Neonatal Pain Management Practice and Associated Factors among Nurses Working in Public Hospitals of Southern Ethiopia: A Multicenter Cross- sectional study

Neonatal Pain Management Practice and Associated Factors among Nurses Working in Public Hospitals of Southern Ethiopia: A Multicenter Cross- sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Neonatal Pain Management Practice and Associated Factors among Nurses Working in Public Hospitals of Southern Ethiopia: A Multicenter Cross- sectional study Addisu Urmale, Asmare Getie, Nega Degeifa, Agegnehu Bante This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5440099/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Neonatal pain management is an integral part of nurse’s practices working in neonatal intensive care units. Improper neonatal pain management can have negative consequence for the health and development of newborns. In Ethiopia, neonatal pain management practices among nurses working in neonatal intensive care unit were not well known. Hence, this study assessed neonatal pain management practice and associated factors among nurses working in the neonatal intensive care units of public hospitals in Southern Ethiopia. Methods: An institution-based cross-sectional study design was conducted among 369 randomly selected nurses working in the neonatal intensive care units of public hospitals in southern Ethiopia. Data were collected using a pre-tested, structured, and self-administered questionnaire accompanied with an observation checklist. The collected data were reviewed, coded and entered using Epi-data version 3.1 and exported to SPSS version 26 for analysis. Bivariate and multivariable logistic regression analyses were used to identify the associations between outcome and predictor variables. The degree of association was estimated with odds ratio with 95% confidence level and P-values < 0.05 were considered to detect statistical significance. Results: The study revealed that 18.3% (95%CI: 14.4, 22.7) of the nurses had good neonatal pain management practice. On observation 16.2% (95%CI: 6.2, 32.0) of nurses were practicing proper neonatal pain management. Respondents with age ≤ 30 years [AOR = 3.02, 95%CI (1.30, 7.01)], married nurses [AOR = 4.90, 95%CI(2.09, 9.49)],availability of anti-pain drug in the unit [AOR = 7.24, (2.66, 11.69)], shortage of nursing staff at each shift [AOR = 0.097, (0.034, 0.279), and poor knowledge about neonatal pain [AOR = 0.23, (0.08, 0.62)] were factors significantly associated with good neonatal pain management practice. Conclusions: The overall practice of neonatal pain management is relatively low. Improving practice of neonatal pain management requires; hiring of adequate nursing staff, improving acess to anti-pain drugs in the unit, and enhancing nurse’s knowledge regarding neonatal pain management. Practice Pain Neonatal intensive care unit Nurses Figures Figure 1 Introduction According to the revised definition of the International Association for the Study of Pain (IASP), pain is - “An unpleasant sensory and emotional experience associated with actual or potential tissue damage” ( 1 ). Pain has been with humans from the beginning of time. It is an interesting characteristic of life rescuing human beings and informing them of harmfulness of external factors ( 2 ). Pain management practice is the process of providing medical care that alleviates or reduces pain. It is a set of activities that should be provided by nurses to manage the patients’ pain effectively ( 3 ). Pain management practice used to relieve pain includes pharmaceutical and non-pharmaceutical ways. Non-pharmacological ways to reduce pain in neonates include nonnutritive sucking both with and without sucrose use, swaddling or facilitated tucking, kangaroo mother care, positioning, breastfeeding, music therapy, and multi-sensorial stimulation ( 4 ). Pharmacological intervention is administering analgesics to relieve the patients’ pain. It is classified into three main groups of analgesics including opioid analgesics, non-opioid analgesics, and adjuvants ( 5 ). According to the literature, neonates in the neonatal intensive care unit (NICU) are exposed to an average of 7.5 to 17.3 medical procedures per day, most of which are quite painful, underscoring the significance of neonatal pain management ( 6 ). Repetitive or untreated pain can lead to altered brain development and function, impaired cognitive and motor function, intracranial bleeding, a reduced immunological response and internalizing behavior later in life ( 7 ). In neonates, the pain might provoke stress responses such as apneas, bradycardia and hypoxia, which adversely affect the infant’s neurodevelopment ( 8 ) For hospitalized newborns, there are pain management approaches that may be utilized at the bedside to calm them and relieve their discomfort ( 9 ). Despite advancement in pain assessment and intervention, several studies have indicated that nurses neonatal pain management practice is insufficient specially in developing country like Ethiopia, also previously there is no a such study conducted in the study area ( 10 ). Therefore, data regarding neonatal pain management practices and affecting factors are essential for taking appropriate actions. Thus this study aimed to assess neonatal pain management practice and associated factors among healthcare providers working in NICUs of public hospitals in eastern Ethiopia Methods Study area, design and period An institutional based cross-sectional study was conducted in public hospitals of Southern Ethiopia from January 1 to February 29, 2024. Southern Ethiopia is one among twelve regional states of Ethiopia. Southern Ethiopia consist of 12 Zones and 29 hospitals. Such as; Wolaita Zone which have 9 hospitals (Bombe primary hospital, Boditi primary hospital, Bele primary hospital, Humbo primary