Understanding Nurse Characteristics that Influence Assessment and Intention to Treat Pain in Postoperative Patients: An Integrative Literature Review

Published:April 14, 2022DOI:



      An understanding of nurse characteristics that influence pain management, which are potentially amenable to change, can help to refine and improve nurse education and practice, resulting in better patient outcomes. The purpose of this review was to identify nurse characteristics that influence their assessment of and intention to treat postoperative pain.


      Integrative literature review.

      Data sources

      A systematic search of electronic databases (CINAHL, Scopus, PsycINFO, Medline, and Embase), using these constructs “pain assessment”, “pain management”, “postoperative pain”, “nurses”, “cultural beliefs” and “nurses’ perceptions” was conducted for the period 2000 to October 2020.

      Review/Analysis methods

      Following a systematic screening process, the included articles were analyzed and synthesized to identify themes and subthemes.


      A total of 40 articles were included with three main themes identified: nurse knowledge; nurse sociocultural factors, personal beliefs and attitudes, and other characteristics; and believing or doubting the patient. There was evidence that targeted education interventions can improve nurse knowledge and nurses’ clinical practice in relation to pain management. What was less clear was which nurse attitudes and biases influenced their pain management practice or how these could be changed.


      More studies are needed to investigate the influence of cultural characteristics on pain assessment and management. There is a need for further quantitative studies that explore the relationship between nurse characteristics and their pain management practice. Intervention studies using innovative educational approaches that change attitudes and biases, and improve practice are needed.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Pain Management Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Abdalrahim M.S.
        • Majali S.A.
        • Stomberg M.W.
        • Bergbom I.
        The effect of postoperative pain management program on improving nurses’ knowledge and attitudes toward pain.
        Nurse Education in Practice. 2011; 11: 250-255
        • Al Khalaileh M.
        • Al Qadire M.
        Pain management in Jordan: Nursing students’ knowledge and attitude.
        British Journal of Nursing. 2013; 22: 1234-1240
        • Australian Pain Society (APS)
        Position papers: APS guiding principles for pain management.
        Retrieved Month 02, 2022. 2017; (XXXX, from)
        • Bach A.M.
        • Foreman A.
        • Seibaek L.
        Postoperative pain management: A bedside perspective.
        Pain Management Nursing. 2018; 19: 608-618
        • Baker D.W.
        The Joint Commission’s pain standards: Origin and evolution.
        Oakbrook Terrace, IL. The Joint Commission. 2017; (2017. Retrieved Month 02, 2022 from)
        • Bautista C.
        • Amatangelo M.P.
        • Baby P.
        • Cassier-Woidasky A.K.
        • Dycus K.
        • Edoh E.I.
        • Green T.
        • Ilano K.C.S.
        • Kemboi M.
        • Littlejohns L.
        • Martinez R.C.K.P.
        • Mastamet G.
        • Perera A.
        • Ramazanu S.
        • Ribiero R.M.
        • Serondo D.J.F.
        • Sila F.
        • Strayer A.
        • Soriano G.P.
        • Wessol J.L.
        Cultural perspectives on pain assessment and opioid use: International Neuroscience Nursing Research Symposium Conference Proceedings.
        Journal of Neuroscience Nursing. 2021; 53: 149-156
        • Becker W.
        • Dorflinger L.
        • Edmond S.N.
        • Islam L.
        • Heapy A.A.
        • Fraenkel L.
        Barriers and facilitators to use of non-pharmacological treatments in chronic pain.
        BMC Family Practice. 2017; 18: 41
        • Bonkowski S.L.
        • De Gagne J.C.
        • Cade M.B.
        • Bulla S.A.
        Evaluation of a pain management education program and operational guideline on nursing practice, attitudes, and pain management.
        Journal of Continuing Education in Nursing. 2018; 49: 178-185
        • Brennan F.
        • Carr D.
        • Cousins M.
        Access to pain management-Still very much a human right.
        Pain Medicine. 2016; 17: 1785-1789
        • Briggs E.V.
        • Carr E.C.J.
        • Whittaker M.S.
        Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom.
        European Journal of Pain. 2011; 15: 789-795
        • Brown D.
        • McCormack B.
        Determining factors that have an impact upon effective evidence-based pain management with older people, following colorectal surgery: An ethnographic study.
