Date of Award

10-13-2025

Degree Type

Thesis

Degree Name

MSc in Nursing

Department

School of Nursing and Midwifery, Pakistan

Abstract

Background: Terminally ill patients in Pakistan, especially those receiving care in home health settings, often experience unmanaged pain due to substantial gaps in nurses' knowledge and attitudes towards pain management in end-of-life care (EOLC). Limited understanding of opioid pharmacology, inadequate methods of pain assessment, and widespread opioidophobia contribute to the reduced quality of pain treatment and dying. Although the World Health Organisation (WHO) emphasises the importance of continuing education for palliative care providers, there is a lack of local, evidence-based educational initiatives to adequately prepare home health nurses for effective pain management in EOLC in Pakistan.
Purpose: This study aimed to evaluate the effectiveness of a structured educational intervention in improving nurses’ knowledge and attitudes regarding pain management in EOLC at a tertiary care hospital in Karachi, Pakistan.
Method: A quasi-experimental one-group pretest–posttest design was employed involving 85 Registered Nurses from the Home Health Services department of The Aga Khan University Hospital. The Knowledge and Attitudes Survey Regarding Pain (KASRP) was administered immediately before the commencement of a four-hour educational programme titled “EvidenceBased Pain Management in End-of-Life Care.” The same nurses completed the post-test two weeks after the session. Descriptive statistics were used to summarise demographic characteristics and KASRP scores, while a paired-samples t-test was conducted to determine statistical significance (p < 0.05). Ethical approval was obtained from the institutional review committee, and informed consent was secured from all participants.
Findings: The pre-intervention mean KASRP score was 13.84 ± 3.15 (40.7% correct), indicating poor knowledge and attitudes towards pain management. Following the educational intervention, the mean score increased to 30.62 ± 1.26 (90.1% correct), with all participants achieving a good performance level. Significant improvements were observed across all domains, including the Foundational Principles of Pain Assessment, Pharmacological Principles of Pain Management, and Principles of Substance Use and Regulation. The paired t-test confirmed a statistically significant increase in overall scores, t(84) = –48.31, p < .001, demonstrating a large effect size (Cohen’s d = 5.23).
Conclusion: The educational intervention significantly increased nurses' knowledge and attitudes towards pain management in EOLC. Incorporating structured, evidence-based training into nursing curricula and ongoing professional development can help fill current knowledge gaps, eliminate opiophobia, and promote dignified, pain-free end-of-life care for patients.

First Page

1

Last Page

141

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