hospital, Bitena primary hospital, Kindo primary hospital, Gesuba primary hospital, Bedesa primary hospital & Wolaita sodo university comprehensive specialized hospital), Gamo Zone which have 6 hospitals (Arbaminch General hospital, Gerese primary hospital, Kamba primary hospital, Chencha primary hospital, Selam ber primary hospital & Dilfana primary hospital), Gofa Zone have two hospitals (Sawula General Hospital & Laha primary hospital), Gedio Zone have three hospitals (Yirga chefe primary hospital, Gedeb primary hospital & Dilla university teaching and referral hospital), Konso Zone have two hospitals (Karat primary hospital & Segen primary hospital), Basketo Zone have one hospital (Laska primary hospital), Dirashe Zone one hospital is there (Gidole primary hospital), Burij Zone: one hospital there (Burji primary hospital), Amaro Zone: one hospital there (Amaro kele primary hospital), Ale Zone: there is no hospital in this zone, Ari Zone: two hospital there (Jinka General Hospital & Gazeri primary hospital), and South Omo Zone: where one hospital is there (Koyibe primary hospital) Source population, study population and eligibility criteria The source populations were all nurses working at neonatal intensive care unit at public hospitals of southern Ethiopia. All nurses who had ever worked in each facility’s NICU in the previous six month until the data collection period were included. Nurses who were on annual, sick or maternity leave at the time of data collection were excluded from the study. Sample size determination and sampling procedure The sample size was calculated using a single population proportion formula with assumptions of a 95% confidence level, a 5% margin of error and a 32.2% proportion of neonatal pain management practice from a previous study conducted in Addis Ababa, Ethiopia ( 10 ). $$\:\text{n}=\frac{{\left(\frac{Z\alpha\:}{2}\right)}^{2}p(1-p)}{{d}^{2}}\:\text{n}=\frac{{\left(1.96\right)}^{2}\left(0.322\right)(1-0.322)}{{\left(0.05\right)}^{2}}\:=335$$ Finally, after adding the non-response rate of 10%, the total sample size became 369 . The study included 20 public hospitals in southern Ethiopia that provide NICU services. The calculated sample size was distributed using proportional allocation to size based on the number of nurses who had ever worked in each of selected public hospital NICUs in the previous six months until the data collections. The study participants were selected using simple random sampling after obtaining a list of nurses who had ever worked in each public hospital NICUs in the previous six months till the data collection period, whereas participants for the observation were selected purposively from among nurses who were caring for ill neonates. 10% (37 nurses) of the total sample size of nurses were observed. Data collection tools and procedure Data were collected using a pre-tested structured self-administered questionnaire and an observation checklist. It was adapted from a valid and reliable instrument in previous studies. 20 diploma nurses facilitated the data collection, while 12 BSc nurses supervised it. Before the self-administered questionnaire, covert and non-participant observation was conducted. Following a brief explanation of the stuy’d purpose and consent, the self-administered questionnaire was distributed to participants at the end of their daily shift but before they left the hospital. The completed questionnaires were collected on the same day. On average, it took participants 20–30 min to complete the questionnaire. The questionnaires consisted of four parts,, the first part containing 6 items related to the socio-demographics such as age, gender, marital status, level of education, and work experience as nurse and in NICU; second part is 20 items regarding knowledge about neonatal pain management; the third part is 20 items regarding self-reported practical related questions which participants were asked to reply according to five-point Likert scales ranging from “always” to “never” and scored as; never ( 1 ), rarely ( 2 ), sometimes ( 3 ), most of the time ( 4 ) and always ( 5 ). The total score for items ranged from 20 to 100. The fourth part is 6 questions related to factors associated with neonatal pain management and were answered as, ‘yes’ or ‘no’. Operational definitions Neonatal pain: At least one type of pain; birth trauma, acute procedural pain, acute post-operative pain or chronic pain is considered neonatal pain ( 10 ) Neonatal pain management: Reducing invasive procedures and using pharmacological, behavioral or environmental measures to manage neonatal pain ( 10 ). Good practice: Eighteen yes or no questions with a total score ranging from 0 to 18 points were used to assess the level of practice related to neonatal pain management. The mean value for practice-related items was used as the cut-off point and healthcare providers with a score of ≥ 11.38 were considered good practices ( 11 ). Poor practice: Healthcare providers who scored < 11.38 were considered to have poor practices ( 11 ). Adequate knowledge: Twenty yes or no questions with a total score ranging from 0 to 20 points were used to assess the level of knowledge related to neonatal pain management. The mean for knowledge-related items was used as the cut-off point, and healthcare providers who scored ≥ 14.92 were considered to have adequate knowledge ( 10 ). Inadequate knowledge: Healthcare providers who scored < 14.92 for knowledge-related items were considered to have inadequate knowledge ( 10 ). Data quality assurance Structured, validated and reliable adapted questionnaires were used to collect the data from each study participant. To ensure further the quality of the data collection tool, a pre-test was done two weeks before the actual data collection. The pretest was conducted on 5% (18 nurses) of the total sample size in Hawassa