Pain Management Strategies to Enhance Patients’ Satisfaction Post Abdominal Surgeries in Selected Federal Teaching Hospitals, South-West Nigeria
Rotimi Williams Dada, Nwaomah EE, Grace Orunmuyiwa, Bello Q, Abiodun Titilayo, Opaleye TE, Sola Omitogun, Ayokunnumi Dada,
Department of Adult Health/ Medical-surgical Nursing , Babcock University, Ilishan Remo, Ogun State , Lagos, Lagos State, Nigeria
Correspondence: Dada, Rotimi W.
1Department of Adult Health/ Medical surgical Nursing, BU, Ilishan Remo, Ogun StateNigeria
Background:
Patient’s satisfaction is a measure of the quality of care after postoperative pain management. Abdominal surgery is one of the major operations frequently carried out in teaching hospitals in Nigeria. Studies have shown that surgical patients in Nigeria experience extended hospital stays, delayed recovery, and increased postoperative complications as a result of inadequate pain management. Despite the frequency of the abdominal surgeries performed, there is limited data on optimal pain management strategies to enhance patients’ satisfaction. Furthermore, many patients in the federal teaching hospitals in South-West, Nigeria continue to express dissatisfaction post-surgery.
Objective: This study investigated the pain management strategies to enhance patients’ satisfaction post abdominal surgery in selected federal teaching hospitals in South-West, Nigeria.
Methods: The study was conducted using a qualitative method. Twelve abdominal surgical patients were purposively selected for the qualitative phase guided by data saturation. An interview guide was used in conducting semi-structured interviews. The obtained data were thematically analysed.
Results: The findings revealed six themes: Patients’ experiences with abdominal surgical pains, satisfaction with methods used, factors promoting coping mechanisms, fear of drugs’ adverse effects, strategies used in managing pain and suggestions for effective pain management.
Conclusion: This study highlights the importance of multimodal pain management in enhancing patient satisfaction after abdominal surgery in South-West Nigeria. Findings reveal that combining pharmacologic and non-pharmacologic strategies improves pain relief and recovery. To enhance care, hospitals should implement policies supporting integrated pain management, provide continuous staff training, educate patients on pain relief options, and establish monitoring systems for patient feedback. A multidisciplinary approach involving surgeons, anesthetists, and nurses is essential. These measures will improve postoperative outcomes, reduce complications, and enhance patient satisfaction, ultimately leading to better healthcare delivery in federal teaching hospitals.
Keywords: Pain management Strategies, Patient satisfaction, Abdominal surgery, Teaching Hospitals
Abdominal surgery encompasses various procedures within the abdominal cavity, targeting conditions like appendicitis, hernias, and cancers to improve organ function by removing obstructions. It serves both diagnostic and therapeutic purposes (5). Postoperative pain is a universal issue that affects recovery, patient satisfaction, and overall healthcare quality. Effective pain management alleviates discomfort, enhances psychological well-being, and expedites recovery, making it a critical focus in surgical care (22).
Globally, effective post-abdominal surgery pain management emphasizes a multidisciplinary approach, pre-operative education, individualized plans, and advanced techniques like multimodal analgesia. Despite advances like laparoscopy, challenges persist, including access to skilled surgeons and resources (21, 11). Factors influencing pain include demographics, surgery type, and pain tolerance. Patient satisfaction extends beyond pain relief to include healthcare quality, decision-making involvement, and support services (23)
In Africa, pain management is influenced by resource availability, staff expertise, and cultural attitudes. Multimodal analgesia and tailored strategies are critical for addressing socioeconomic and cultural contexts (12, 13, 14, 22). Technological innovations like wearable devices are enhancing personalized pain management (6). In Nigeria, pain management is hindered by resource constraints, limited training, and reliance on outdated methods, resulting in significant postoperative pain (4). Challenges include inadequate analgesia, inconsistent protocols, and underreporting of pain due to cultural and communication barriers (18, 17).
Efforts to improve pain management in Nigeria highlight the importance of combining pharmacological and non-pharmacological methods with patient-centered care (15, 16, 19,). However, the lack of standardized protocols and modern techniques underscores the need for systematic and patient-centered approaches to improve satisfaction and outcomes (2, 3). Multimodal analgesia, patient-controlled analgesia, and regional anesthesia are proven strategies but are underutilized in sub-Saharan Africa. (1, 9).
