pain assessment tools effective in assessing pain

Response Frequency Percent

Agree 23 45.1

neutral 7 13.7

Strongly agree 19 37.3

Disagree 2 3.9

Total 51 100

Source: Field Survey, 2018

Majority (45.1%) of the respondents revealed that pain assessment tools are effective

when used in assessing pain whiles 13.7% neither agreed nor disagreed. Also, 37.3%

strongly agreed to the statement. Effective post operative pain management can be

achieved if it is well planned and delivered in a consistent and evidence based manner

and this must be based on client’s assessment of their own pain if possible. Due to the

subjective nature of pain and the many factors that cause pain, no two individuals will

experience the same pain even if they had same surgery. Healthcare professionals

need to be aware of this so that pain management can be tailored towards individual

needs (White et al, 2007)

28
Table 15:Is pain assessment tools important?

Response Frequency Percent

Extremely important 33 64.7

Minimally important 4 7.8

moderately important 14 27.5

Total 51 100.0

Source: Field Survey, 2018

According to table above 15, 64.7% confirmed that pain assessment tool is extremely

important whiles 7.8% noted minimally important and 27.5% said moderately

important.

The above explanation is a fact coming from these workers using these tools. They

know the importance and the easiness in using these tools and so the higher

percentage representing the response given shows how important and needful these

tools are.

More years of experiences nurses has been associated with more confident in the

ability to assess pain, but less use of pain assessment tools (Rose, et al, 2011).

Infact, patients are the ones suffering for their pain and what they have been through.

Usually, their descriptions about is true and the responses in the table above means it

had worked for nurses who listens to them.

29
Table 16: Do you always agree with patient’s statement about their pain?

Responses Frequency Percentages

Yes 28 54.9

No 23 45.1

Total 51 100.0

Source: Field Survey, 2018

According to table 16, 54.9 % representing 28 respondents affirmed that they agree

with patients statement about their pain before any assessment are done whiles 45.1%

begged to differ . The inability of many patients to communicate adequately with the

health professionals providing their care strikes at one of the most basic tenets of pain

control, namely the need for patient input in pain control decisions given the

subjective nature of pain (Erstad et al., 2009).

Table 17:In your opinion, who provides the accurate rating of post-operative
pain?

Response Frequency Percent

Nurse, physician and patient 1 2.0

Nurse 14 27.5

Patients 34 66.7

Physician 2 3.9

Total 51 100.0

Source: Field Survey, 2018

30
The table 18 above indicates that, mostly, the patients and the nurses are able to

provide accurate assessments and ratings on pain. For instance, the table above, shows

that 1(2.0%) said nurse, physicians and patients are able to give accurate ratings about

post operative pains, 14 represented by 27.5% said nurses are the best, 34(66.7%)

representing the highest number said patients are able to, these means that patients

knows their pain and the descriptions given by them are accurate which helps the

nurses to know which of these tools to apply on them.

Finally, 2 represented 3.9 % said it is the physicians who are able to give accurate

ratings.

Table 18:Lack of familiarity with assessment tools

Response Frequency Percent

Agree 16 31.4

Disagree 7 13.7

Neutral 5 9.8

Strongly Agree 23 45.1

Total 51 100.0

In the table above, the responses gathered on agree (16 (31.4%), disagree (7 (13.7%),

neutral (5 (9.8%) and strongly agree (23 (45.1%) revealed these information.

This means that, the majority strongly agree to the fact that, they are neither

convenient nor familiar using the assessment tools available to them.

31
Table 19: Lack of protocols for pain assessment

Response Frequency Percent

Agree 24 47.1

Disagree 2 3.9
Valid
Neutral 1 2.0

Strongly Agree 24 47.1

Total 51 100.0

Source: Field Survey, 2018

24 (47.1%) of the respondents agree that there is lack of pain assessment tools.

2(3.9%) disagree, 1(2.0%) did not give any responses on either sides. 24(47.1%)

strongly agree there are lack of protocols for pain assessment.

This means that, there is the need for protocols to be followed which at a point in time

will make the treatment of patients easier.

Table 20:Poor documentation of pain assessment and management

Response Frequency Percent

Agree 21 41.2

Disagree 4 7.8

Neutral 5 9.8

Strongly Agree 20 39.2

Strongly disagree 1 2.0

Total 51 100.0

Source: Field Survey, 2018

Infact, out of the 51 respondents interviewed, 21(41.2%) of the total population

32
agreed to the fact that there is a poor documentation of post operative assessment

methods that is to be adopted by staff. 20(39.2%) of the population strongly agreed.

However, 4 of the respondents representing 7.8% disagree, 5(9.8%) did not revealed

any grievances on the subjects.