University Comprehensive Specialized Hospital. The levels of reliability and validity were assessed using SPSS statistics 26 software after retrieving data from the 5% of the nurses. On the pretest, Cronbach alpha of knowledge and practice were resulted in acceptable reliability range (0.787 and 0.771) respectively. Completeness and consistency of questionnaire were checked before and immediately after data were collected by each data collectors and supervisors. Data processing and analysis Data was checked manually for completeness and then data were cleaned, coded and entered in to Epi-data version 3.1 then transferred to SPSS version 26 computer program for analysis. Finally, the data was processed descriptively and analytically. Descriptive statistics such as frequency, mean, percentage, and summary table was used to summarize participants pertinent findings using tables, graphs, texts, and charts. To identify the predictive variables a bivariate analysis was conducted and factors with a p-value < 0.25 were candidate to multivariable logistic regression model. Then, after the identified factors were entered into multivariable analysis to control the confounding factors and those factors with a p-value < 0.05 at a 95% CI were declared as a predictor of the outcome variable. Finally, the findings of the study are presented using texts, tables, and figures. Results Sociodemographic characteristics A total of 356 nurses were participated in the study with a response rate of 96.47%. Among the participants, 194 (54.5%) were male and 286 (80.3%) were married. Over half, 199 (55.9%) were comprehensive Bsc nurses. Additionally, 161 (43.6%) had NICU experience ranging from six months to 24 months (Table 1 ) Table 1 Socio-demographic characteristics of nurses in public hospitals in Southern -Ethiopia, 2024, (n = 356). Variables Response category Frequency(f) Percentage (%) Age ≤ 30 years 201 56.5 > 30 years 155 43.5 Gender of participants Female 162 45.5 Male 194 54.5 Marital status Unmarried 70 19.7 Married 286 80.3 Educational status Diploma 90 25.3 Comprehensive nurse 199 55.9 Neonatal BSc nurse 67 18.8 Work experience in NICU 6months– 24months 161 45.2 > 24 months 195 54.8 Nurses practice in neonatal pain management The prevalence of neonatal pain management practice was found 65 (18.3%) with 95%CI: 14.4%, 22.7% Over half, 193 (54.2%), of participants always use non – nutritive suckling, and 158 (44.4%) of them encourage breastfeeding to relieve the pain in newborns. In addition, 167 (46.9%) of the respondents used more than one non-pharmacological measurement whereas 264 (74.2%) used both pharmacological and non-pharmacological combined to relieve pain in newborns. Regarding predictor variables, more than half, 238 (66.9%) did not provided in-service neonatal pain management training, 179 (50.3%) of participants did not gated support from leaders. In addition, 163 (45.8%) used standardized neonatal pain measurement scales, more two-third 267 (75.0%) of participants used national NICU guideline for pain management, 230 (64.6%) of participants perhaps there were shortage of nurses staff in each work shift. Furthermore 218 (61.2%) learned pain management practice at college or university level. Among the total respondents, 289 (81.2%) of them agreed that pre-term newborns experience pain. Similarly, the majority of 276 (77.5%) respondents agreed that full-term newborns feel pain. The number of participants who agreed that the vital sign of neonates can be affected by pain was 323 (90.7%). There were also more than half 56.7% of respondents who reported they knew that light and noise affect newborns' reactions to pain. Among the participants, 249 (69.9%) respondents stated that nurses’ have sufficient knowledge to manage pain in the neonate, and pain is considered one of the vital signs in newborns as stated by respondents 302 (84.8%). In general more than two-thirds, 249 (69.9%) of nurses have adequate knowledge regardingneonatalpainmanagement(Fig. 1 ). Observation findings regarding neonatal pain management practice. Out of 37 observed participants, majority 30 (81.1%) used pharmacological and non-pharmacological combined to relieve pain in newborns. More than two-fifth, 16 (43.2%) of the observed nurses did not document data related to pain management in patients chart. In general from observational findings, the proportion of nurses who were practicing proper pain management practice was 6 (16.2%) with 95%CI: 6.2%, 32.0% (Table 2 ). Table 2 Observational findings of the practice of neonatal pain management in public hospitals of Southern Ethiopia, 2024 (n = 37). Characteristics Frequency Done Not done Using validated pain assessment scale 25 (67.6%) 12 (32.4%) The nurses perform at least one non pharmacological pain management interventions. 28 (75.7%) 9(24.3%) Performing pharmacological intervention (the nurse administered any analgesia to relief pain) 22 (59.5%) 15 (40.5%) Perform both pharmacological and non-pharmacological combined to relieve pain in newborns 30 (81.1%) 7(18.9%) Documenting all data related to pain management in patients chart 21 (56.8%) 16 (43.2%) Perform pain management according to protocol and national NICU guideline. 