Kolcaba’s Theory of Comfort frames this research, emphasizing relief from physical, psychological, and environmental discomforts (10, 7). This study seeks to investigate the pain management strategies to enhance patients’ satisfaction post abdominal surgery in selected federal teaching hospitals in South-West, Nigeria.
Study Setting
The research was conducted in clinical settings within selected Federal Teaching Hospitals in the southwest geopolitical zone of Nigeria, which includes Lagos, Ogun, Oyo, Osun, Ekiti, and Ondo states. However, only Lagos, Oyo, and Osun have Federal Teaching Hospitals. This region is characterized by a mix of urban and semi-urban populations and houses several tertiary healthcare institutions offering advanced medical services, including surgeries and pain management. Federal Teaching Hospitals were chosen strategically as they are tertiary facilities with specialized units like surgical and pain management departments, serving as referral centers for complex cases and providing diverse surgical interventions. They also play a critical role in training healthcare professionals and conducting research, making them suitable for implementing and evaluating pain management strategies. Two hospitals were randomly selected for the study: Lagos University Teaching Hospital (LUTH) in Lagos State and Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) in Osun State. Both institutions are renowned for their expertise, high patient turnover, advanced medical facilities, and established protocols for abdominal surgeries. The study aimed to develop pain management strategies to enhance client satisfaction post-abdominal surgery in the surgical wards of these hospitals.
Study Design and population
This was a descriptive qualitative method approach. The study population were adult patients who had undergone abdominal surgery in selected Federal Teaching Hospitals (LUTH and OAUTHC) in Southwest Nigeria.
Inclusion/ Exclusion criteria
Eligible participants are adults (18+), treated at LUTH or OAUTHC, reporting pain 6 hours to one week post-abdominal surgery, and capable of detailed feedback. Excluded are those with chronic pain, ICU/PACU stays, outpatient surgeries, advanced techniques, cognitive/language issues, or who decline consent. Immediate postoperative patients are also excluded.
Sample size determination
The sample size for the study included interviews with 12 participants, conducted until data saturation was reached—when no new information emerged from additional interviews.
Sampling Technique
A purposive sampling technique was employed to gather in-depth insights from individual patients based on their experiences with pain management following abdominal surgery during the study period.
Research tools and data collection techniques
A semi-structured interview guide was employed for data collection, allowing the researcher to utilize a prepared set of questions while accommodating natural conversation and probing questions based on participant responses. This approach facilitates both depth and breadth in data collection, enabling exploration of participants’ detailed experiences and perceptions.
Validity and Reliability in Quantitative Research
Prior to the final data collection, the interview guide underwent pretesting with five patients who had undergone abdominal surgery but were excluded from the main study. This process facilitated the identification and revision of unclear or ambiguous items based on participant feedback. Moreover, experts in pain management and the research supervisor rigorously reviewed the guide to enhance its credibility, transferability, dependability, and confirmability in achieving the study objectives.
Method of Data Collection
In this study, data collection was carefully timed to ensure participants were in optimal condition to provide accurate and coherent accounts of their pain management experiences. Interviews were conducted once patients had fully recovered consciousness and regained the capacity for effective communication. This timing was crucial to capture immediate and relevant insights into their initial pain management experiences. Each interview commenced with an explanation of the study’s purpose, followed by obtaining informed consent from respondents. The interviews were facilitated by the principal investigator and trained research assistants, all of whom were registered nurses with a Bachelor of Nursing Science (BNSc) degree, and were conducted in the surgical wards of the participating institutions. Detailed notes were taken during and after the interviews to document non-verbal cues and initial impressions. Interviews continued until data saturation was achieved, defined as the point at which no new themes or information emerged.
Audio recordings of the interviews were transcribed verbatim to ensure data accuracy. The transcripts were thoroughly reviewed and cross-checked against the recordings to identify and correct any errors, ensuring the reliability and comprehensiveness of the data.
Method of Data Analysis
The researcher conducted a thematic analysis of qualitative data using ATLAS.ti (version 24). Data preparation involved importing interview transcripts and notes into the software, followed by immersion in the data to identify emerging concepts and patterns. Systematic coding was performed through deductive coding, guided by research questions, and inductive coding derived from the data. ATLAS.ti facilitated theme identification by clustering related codes into preliminary patterns, which were refined to capture the data’s complexity. Themes were clearly defined and supported by participant quotations for validity.
A total of 12 patients participated in the semi-structured interviews, with ages ranging from 26 to 48 years and a mean age of 37 ± 7 years. The majority were married, with diverse occupations: 7 public servants, 4 traders, and 1 artisan. This socio-demographic diversity was essential for exploring the influence of socio-demographic factors on pain management and patient satisfaction with pain relief.