In a nutshell, only 1 of the respondents representing 2% strongly disagreed.

This means that, though nurses are aware of the post operative methods they, the

hospital do not have any standard for them to follow to assist victims. However also,

they only work on patients using their experiences and skills they have acquired

throughout the years working as a nurse.

Table 21: Lack of education on assessment tools

Response Frequency Percent

Agree 20 39.2

Disagree 5 9.8

Neutral 2 3.9
Valid
Strongly Agree 24 47.1

Total 51 100.0

Source: Field Survey, 2018

Infact, out of the 51 respondents interviewed, 20 (39.2%) of the total population

agreed to the fact that there is a poor documentation of post operative assessment

methods that is to be adopted by staff. 24 (47.1%) of the population strongly agreed.

However, 5 of the respondents representing 9.8% disagree, 2 (3.9%) did not revealed

any grievances on the subjects.

33
The nurses have prior knowledge on most of the post operative assessment tools but

they lack the education in handling patients regarding that. This means that, though

nurses can apply other methods to patients treatments, they do not have the training to

do so.

Taylor and Stanbury (2009) also affirms in a study inadequate knowledge of pain

management principles and inadequate staff training as some of the major challenges

facing the health sector regarding pain assessment tools and methods applied on

patients.

What errors have you identified on post-operative pain assessment?

Nurses were interviewed to know some of the errors that they have come across in

their daily tasks, it was realised that, lack of analgesics for severe pains, inaccurate

rating, lack of familiarity with assessment tools, delay in administration of analgesics,

delay on the part of medical staff and negligence on the part of medical staff which

include nurses and doctors.

Respondents believes that, in resolving some of these challenges, a critical effort from

all stakeholders form the health sector is key to address some of these setbacks.

Life is mostly left in the hands of these health workers. However, their roles assigned

to them must be realised in all aspect of their dealings.

34
Based on your assessment what is your general recommendation on post-operative

pain assessment?

At this point, we have majority of the nursing making the following recommendations

and suggestions that will help rectify some of the challenges regarding post operative

assessment.

Among the many reasons give, nurses proposed a training and workshops be

organised for staff in that regard.

Also, the processes for post pain assessment must be well documented to aid nurses in

carrying out their tasks efficiently. Then also, there has to be protocols to address post

operative pain assessment.

When this is achieved, nurses would be able to provide proper health care and give

out the right prescriptions to patients during treatments.

35
 CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.0 Summary of findings

The after the analysis, there were some shocking revelations which a health sector

must take a critical look at no matter what.

Pain is an unpleasant aspect of a condition, especially with post-operative pain.

Deaths have occurred in areas where there were less attention.

These were few concerns known during the analysis.

 Majority (45.1%) of the respondents revealed that pain assessment tools are

effective when used in assessing pain whiles 13.7% neither agreed nor

disagreed. Also, 37.3% strongly agreed to the statement.

 64.7% confirmed that pain assessment tool is extremely important whiles

7.8% noted minimally important and 27.5% said moderately important.

 Infact, out of the 51 respondents interviewed, 21(41.2%) of the total

population agreed to the fact that there is a poor documentation of post

operative assessment methods that is to be adopted by staff. 20 (39.2%) of the

population strongly agreed. However, 4 of the respondents representing 7.8%

disagree, 5(9.8%) did not revealed any grievances on the subjects.

 Nurses also complained about inaccurate ratings from pain assessment tools

and lack of familiarity of tools to be applied on such patients.

36
5.1 Conclusion

Despite the growing awareness on pain management, patients still suffer from

unnecessary pain in many hospitals and this impact on their physical, emotional and

spiritual health and quality of life. Pain management is an important aspect of patient

care and nurses play a significant role in providing pain assessment and treatment.

The study revealed that, surgical clients experienced moderate to severe post

operative pain within the first 24 hours after surgery. Majority of surgical patients

were not given the opportunity to participate in decision making concerning their post

operative pain management.

In conclusion, postoperative pain relief must reflect the needs of each patient since the

final determinant of the adequacy of pain relief will be the patient’s own estimation

5.2 Recommendations

1. Pain management and control should be addressed as a public health issue and all

stakeholders in the help delivery system should come on board to help in its

management.

2. It is recommended that, all clinical staff especially nurses should encourage

surgical clients to use non-medicinal methods to complement analgesic use in their

post operative pain management. The use of non medicinal methods in pain

management and control has shown to be effective as this diverts patient’s attention

from the pain perception.

3. Surgical clients should be allowed and given the opportunity to participate in

decision making concerning their post operative pain management and this will go a

long way to help improve post operative pain management.