12 (32.4%) 25 (67.6%) Perform pain assessment according to standardized neonatal pain assessment scales 31 (83.8%) 6 (16.2%) Re-assessed the pain after administration of analgesics 15 (40.5%) 22 (59.5%) Factors associated with neonatal pain management practice. In this study, socio-demographic factors; age, gender, marital status, level of education, work experience, environment and organizational factors such as the presence of guidelines, presence of analgesics and provision of training; and nurses related factors such as neonatal pain management knowledge, documentation of pain score in patients chart, and giving pharmacological & non-pharmacological treatment were utilized through bivariate logistic regression. From those predictors, knowledge level, documentation of pain score in patient’s charts, presence of protocols and guidelines in the unit, provision of in-service training, marital status, non-pharmacological pain management and work experience in NICU (p < 0.25) were significantly associated with nurses practice on managing neonatal pain bivariate logistic regression analysis. In multivariable logistic regression analysis, age of nurses (AOR = 3.020, 95%CI: 1.301,7.007), marital status (AOR = 4.898, 95%CI: 2.087, 9.493), presence of pharmacological drug in the unit (AOR = 7.24, 95%CI: 2.659, 11.692), presence of shortage of nursing staff in each shift (AOR = 0.097, 95%CI: 0.034, 0.279), and inadequate knowledge level of nurses regarding neonatal pain management (AOR = 0.227, 95%CI: 0.083, 0.623) were identified to be significantly associated with good neonatal pain management practice (Table 3 ). Table 3 Multivariable analysis result for factors associated with practice of neonatal pain management among nurses working in public hospitals of South Ethiopia, 2024 (n = 356) Variables Category Neonatal pain management practice 95% CI P.value Good Poor COR AOR Age ≤ 30 years 42(20.9%) 159(79.1%) 1.52(0.87, 2.65) 3.0(1.30, 7.00) 0.01 > 30years 23(14.8%) 132(85.2%) 1 1 Work experience in NICU ≤ 24months 21(11.8%) 157(88.2%) 0.41(0.231, 0.72) 0.6(0.27, 1.36) 0.23 > 24months 44(24.7%) 134(75.3%) 1 1 Marital status Married 24(34.3%) 46(65.7%) 3.12(1.72, 5.63) 4.9(2.09,9.49) 0.00 Unmarried 41(14.3%) 245(85.7%) 1 1 Availability of anti-pain drugs in the unit. Yes 51(19.9%) 205(80.1%) 1.528(0.80, 2.91) 7.24(2.18, 11.7) 0.00 No 14(14.0%) 86(86.0%) 1 1 In-service training No 31(13.0%) 207(87.0%) 0.37(0.21, 0.64) 0.571(0.25, 1.33) 0.19 Yes 34(28.8%) 84(71.2%) 1 1 Shortage of nursing NICU staff Yes 5(4.0%) 121(96.0%) 0.117(0.05, 0.30) 0.10(0.03, 0.30) 0.000 No 60(26.1%) 170(73.9%) 1 1 Knowledge level Inadequate 41(16.5%) 208(83.5%) 0.68(0.39, 1.20) 0.227(0.08, 0.62) 0.004 Adequate 24(22.4%) 83(77.6%) 1 1 Discussion This study aimed to assessing nurse’s practice of neonatal pain management in public hospitals of southern-Ethiopia. The finding showed that 18.3% (95%CI: 14.4%, 22.7%) of nurses reported that they have good neonatal pain management practice, while 16.2% of nurses had good neonatal pain management practice on observation. Age of nurses, marital status, knowledge about neonatal pain management, adequate nursing staff in each shift, and availability of anti-pain drugs in the unit were factors identified in this study that showed significant association with good practice of neonatal pain management. The findings of this study were low compared to studies conducted in Malaysia, Ghana, Addis Ababa in which was 41.67%, 42.2%, and 32.2% of them had good practice in neonatal pain management respectively (10, 12, 13). This could be due difference in health care infrastructures, study setting or sampling variation that previous studies mainly based on self-report practice that may overestimate the practice. On other hand the finding of this study were higher compared to studies conducted in Rwanda and West Ormia in which was 15.2%, 16.3% of them had good practice in neonatal pain management respectively (14, 15). This could be due to the difference in timing and sample size. In case of study done in Rwanda only 75 nurses were study participants while 206 nurses were participated on study conducted in West Oromia comparatively this study has large sample size (14, 15). The nurse’s age and marital status significantly associated with good practice of neonatal pain management. Those nurses who were age ≤30 years had three times higher have good neonatal pain management practice compared to counterpart and those nurse who were married had 4.9 times higher to have good neonatal pain management practice when compared to those unmarried nurses. This may be due to marriage provides individuals with a network of help others, and to fulfill their responsibility (16). The odd of good practice of neonatal pain management was 0.10 times less among nurses where there was shortage of nursing staff in the unit than the counterpart. When nurse staffing is inadequate, the ability to practice ethically is questionable. This may be due to when there inadequate staff there was tight schedule at the NICU. This denotes that hiring adequate nursing staff in neonatal intensive care unit can improve neonatal pain management practice. Those nurses where there had anti-pain drugs in their unit had seven times higher to good neonatal pain management practice than nurses where there were no anti-pain drugs in there unit. Giving anti-pain is one of pain management practice, when there was deficiency of anti-pain or analgesics in unit nurses’ are prone to poor pain management practice. This study showed 177 (49.7%) study participants only use pharmacological method to relieve pain in newborns while over half 182 (51.1%) of respondents use pharmacological and non-pharmacological combined to relieve pain in neonates. This was in line with study conducted in Addis Ababa (10). This implies using a combination of various non-pharmacological measures achieves high effectiveness than when one of these measures is used alone (17). Non-nutritive sucking 308 (86.5%), breastfeeding 130 (36.5%), positioning 88 (24.7), kangaroo mother care 90 (25.3%), are the most often employed non-pharmacological pain management techniques. Those findings was in line with study conducted in Rwanda(14), and Bangladesh(18). By contrast the first common non-pharmacological measure used in Brazil was providing oral glucose/sucrose (17). This could be due to difference in healthcare infrastructure and study setting. In this study, inadequate knowledge about neonatal pain management had shown