        Journal of Clinical Nursing. 2006; 15: 1287-1298
        • Buvanendran A.
        • Fiala J.
        • Patel K.A.
        • Golden A.D.
        • Moric M.
        • Kroin J.S.
        The incidence and severity of postoperative pain following inpatient surgery.
        Pain Medicine. 2015; 16: 2277-2283
        • Cano Romero M.D.
        • Muñoz Sastre M.T.
        • Quintard B.
        • Sorum P.C.
        • Mullet E.
        The ethics of postoperative pain management: Mapping nurses' views.
        International Journal of Nursing Practice. 2017; 23
        • Carlson C.L.
        Prior conditions influencing nurses’ decisions to adopt evidence-based postoperative pain assessment practices.
        Pain Management Nursing. 2010; 11: 245-258
        • Chatchumni M.
        • Namvongprom A.
        • Eriksson H.
        • Mazaheri M.
        Thai nurses’ experiences of post-operative pain assessment and its’ influence on pain management decisions.
        BMC Nursing. 2016; 15: 1-8
        • Chatchumni M.
        • Namvongprom A.
        • Eriksson H.
        • Mazaheri M.
        Treating without seeing: Pain management practice in a Thai context.
        Pain Research and Management. 2016; (2016)9580626
        • Chou R.
        • Gordon D.B.
        • de Leon-Casasola O.A.
        • Rosenberg J.M.
        • Bickler S.
        • Brennan T.
        • Carter T.
        • Cassidy C.L.
        • Chittenden E.H.
        • Degenhardt E.
        • Griffith S.
        • Manworren R.
        • McCarberg B.
        • Montgomery R.
        • Murphy J.
        • Perkal M.F.
        • Suresh S.
        • Sluka K.
        • Strassels S.
        • Wu C.L.
        Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council.
        Journal of Pain. 2016; 17: 131-157
        • Cousins M.
        • Lane-Krebs K.
        • Johnston-Devin C.
        Student nurses’ pain knowledge and attitudes toward pain management over the last 20 years: A systematic review.
        Nurse Education Today. 2022; 108105169
        • Cui C.
        • Wang L.X.
        • Li Q.
        • Zaslansky R.
        • Li L.
        Implementing a pain management nursing protocol for orthopaedic surgical patients: Results from a PAINOUT project.
        Journal of Clinical Nursing. 2018; 27: 1684-1691
        • Drew D.
        • Gordon D.B.
        • Morgan B.
        • Manworren R.C.B.
        As needed” range orders for opioid analgesics in the management of pain: A consensus statement of the American Society for Pain Management Nursing and the American Pain Society.
        Pain Management Nursing. 2018; 19: 207-210
        • Duncan K.
        • Pozehl B.
        Effects of performance feedback on patient pain outcomes.
        Clinical Nursing Research. 2000; 9: 379-397
        • Duncan K.
        • Pozehl B.
        Effects of individual performance feedback on nurses’ adherence to pain management clinical guidelines.
        Outcomes Management for Nursing Practice. 2001; 5: 57-62
        • Edwards H.E.
        • Nash R.E.
        • Yates P.M.
        • Walsh A.M.
        • Fentiman B.J.
        • McDowell J.K.
        • Skerman H.M.
        • Najman J.M.
        Improving pain management by nurses: A pilot peer intervention program.
        Nursing & Health Sciences. 2001; 3: 35-45
        • Ene K.W.
        • Nordberg G.
        • Bergh I.
        • Johansson F.G.
        • Sjöström B.
        Postoperative pain management - the influence of surgical ward nurses.
        Journal of Clinical Nursing. 2008; 17: 2042-2050
        • Gan T.J.
        Poorly controlled postoperative pain: prevalence, consequences, and prevention.
        Journal of Pain Research. 2017; 10: 2287-2298
        • Gerbershagen H.J.
        • Aduckathil S.
        • van Wijck A.J.
        • Peelen L.M.
        • Kalkman C.J.
        • Meissner W.
        Pain intensity on the first day after surgery: A prospective cohort study comparing 179 surgical procedures.
        Anesthesiology. 2013; 118: 934-944
        • Green C.R.
        • Anderson K.O.
        • Baker T.A.
        • Campbell L.C.
        • Decker S.
        • Fillingim R.B.
        • Kalauokalani D.A.
        • Lasch K.E.
        • Myers C.
        • Tait R.C.
        • Todd K.H.
        • Vallerand A.H.
        The unequal burden of pain: Confronting racial and ethnic disparities in pain.
        Pain Medicine. 2003; 4: 277-294
        • Harper P.
        • Ersser S.
        • Gobbi M.
        How military nurses rationalize their postoperative pain assessment decisions.
        Journal of Advanced Nursing. 2007; 59: 601-611
      1. Carr, D. B., & Morlion, B. (2017). What the public should know about pain after surgery. International Association for the Study of Pain. Retrieved Month 11, 2021, from