37
 REFERENCES

Apfelbaum, J. L., Chen, C., Mehta, S. S., & Gan, T. J. (2003). Postoperative

pain experience: Results from a national survey suggest postoperative

pain continues to be undermanaged. Anesthesia and Analgesia, 97(2),

534–540

Griffiths, R. J., & Justin, D. M. (2006). Perioperative management of pain.

Surgery, 24(10), 325-328 Hodges SC, Mijumbi C, Okello M,

McCormick BA, Walker IA, Wilson IH. Anaesthesia services in

developing countries: defining the problems. Anaesthesia 2007; 62: 4.

Pearson, & Osbom. (2010). Nursing Management of the Surgical Patient.

http.//www.bookdev. com/pearon/osbom/chapter/mis osb01023 01 SE
(25.pdf).

Rachel, E., Davis, Charles, V., Ania, H., & Alison, M. (2011). Exploring the
Care Experience of Patient undergoing Spinal Surgery: A qualitative
study: doi:10.1111/j.1365-2753.2011.01783.x.

Rhodes, L., Gail, M., & Alan, P. (2006). Patient Subjective Experience and
Satisfaction During the Perioperative Period in the Day Surgery
Setting: A systematic review. 12: 178–192.

Rosen, S., Svensson, M., & Nilsson, U. (2008). Calm or not calm. The
Question of Anxiety in the Penanesthesia Patient. journal of
periAnesthesia Nursing, 23, 237-246

Qu, S., Sherwood, G.D., McNeill, J.A., Zheng, L., 2008. Postoperative pain
management outcome in Chinese inpatients. Western Journal of
Nursing Research, 30(8), 975-990

38
 APPENDIX

QUESTIONNAIRES

This research is conducted for academic purposes and you are assured of
confidentiality and anonymity of the information you provide. Please can
you take a few minutes to complete this form? Please tick where
appropriate.

SECTION A - Bio-data of Respondent

1. Gender of respondent a. Male [ ] b. Female [ ]
2. Age of respondents. a. 20-30 [ ] b. 31-40 [ ] c. 41-50 [ ] d. 51+ [ ]
3. Educational level a. certificate [ ] b. Diploma [ ] c. Degree [ ] d. Masters [ ]
e. Doctorate [ ]
4. Marital Status: a. Married [ ] b. Single [ ] c. Divorced [ ] d. Widowed [ ]
5. What is your current job title/rank? ……………………………………………
6. How long have you been working as a nurse?
a. Less than a year [ ] b. 1-4 years [ ] c. 5-8 years [ ] d. Above 8 years [ ]
SECTION B - Pain experience of patients who undergo surgery
7. Pain can affect mood and emotions of patients

a. strongly agree b. Agree c. neutral b. disagree d. strongly disagree

8. Pain can cause nausea

a. strongly agree b. Agree c. neutral b. disagree d. strongly disagree

9. Pain can affect patients communication

a. strongly agree b. Agree c. neutral b. disagree d. strongly disagree

10. Pain can affect patients sleep pattern?

a. strongly agree b. Agree c. neutral b. disagree d. strongly disagree

11. Patients are usually satisfied with post-operative pain management?

a. strongly agree b. Agree c. neutral b. disagree d. strongly disagree

12. What pain assessment tools do you use in assessing post-operative pain among
patients?

39
 a. Visual analogue scale (VAS) b. Numerical Rating scale (NRS) c. Verbal
descriptor scale(VDS) d. Others
specify…………………………………………………..

13. How often do you use pain assessment tools in assessing post-operative pain
among patients?

a. always b. often c. sometimes d. rarely e. never

14. Are pain assessment tools effective in assessing pain?

a. strongly agree b. Agree c. neutral b. disagree d. strongly disagree

15. Is pain assessment tool important? a. Extremely important b. moderately

important

c. Minimally d. Not important

16. Do you always agree with patient’s statement about their pain? a. Yes b.
No.

17. In your opinion, who provides the accurate rating of post-operative pain?
a. Physician b. Nurse c. Patients d. Relatives e. other
(Please specify)………………………………………………………….

SECTION C - Challenges contributing to quality of postoperative pain

assessment

Options Strongly Agree Neutral Disagree Strongly

Agree Disagree
18. Lack of familiarity with
assessment tools

19. Lack of protocols for pain

assessment

20. Poor documentation of pain

assessment and management

21. Lack of education on assessment

tools

22. What errors have you identified on post-operative pain assessment?

40
…………………………………………………………………………………………
………
23. Based on your assessment what is your general recommendation on post-
operative pain assessment?

…………………………………………………………………………………………
………

41
42