a significant association with good practice of neonatal pain management. The odd of good practice of neonatal pain management was 22.7% times lower among nurses who had inadequate knowledge about neonatal pain management than the counterpart. This finding is consistent with recent studies conducted in Brazil (17), Addis Ababa (10), and West Oromia (15). This implies as the knowledge of the nurse's increases regarding neonatal pain management the practice will also advance and be effective in pain management. This might be due to the fact that good knowledge leads to confidence, skill and readiness of nurse to perform their routine activities. This study attempted to close the research gap, there are limited studies that showed nurses practice and factors affecting practice of neonatal pain management, therefore, this study aimed to fill these research gap in Ethiopia. The result of this study identified that there was a gap in the practice of neonatal pain management. The observational result served as a supplementary for the findings. This study had its limitations, and the results must interpret by considering those limitations. Conclusions This study showed that the practice of nurses regarding neonatal pain management was low. Age of the nurses, marital status, presence of shortage of nursing staff in each shift, presence of pharmacological anti-pain drugs in the unit, and knowledge of nurse regarding neonatal pain management were found to be independent predictors for good neonatal pain management practice. Abbreviations AOR Adjusted Odds Ratio CI Confidence Interval COR Crude Odds Ratio IRB Institutional Review Board NICU Neonatal Intensive Care Unit SPSS Statistical package for social sciences WHO World Health Organization Declarations Acknowledgements : We would like to express our sincere gratitude to the Arba Minch University College of Health and Medical Science for giving us the opportunity and support to perform this research. We would like to extend our deepest appreciation and thanks to our colleagues for their unlimited advice, constructive suggestions and motivation that helped us in this project. Funding: This study was supported by the Arba Minch University; however, Arba Minch University has no role in manuscript preparation and publication. Data Availability : All relevant data are within the manuscript. Ethical approval and consent to participate : Since the study involved human participant’s Ethical approval was obtained from ethical review Board of the Arba Minch University (reference number IRB/23111/2023). Written informed consent from the each study participants was obtained. Their name and other forms of personal identification were not entered into the data collection format to maintain confidentiality. Clinical trial number: Not applicable. Consent for publication: Not applicable. Competing interests: The authors have declared that no competing interests exist. References Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-82. Tarjoman A, Vasigh A, Safari S, Borji M. Pain management in neonatal intensive care units: A cross sectional study of neonatal nurses in Ilam City. Journal of Neonatal Nursing. 2019;25(3):136-8. Alzghoul BI, Abdullah NAC. Pain management practices by nurses: an application of the knowledge, attitude and practices (KAP) model. Global journal of health science. 2016;8(6):154. Golianu B, Krane E, Seybold J, Almgren C, Anand K, editors. Non-pharmacological techniques for pain management in neonates. Seminars in perinatology; 2007: Elsevier. Smith MT, Muralidharan A. Pain pharmacology and the pharmacological management of pain. Pain-E-Book: Pain-E-Book. 2022:225. Hall RW, Anand KJ. Pain management in newborns. Clinics in perinatology. 2014;41(4):895-924. Allegaert K, Van Den Anker JN. Neonatal pain management: still in search of the Holy Grail. International journal of clinical pharmacology and therapeutics. 2016;54(7):514. Orovec A, Disher T, Caddell K, Campbell-Yeo M. Assessment and management of procedural pain during the entire neonatal intensive care unit hospitalization. Pain Management Nursing. 2019;20(5):503-11. Guedj R, Danan C, Daoud P, Zupan V, Renolleau S, Zana E, et al. Does neonatal pain management in intensive care units differ between night and day? An observational study. BMJ open. 2014;4(2):e004086. Wari G, Wordofa B, Alemu W, Habte T. Knowledge and practice of nurses and associated factors in managing neonatal pain at selected public hospitals in Addis Ababa, Ethiopia, 2020. Journal of multidisciplinary healthcare. 2021:2275-86. Kebede SM, Degefa M, Getachew T, Lami M, Tadesse B, Bekele H. Neonatal pain management practice in the neonatal intensive care unit of public hospitals: a survey of healthcare providers in eastern Ethiopia. International Health. 2023:ihad095. Qasim YK, Abdeljawad H, Abusafia AH. Nurses' knowledge and practice in assessment and management of neonatal pain at Governmental Hospitals in Gaza Strip: A cross sectional study. Clinical Journal of Nursing Care and Practice. 2021;5(1):038-42. Wuni A, Salia SM, Mohammed Ibrahim M, Iddriss I, Abena Nyarko B, Nabila Seini S, et al. Evaluating knowledge, practices, and barriers of paediatric pain management among nurses in a tertiary health facility in the northern region of Ghana: A descriptive cross-sectional study. Pain Research and Management. 2020;2020. Muteteli C, Tengera O, Gowan M. Neonatal pain management among nurses and midwives at two Kigali hospitals. Rwanda Journal of Medicine and Health Sciences. 2019;2(2):138-46. Mekonen MWM, Muhye MAB, Gobeza MMB. Knowledge, Practice, and factors associated with neonatal pain management among nurses working at West Oromia Public Hospitals, Ethiopia: A cross-sectional study. 2022. Cherlin AJ. The weakening link between marriage and the care of children. Family Planning Perspectives. 