Nurses’ Knowledge and Practices of Pain Management in End-of-Life Care: A Qualitative Study in Ghana

Abstract

Background: Effective pain management is central to end-of-life (EOL) care, yet patients in low- and middle-income countries often experience preventable suffering. Nurses, as frontline providers, play a pivotal role in pain control; however, there is a paucity of Ghanaian qualitative evidence exploring nurses’ knowledge and practices regarding EOL pain management. Aim: To explore nurses’ knowledge and practices of pain management in EOL care. Methods: An exploratory descriptive qualitative study was conducted at the Komfo Anokye Teaching Hospital, a tertiary hospital in Ghana. Sixteen registered nurses were recruited using purposive sampling. Data was collected through semi-structured, in-depth interviews conducted until data saturation was achieved. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically following Braun and Clarke’s framework. Data analysis was conducted manually through iterative coding and theme development. Results: Two major themes emerged: nurses’ understanding of pain, and their pain management practices. Most nurses conceptualized pain in biomedical terms, though some acknowledged psychological and emotional dimensions. While familiar with standardized assessment tools, nurses often relied on patient self-report and observational cues. Pharmacological interventions, particularly opioids such as morphine, were commonly used but constrained by availability and cost. Non-pharmacological strategies, including repositioning, conversation, and music, were applied to complement pharmacological care. Conclusion: Nurses demonstrated awareness of the multidimensional nature of pain, but inconsistencies in assessment and systemic barriers limit effective EOL care. Strengthening palliative care education, institutional pain management protocols, and national policies to improve opioid accessibility is critical to enhancing nursing practice and improving quality of life for patients at the end of life.