      2. Hinther, A., Nakoneshny, S. C., Chandarana, S. P., Matthews, T. W., & Dort, J. C. (2018). Efficacy of postoperative pain management in head and neck cancer patients. Journal of Otolaryngology – Head & Neck Surgery, 47(1), 29.

        • Hirsh A.T.
        • George S.Z.
        • Robinson M.E.
        Pain assessment and treatment disparities: A virtual human technology investigation.
        Pain. 2009; 143: 106-113
        • Horbury C.
        • Henderson A.
        • Bromley B.
        Influences of patient behaviour on clinical nurses’ pain assessment: Implications for continuing education.
        Journal of Continuing Education in Nursing. 2005; 36 (quiz 46-47): 18-24
        • Ibeneme S.
        • Eni G.
        • Ezuma A.
        • Fortwengel G.
        Roads to health in developing countries: Understanding the intersection of culture and healing.
        Current Therapeutic Research. 2017; 86: 13-18
        • International Association for the Study of Pain (IASP)
        (n.d.). Task force on wait-times: Summary and recommendations.
        Retrieved Month 02, 2022. 2022; (from)
        • Jang J.H.
        • Park W.H.
        • Kim H.
        • Chang S.O.
        Ways of reasoning used by nurses in postoperative pain assessment.
        Pain Management Nursing. 2020; 2 (1): 379-385
        • Kaki A.M.
        • Daghistani M.F.
        • Msabeh A.A.
        Nurses' knowledge of pharmacological measures on acute pain management in Western Saudi Arabia.
        Saudi Medical Journal. 2009; 30: 279-283
        • Kidanemariam B.Y.
        • Elsholz T.
        • Simel L.L.
        • Tesfamariam E.H.
        • Andemeskel Y.M.
        Utilization of non-pharmacological methods and the perceived barriers for adult postoperative pain management by the nurses at selected National Hospitals in Asmara, Eritrea.
        BMC Nursing. 2020; 19: 100
        • Kim H.S.
        • Schwartz-Barcott D.
        • Tracy S.M.
        • Fortin J.D.
        • Sjöström B.
        Strategies of pain assessment used by nurses on surgical units.
        Pain Management Nursing. 2005; 6: 3-9
        • Klopper H.
        • Andersson H.
        • Minkkinen H.
        • Ohlsson C.
        • Sjöström B.
        Strategies in assessing postoperative pain – a South African study.
        Intensive and Critical Care Nursing. 2006; 22: 12-21
        • Lasch K.E.
        Culture, pain, and culturally sensitive pain care.
        Pain Management Nursing. 2000; 1 (Suppl 1): 16-22
        • Leininger M.
        Culture care theory: A major contribution to advance transcultural nursing knowledge and practices.
        Journal of Transcultural Nursing. 2002; 13: 189-201
        • Mackintosh-Franklin C.
        Registered nurses' personal responses to postoperative pain: A descriptive qualitative study.
        Pain Management Nursing. 2014; 15: 580-587
        • Manias E.
        Pain and anxiety management in the postoperative gastro-surgical setting.
        Journal of Advanced Nursing. 2003; 41: 585-594
        • Manias E.
        • Botti M.
        • Bucknall T.
        Observation of pain assessment and management – the complexities of clinical practice.
        Journal of Clinical Nursing. 2002; 11: 724-733
        • Maunsaiyat P.
        • Akavipat P.
        • Phonsayom N.
        Evaluation of acute postoperative pain monitoring program for nurses in Thailand.
        Saudi Medical Journal. 2009; 30: 1323-1327
        • McCaffery M.
        Nursing practice theories related to cognition, bodily pain, and man-environment interactions.
        University of California Students’ Store, Los Angeles1968
        • McCaffery M.
        • Ferrell B.R.
        • Pasero C.
        Nurses' personal opinions about patients' pain and their effect on recorded assessments and titration of opioid doses.
        Pain Management Nursing. 2000; 1: 79-87
      3. Joanna Briggs Institute (JBI). (2020). Critical appraisal tools. Retrieved Month 11, 2020, from