1988:302-6. Costa T, Rossato LM, Bueno M, Secco IL, Sposito NPB, Harrison D, et al. Nurses' knowledge and practices regarding pain management in newborns. Revista da Escola de Enfermagem da USP. 2017;51:e03210. Hossain MS. Nurses’ knowledge and attitudes, and pain management practice of post-operative children in Bangladesh: Prince of Songkla University; 2010. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5440099","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":379268427,"identity":"d3109275-88cd-40ae-9c73-e121a8e1c2a5","order_by":0,"name":"Addisu Urmale","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYFCCBIMDEAZzA/OfChDN3ECsFsYGBp4zIC2MhLUwwLXwtkEZ+AB/e/LGgz/bDufrth9sfCA5rzaavx2o5UfFNpxaJM48KzjM23bYctuZxGYDw23Hc2ccZmxg7DlzG7c1N3IMDjO2HTYwO5DYJpG47VhuA1ALM2Mbbi3yQC0ghxmYnX/Y/uPgnGO58wlpMQBqOcAL0nIjsY2xsaEmdwMhLYYgv/CcSwdqedgszXDsQO5GoJaD+Pwidzx588cfZdZAhyUf/MxQU5c77/zhgw9+VODxPho4DCYPEK0eCOpIUTwKRsEoGAUjBAAAzG9mwtbknooAAAAASUVORK5CYII=","orcid":"","institution":"Arba Minch University","correspondingAuthor":true,"prefix":"","firstName":"Addisu","middleName":"","lastName":"Urmale","suffix":""},{"id":379268428,"identity":"bfc15dea-fb18-4f99-b5c9-b23955b89678","order_by":1,"name":"Asmare Getie","email":"","orcid":"","institution":"Arba Minch University","correspondingAuthor":false,"prefix":"","firstName":"Asmare","middleName":"","lastName":"Getie","suffix":""},{"id":379268430,"identity":"15e2caa4-1dea-46b4-b92b-b2563ba823cd","order_by":2,"name":"Nega Degeifa","email":"","orcid":"","institution":"Arba Minch University","correspondingAuthor":false,"prefix":"","firstName":"Nega","middleName":"","lastName":"Degeifa","suffix":""},{"id":379268431,"identity":"11ae3ade-7624-4195-859d-f454ca2f1e03","order_by":3,"name":"Agegnehu Bante","email":"","orcid":"","institution":"Arba Minch University","correspondingAuthor":false,"prefix":"","firstName":"Agegnehu","middleName":"","lastName":"Bante","suffix":""}],"badges":[],"createdAt":"2024-11-12 13:53:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5440099/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5440099/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71874039,"identity":"6fc9404b-e59c-4281-ae0c-335dbef86a6a","added_by":"auto","created_at":"2024-12-19 10:44:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":10431,"visible":true,"origin":"","legend":"\u003cp\u003eNurses knowledge level regarding neonatal pain management in public hospitals in southern Ethiopia, 2024 (n = 356).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5440099/v1/3506064cde116f9de6483c3f.png"},{"id":106093806,"identity":"016b657f-cfbf-4ec5-9b90-4c650b63abcb","added_by":"auto","created_at":"2026-04-03 11:39:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":855456,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5440099/v1/05df84a0-d72a-44e2-8389-d5c6c630384d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Neonatal Pain Management Practice and Associated Factors among Nurses Working in Public Hospitals of Southern Ethiopia: A Multicenter Cross- sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccording to the revised definition of the International Association for the Study of Pain (IASP), pain is - \u0026ldquo;An unpleasant sensory and emotional experience associated with actual or potential tissue damage\u0026rdquo; (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Pain has been with humans from the beginning of time. It is an interesting characteristic of life rescuing human beings and informing them of harmfulness of external factors (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePain management practice is the process of providing medical care that alleviates or reduces pain. It is a set of activities that should be provided by nurses to manage the patients\u0026rsquo; pain effectively (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Pain management practice used to relieve pain includes pharmaceutical and non-pharmaceutical ways. Non-pharmacological ways to reduce pain in neonates include nonnutritive sucking both with and without sucrose use, swaddling or facilitated tucking, kangaroo mother care, positioning, breastfeeding, music therapy, and multi-sensorial stimulation (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Pharmacological intervention is administering analgesics to relieve the patients\u0026rsquo; pain. It is classified into three main groups of analgesics including opioid analgesics, non-opioid analgesics, and adjuvants (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to the literature, neonates in the neonatal intensive care unit (NICU) are exposed to an average of 7.5 to 17.3 medical procedures per day, most of which are quite painful, underscoring the significance of neonatal pain management (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Repetitive or untreated pain can lead to altered brain development and function, impaired cognitive and motor function, intracranial bleeding, a reduced immunological response and internalizing behavior later in life (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In neonates, the pain might provoke stress responses such as apneas, bradycardia and hypoxia, which adversely affect the infant\u0026rsquo;s neurodevelopment (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) For hospitalized newborns, there are pain management approaches that may be utilized at the bedside to calm them and relieve their discomfort (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite advancement in pain assessment and intervention, several studies have indicated that nurses neonatal pain management practice is insufficient specially in developing country like Ethiopia, also previously there is no a such study conducted in the study area (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Therefore, data regarding neonatal pain management practices