Nurses’ Knowledge and Practices Regarding Pain Assessment in Non-Verbal Critically Ill Patients
TL;DR
Most nurses demonstrated suboptimal pain-assessment practices, despite moderate overall knowledge, and regular competency-based training and consistent availability of standardized behavioural assessment tools may improve pain assessment in non-verbal critically ill patients.
Abstract
Accurate pain assessment in non-verbal critically ill patients is essential for appropriate pain management. Nurses’ knowledge, training and access to validated behavioural pain-assessment tools may influence routine assessment practices. Objective: To assess nurses’ knowledge and practices regarding pain assessment in non-verbal critically ill patients and identify factors associated with good pain-assessment practice. Methods: A multicentre descriptive correlational cross-sectional study was conducted from December 2025 to May 2026 among 165 registered nurses working in adult critical-care units at Mayo Hospital Lahore and WAPDA Teaching Hospital Complex, Lahore. Participants were selected through proportionate stratified random sampling. Data were collected using a structured questionnaire comprising demographic characteristics, 20 knowledge items, 15 practice items and 10 perceived barriers. Descriptive statistics, correlation tests and multivariable binary logistic regression were applied using SPSS version 29. Results: The mean age of participants was 32.08 ± 6.45 years, and 124 (75.2%) were female. Formal pain-assessment training was reported by 69 (41.8%) nurses, while CPOT or BPS was available to 78 (47.3%). The mean knowledge score was 13.96 ± 2.53 out of 20, with 75 (45.5%) nurses demonstrating good knowledge. The mean practice score was 54.45 ± 6.83 out of 75, and only 64 (38.8%) demonstrated good practice. Knowledge and practice scores showed a moderate positive correlation (ρ=0.495, p<0.001). Knowledge score (aOR=1.41; 95% CI: 1.18–1.67), previous training (aOR=2.40; 95% CI: 1.14–5.05) and availability of CPOT/BPS (aOR=2.34; 95% CI: 1.11–4.94) independently predicted good practice. High workload, competing emergencies and unavailable assessment forms were the leading barriers. Conclusion: Most nurses demonstrated suboptimal pain-assessment practices, despite moderate overall knowledge. Regular competency-based training and consistent availability of standardized behavioural assessment tools may improve pain assessment in non-verbal critically ill patients.