Table 4.1: Socio-Demographic data of the Participants in the Study
| Respondents | Age | Gender
s |
Marital
status |
Education | Occupation | Monthly
Income (₦) |
Institution |
| Participant 1 | 39 | F | Married | BSc | Clerical Officer | 90,000.00 | LUTH |
| Participant 2 | 48 | F | Married | SSCE | Cleaner | 27,000.00 | LUTH |
| Participant 3 | 38 | F | Divorce | SSCE | Caterer | 25,000.00 above | OAUTHC |
| Participant 4 | 41 | F | Single | SSCE | Fashion Designer | 30,000 | OAUTHC |
| Participant 5 | 39 | F | Married | BSc | Business | 50,000.00 above | LUTH |
| Participant 6 | 35 | M | Divorcee | ND | Civil Servant | 100,000.00 | OAUTHC |
| Participant 7 | 26 | M | Married | HND | Civil Servant | 105,000.00 | OAUTHC |
| Participant 8 | 38 | M | Married | BSc | Business | 80,000.00 | LUTH |
| Participant 9 | 38 | M | Married | SSCE | Clerck | 50,000.00 | LUTH |
| Participant 10 | 32 | F | Married | BSc | Business | 70,000.00 | LUTH |
| Participant 11 | 32 | M | Married | OND | Civil Servant | 60,000.00 | OAUTHC |
| Participant 12 | 46 | M | Married | SSCE | Business | 110,000.00 | LUTH |
The results were systematically organized and presented according to themes and subthemes derived from participants’ responses. The key themes included.
Below is the expression of their experiences:
Patient experiences with abdominal surgical pain
Participants described their pain experiences as severe and unbearable. A female respondent shared, “The experience was bad because of the pain… I take my drugs to feel better, but the pain still remains, not relieved.” Similarly, a male respondent remarked, “I was told there would be pain after surgery, but I never expected it to be unbearable upon waking.” Another participant stated, “I know pain medications like ibuprofen and distractions help, but the pain was too intense to focus on anything, like watching television.” These narratives highlight the overwhelming nature of postoperative pain despite medication use
Factors promoting coping mechanisms
Participants perceived gender, ethnicity, age, and individual differences as key factors influencing pain tolerance. A male respondent noted, “Age and gender could be a factor,” while another claimed, “Men withstand pain more than women.” Others emphasized personal variations in pain perception, with one stating, “People have different ways of bearing pain; our bodies are not the same.” Cultural background was also cited, with participants suggesting that individuals from northern Nigeria, such as Fulanis and Hausas, tend to exhibit higher pain tolerance. Additionally, participants linked pain endurance to surgery extent, with a female respondent remarking on the severity of postoperative pain despite being informed about it.
Fear of adverse drug side effect
Respondents expressed concerns about the adverse effects of drugs, influencing their approach to pain management. . Male ‘respondent’ 1 acknowledged the effectiveness of pain medications like Panadol, ibuprofen, and co-codamol but expressed reluctance to take them frequently due to potential adverse effects.
Yes now… i know pain drugs like Panadol, ibuprofen and co-codamol. Tab. and casting your mind from the pain you know… sometimes you don’t want to take the drugs all the time because of the adverse effects, you tried to endure it, but you cannot take the pain away. (‘Male respondent’
Satisfaction with pain management methods
Despite challenges, most participants expressed satisfaction with the pain management provided by nurses, highlighting their responsiveness and professionalism. A female respondent noted, “They give me my drugs quick,” while another praised the staff’s friendliness, saying, “God bless them, I love the way they treat me.” Male participants echoed similar views, appreciating the nurses’ skills and care. However, some expressed partial or complete dissatisfaction due to persistent pain. One male respondent remarked, “I am a bit satisfied, but the pain has not gone,” while another expressed frustration, saying, “The pain no dey easy… I am not satisfied.”
Strategies used in managing pain, along with suggestions for improvement
Several respondents recommended stronger pain medications and diversional therapy to improve pain relief. A female participant suggested, “Stronger pain drugs and diversional therapy could help.” Similarly, two male respondents advocated for more potent medications, with one stating, “Strong pain medicine, and moving around and doing something else,” while another recommended “Stronger drugs like diclofenac, and exercises.”