and affecting factors are essential for taking appropriate actions. Thus this study aimed to assess neonatal pain management practice and associated factors among healthcare providers working in NICUs of public hospitals in eastern Ethiopia\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy area, design and period\u003c/h2\u003e \u003cp\u003eAn institutional based cross-sectional study was conducted in public hospitals of Southern Ethiopia from January 1 to February 29, 2024. Southern Ethiopia is one among twelve regional states of Ethiopia. Southern Ethiopia consist of 12 Zones and 29 hospitals. Such as; Wolaita Zone which have 9 hospitals (Bombe primary hospital, Boditi primary hospital, Bele primary hospital, Humbo primary hospital, Bitena primary hospital, Kindo primary hospital, Gesuba primary hospital, Bedesa primary hospital \u0026amp; Wolaita sodo university comprehensive specialized hospital), Gamo Zone which have 6 hospitals (Arbaminch General hospital, Gerese primary hospital, Kamba primary hospital, Chencha primary hospital, Selam ber primary hospital \u0026amp; Dilfana primary hospital), Gofa Zone have two hospitals (Sawula General Hospital \u0026amp; Laha primary hospital), Gedio Zone have three hospitals (Yirga chefe primary hospital, Gedeb primary hospital \u0026amp; Dilla university teaching and referral hospital), Konso Zone have two hospitals (Karat primary hospital \u0026amp; Segen primary hospital), Basketo Zone have one hospital (Laska primary hospital), Dirashe Zone one hospital is there (Gidole primary hospital), Burij Zone: one hospital there (Burji primary hospital), Amaro Zone: one hospital there (Amaro kele primary hospital), Ale Zone: there is no hospital in this zone, Ari Zone: two hospital there (Jinka General Hospital \u0026amp; Gazeri primary hospital), and South Omo Zone: where one hospital is there (Koyibe primary hospital)\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSource population, study population and eligibility criteria\u003c/h3\u003e\n\u003cp\u003eThe source populations were all nurses working at neonatal intensive care unit at public hospitals of southern Ethiopia. All nurses who had ever worked in each facility\u0026rsquo;s NICU in the previous six month until the data collection period were included. Nurses who were on annual, sick or maternity leave at the time of data collection were excluded from the study.\u003c/p\u003e\n\u003ch3\u003eSample size determination and sampling procedure\u003c/h3\u003e\n\u003cp\u003eThe sample size was calculated using a single population proportion formula with assumptions of a 95% confidence level, a 5% margin of error and a 32.2% proportion of neonatal pain management practice from a previous study conducted in Addis Ababa, Ethiopia (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:\\text{n}=\\frac{{\\left(\\frac{Z\\alpha\\:}{2}\\right)}^{2}p(1-p)}{{d}^{2}}\\:\\text{n}=\\frac{{\\left(1.96\\right)}^{2}\\left(0.322\\right)(1-0.322)}{{\\left(0.05\\right)}^{2}}\\:=335$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFinally, after adding the non-response rate of 10%, the total sample size became \u003cb\u003e369\u003c/b\u003e. The study included 20 public hospitals in southern Ethiopia that provide NICU services. The calculated sample size was distributed using proportional allocation to size based on the number of nurses who had ever worked in each of selected public hospital NICUs in the previous six months until the data collections. The study participants were selected using simple random sampling after obtaining a list of nurses who had ever worked in each public hospital NICUs in the previous six months till the data collection period, whereas participants for the observation were selected purposively from among nurses who were caring for ill neonates. 10% (37 nurses) of the total sample size of nurses were observed.\u003c/p\u003e\n\u003ch3\u003eData collection tools and procedure\u003c/h3\u003e\n\u003cp\u003eData were collected using a pre-tested structured self-administered questionnaire and an observation checklist. It was adapted from a valid and reliable instrument in previous studies. 20 diploma nurses facilitated the data collection, while 12 BSc nurses supervised it. Before the self-administered questionnaire, covert and non-participant observation was conducted. Following a brief explanation of the stuy\u0026rsquo;d purpose and consent, the self-administered questionnaire was distributed to participants at the end of their daily shift but before they left the hospital. The completed questionnaires were collected on the same day. On average, it took participants 20\u0026ndash;30 min to complete the questionnaire.\u003c/p\u003e \u003cp\u003eThe questionnaires consisted of four parts,, the first part containing 6 items related to the socio-demographics such as age, gender, marital status, level of education, and work experience as nurse and in NICU; second part is 20 items regarding knowledge about neonatal pain management; the third part is 20 items regarding self-reported practical related questions which participants were asked to reply according to five-point Likert scales ranging from \u0026ldquo;always\u0026rdquo; to \u0026ldquo;never\u0026rdquo; and scored as; never (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), rarely (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), sometimes (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), most of the time (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) and always (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The total score for items ranged from 20 to 100. The fourth part is 6 questions related to factors associated with neonatal pain management and were answered as, \u0026lsquo;yes\u0026rsquo; or \u0026lsquo;no\u0026rsquo;.