      4. Miró, J., Castarlenas, E., Solé, E., Martí, L., Salvat, I., & Reinoso-Barbero, F. (2019). Pain curricular across healthcare professions undergraduate degrees: A cross-sectional study in Catalonia, Spain. BMC Medical Education, 19(1), 307.

        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.
        BMJ. 2009; 339: b2535
        • Pasero C.
        • Quinlan-Colwell A.
        • Rae D.
        • Broglio K.
        • Drew D.
        American Society for Pain Management Nursing Position Statement: Prescribing and administering opioid doses based solely on pain intensity.
        Pain Management Nursing. 2016; 17: 170-180
        • Puls-McColl P.J.
        • Holden J.E.
        • Buschmann M.T.
        Pain management: An assessment of surgical nurses' knowledge.
        MEDSURG Nursing. 2001; 10: 185-191
        • Ravaud P.
        • Keïta H.
        • Porcher R.
        • Durand-Stocco C.
        • Desmonts J.M.
        • Mantz J.
        Randomized clinical trial to assess the effects of an educational programme designed to improve nurses’ assessment and recording of postoperative pain.
        British Journal of Surgery. 2004; 91: 692-698
        • Richards J.
        • Hubbert A.O.
        Experiences of expert nurses in caring for patients with postoperative pain.
        Pain Management Nursing. 2007; 8: 17-24
        • Schafheutle E.I.
        • Cantrill J.A.
        • Noyce P.R.
        Why is pain management suboptimal on surgical wards?.
        Journal of Advanced Nursing. 2001; 33: 728-737
        • Schardt C.
        • Adams M.B.
        • Owens T.
        • Keitz S.
        • Fontelo P.
        Utilization of the PICO framework to improve searching PubMed for clinical questions.
        BMC Medical Informatics and Decision Making. 2007; 7: 16
        • Scher C.
        • Meador L.
        • Van Cleave J.H.
        • Reid M.C.
        Moving beyond Pain as the Fifth Vital Sign and patient satisfaction scores to improve pain care in the 21st century.
        Pain Management Nursing. 2018; 19: 124-129
        • Schiavenato M.
        • Craig K.D.
        Pain assessment as a social transaction: Beyond the ‘‘gold standard.
        Clinical Journal of Pain. 2010; 26: 667-676
        • Schreiber J.A.
        • Cantrell D.
        • Moe K.A.
        • Hench J.
        • McKinney E.
        • Lewis C.P.
        • Weir A.
        • Brockopp D.
        Improving knowledge, assessment, and attitudes related to pain management: Evaluation of an intervention.
        Pain Management Nursing. 2014; 15: 474-481
        • Schug S.A.
        • Palmer G.M.
        • Scott D.A.
        • Alcock M.
        • Halliwell R.
        • Mott J.F.
        Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine.
        Acute Pain Management: Scientific Evidence. 5th edition. ANZCA & FPM, Melbourne, 2020 (Retrieved Month 02, 2021, from
        • Shoqirat N.
        We are nurses, they are doctors': Barriers to nurses' roles in pain management following surgery in Jordan.
        International Journal of Nursing Practice. 2015; 21: 200-206
        • Shoqirat N.
        • Mahasneh D.
        • Dardas L.
        • Singh C.
        • Khresheh R.
        Nursing documentation of postoperative pain management: A documentary analysis.
        Journal of Nursing Care Quality. 2018; 34: 279-284
        • Shoqirat N.
        • Mahasneh D.