Participants also highlighted the need for better healthcare resources and responsiveness. A female respondent expressed gratitude but urged improved nurse responsiveness, saying, “Help me thank the nurses, but beg them to answer us quickly.” Another participant acknowledged staff professionalism but emphasized the need for more hospital resources, stating, “God bless them. They show high professional skill, but they can do better.”
The study found that current pain management practices often fail to fully address patient needs, highlighting the importance of better communication, compassionate care, and regular monitoring. Individual differences in pain tolerance necessitate personalized strategies. While medications are vital, patients also benefit from supportive interactions and coping strategies. Concerns about drug side effects and financial barriers impacted medication adherence. Many patients, despite pre-operative counseling, reported severe post-surgery pain. Recommendations included stronger pain medications, diversional therapies, more responsive medical staff, and increased government healthcare support, emphasizing the need for more effective and comprehensive pain management approaches.
The study explored postoperative pain management among patients aged 26 to 48, with an average age of 37 years. Respondents primarily relied on medications, distraction, and endurance to manage pain. Many advocated for stronger medications, particularly opioids, and diversional therapies to improve pain relief. A multimodal approach combining NSAIDs and opioids was commonly used and deemed effective. Despite preoperative counseling, respondents often experienced more severe pain than anticipated, with 25% reporting near worst-possible pain immediately after surgery, though pain decreased over time.
General satisfaction with pain management was high, attributed to prompt medication administration and supportive healthcare providers. Pain tolerance varied, influenced by age, gender, and ethnicity. Respondents noted financial constraints and medication side effects as challenges. Tailored pain management plans, patient education, and continuous monitoring were suggested improvements.
Patients who received treatment at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) reported higher levels of satisfaction compared to those treated at the Lagos University Teaching Hospital (LUTH). Additionally, patients who experienced shorter hospital stays expressed greater satisfaction with their overall care. Several factors influenced patient satisfaction, though not all had a significant impact. Gender and age did not play a substantial role in determining satisfaction levels. However, the hospital setting where surgery was performed significantly affected patient experiences, suggesting that institutional differences in healthcare delivery contributed to varying levels of satisfaction. Education level emerged as an important factor, with individuals possessing higher educational attainment demonstrating greater health literacy and a stronger sense of satisfaction with their care. Similarly, income level was a key determinant, as patients with higher incomes had better access to healthcare resources, ultimately leading to a more positive perception of their treatment experience.
In terms of pain management, a range of strategies was employed to ensure effective relief for patients. General anesthesia was widely preferred for its ability to provide profound pain relief, particularly in surgical settings. Nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids were commonly utilized and found to be effective in managing acute pain. A multimodal pain management approach, which involved combining NSAIDs and opioids, was particularly beneficial as it leveraged the synergistic effects of both drug classes. Furthermore, the implementation of standardized protocols for pain relief administration contributed to improved patient outcomes, ensuring consistency and efficacy in pain management strategies across different healthcare settings.
This study emphasizes the significance of multimodal pain management in improving patient satisfaction following abdominal surgery in Southwest Nigeria. The findings indicate that integrating pharmacologic and non-pharmacologic approaches enhances pain relief and recovery. To optimize patient care, hospitals should adopt policies that support comprehensive pain management, ensure ongoing staff training, educate patients on available pain relief methods, and implement monitoring systems for patient feedback. A collaborative approach involving surgeons, anesthetists, and nurses is crucial. These strategies will enhance postoperative outcomes, minimize complications, and boost patient satisfaction, ultimately contributing to improved healthcare delivery in federal teaching hospitals.
The research faced challenges during data collection, such as delays in securing ethical approval and logistical issues. These difficulties lengthened the data collection timeline and affected respondents’ recruitment, resulting in extended interview sessions and prolonged data compilation phases.
Luth: Lagos University Teaching Hospital
Oauthc: Obafemi Awolowo University Teaching Hospital Complex
Nsaids: Non-steroidal anti-inflammatory drugs
Ethical approval and consent to participate was obtained from Ethics and Research Committee of the Teaching Hospital, (LUTH, OAUTHC). The Medical Directors of the healthcare facilities involved also gave their approval for the study to be carried out. The purpose of the study and the fact that participation was entirely voluntary were fully disclosed to the respondents. Written informed consent was obtained from each respondent individually, and all information collected was kept private.
All the authors gave consent for the publication of the work.
Data and materials associated with the study will be made available by the corresponding author upon reasonable request
The authors declare no conflict of interest associated with the manuscript
No financial support was received for this research.