        • Al-Khawaldeh O.
        • Al Hadid L.
        Nurses' knowledge, attitudes, and barriers toward pain management among postoperative patients in Jordan.
        Journal of Perianesthesia Nursing. 2019; 34: 359-367
        • Shoqirat N.
        • Mahasneh D.
        • Al-Khawaldeh O.
        • Singh C.
        Using opioids with surgical patients: Nurses' attitudes and experiences.
        Journal of Trauma Nursing. 2019; 26: 26-32
        • Shoqirat N.
        • Mahasneh D.
        • Singh C.
        • Al Hadid L.
        Do surgical patients' characteristics and behaviours affect nurses' pain management decisions? A qualitative inquiry.
        International Journal of Nursing Practice. 2019; 25: e12779
        • Sloman R.
        • Rosen G.
        • Rom M.
        • Shir Y.
        Nurses' assessment of pain in surgical patients.
        Journal of Advanced Nursing. 2005; 52: 125-132
        • Stonski E.
        • Weissbrod D.
        • Vicens J.
        • Giunta D.H.
        • Liarte D.
        • Agejas R.J.
        • Lupi S.M.
        • Ondjian I.A.
        • Russi J.
        • González Bernaldo-De-Quiros F.
        • Darío-Waisman G.B.
        • María Verónica B.
        • Bruno R.
        • Camera L.A
        Prevalencia de dolor en la internación en un hospital de alta complejidad de Argentina [Prevalence of pain among patients admitted to a clinical hospital].
        Revista médica de Chile. 2019; 147: 997-1004
        • Tapp J.
        • Kropp D.
        Evaluating pain management delivered by direct care nurses.
        Journal of Nursing Care Quality. 2005; 20: 167-173
        • Tomaszek L.
        • Dębska G.
        Knowledge, compliance with good clinical practices and barriers to effective control of postoperative pain among nurses from hospitals with and without a “Hospital without Pain” certificate.
        Journal of Clinical Nursing. 2018; 27: 1641-1652
        • Watt-Watson J.
        • Garfinkel R.
        • Gallop P.
        • Stevens B.
        • Streiner D.
        The impact of nurses' empathic responses on patients' pain management in acute care.
        Nursing Research. 2000; 49: 191-200
        • Watt-Watson J.
        • Stevens B.
        • Garfinkel P.
        • Streiner D.
        • Gallop R.
        Relationship between nurses' pain knowledge and pain management outcomes for their postoperative cardiac patients.
        Journal of Advanced Nursing. 2001; 36: 535-545
        • Whittemore R.
        • Knafl K.
        The integrative review: Updated methodology.
        Journal of Advanced Nursing. 2005; 52: 546-553
        • Wooldridge S.
        • Branney J.
        Congruence between nurses' and patients' assessment of postoperative pain: A literature review.
        British Journal of Nursing. 2020; 29: 212-220
        • Wu C.-L.
        • Hung Y.-L.
        • Wang Y.-R.
        • Huang H.-M.
        • Chang C.-H.
        • Wu C.-C.
        • Hung C.-J.
        • Yeh T.-F.
        Pain prevalence in hospitalized patients at a tertiary academic medical center: Exploring severe persistent pain.
        PLoS One. 2020; 15e0243574
        • Youngcharoen P.
        • Vincent C.
        • Park C.G.
        • Corte C.
        • Eisenstein A.R.
        • Wilkie D.J.
        Nurses' pain management for hospitalized elderly patients with postoperative pain.
        Western Journal of Nursing Research. 2016; 38: 1409-1432