\u003c/p\u003e\n\u003ch3\u003eOperational definitions\u003c/h3\u003e\n\u003cp\u003eNeonatal pain: At least one type of pain; birth trauma, acute procedural pain, acute post-operative pain or chronic pain is considered neonatal pain (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eNeonatal pain management: Reducing invasive procedures and using pharmacological, behavioral or environmental measures to manage neonatal pain (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGood practice: Eighteen yes or no questions with a total score ranging from 0 to 18 points were used to assess the level of practice related to neonatal pain management. The mean value for practice-related items was used as the cut-off point and healthcare providers with a score of \u0026ge;\u0026thinsp;11.38 were considered good practices (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePoor practice: Healthcare providers who scored\u0026thinsp;\u0026lt;\u0026thinsp;11.38 were considered to have poor practices (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdequate knowledge: Twenty yes or no questions with a total score ranging from 0 to 20 points were used to assess the level of knowledge related to neonatal pain management. The mean for knowledge-related items was used as the cut-off point, and healthcare providers who scored\u0026thinsp;\u0026ge;\u0026thinsp;14.92 were considered to have adequate knowledge (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInadequate knowledge: Healthcare providers who scored\u0026thinsp;\u0026lt;\u0026thinsp;14.92 for knowledge-related items were considered to have inadequate knowledge (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData quality assurance\u003c/h2\u003e \u003cp\u003eStructured, validated and reliable adapted questionnaires were used to collect the data from each study participant. To ensure further the quality of the data collection tool, a pre-test was done two weeks before the actual data collection. The pretest was conducted on 5% (18 nurses) of the total sample size in Hawassa University Comprehensive Specialized Hospital. The levels of reliability and validity were assessed using SPSS statistics 26 software after retrieving data from the 5% of the nurses. On the pretest, Cronbach alpha of knowledge and practice were resulted in acceptable reliability range (0.787 and 0.771) respectively. Completeness and consistency of questionnaire were checked before and immediately after data were collected by each data collectors and supervisors.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData processing and analysis\u003c/h3\u003e\n\u003cp\u003eData was checked manually for completeness and then data were cleaned, coded and entered in to Epi-data version 3.1 then transferred to SPSS version 26 computer program for analysis. Finally, the data was processed descriptively and analytically. Descriptive statistics such as frequency, mean, percentage, and summary table was used to summarize participants pertinent findings using tables, graphs, texts, and charts. To identify the predictive variables a bivariate analysis was conducted and factors with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 were candidate to multivariable logistic regression model. Then, after the identified factors were entered into multivariable analysis to control the confounding factors and those factors with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 at a 95% CI were declared as a predictor of the outcome variable. Finally, the findings of the study are presented using texts, tables, and figures.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic characteristics\u003c/h2\u003e \u003cp\u003eA total of 356 nurses were participated in the study with a response rate of 96.47%. Among the participants, 194 (54.5%) were male and 286 (80.3%) were married. Over half, 199 (55.9%) were comprehensive Bsc nurses. Additionally, 161 (43.6%) had NICU experience ranging from six months to 24 months (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of nurses in public hospitals in Southern -Ethiopia, 2024, (n\u0026thinsp;=\u0026thinsp;356).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResponse category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency(f)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;30 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender of participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComprehensive nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeonatal BSc nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWork experience in NICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6months\u0026ndash; 24months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;24 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eNurses practice in neonatal pain management\u003c/h2\u003e \u003cp\u003eThe prevalence of neonatal pain management practice was found 65 (18.3%) with 95%CI: 14.4%, 22.7%\u003c/p\u003e \u003cp\u003eOver half, 193 (54.2%), of participants always use non \u0026ndash; nutritive suckling, and 158 (44.4%) of them encourage breastfeeding to relieve the pain in newborns. In addition, 167 (46.9%) of the respondents used more than one non-pharmacological measurement whereas 264 (74.2%) used both pharmacological and non-pharmacological combined to relieve pain in newborns.\u003c/p\u003e \u003cp\u003eRegarding predictor variables, more than half, 238 (66.9%) did not provided in-service neonatal pain management training, 179 (50.3%) of participants did not gated support from leaders. In addition, 163 (45.8%) used standardized neonatal pain measurement scales, more two-third 267 (75.0%) of participants used national NICU guideline for pain management, 230 (64.6%) of participants perhaps there were shortage of nurses staff in each work shift. Furthermore 218 (61.2%) learned pain management practice at college or university level.\u003c/p\u003e \u003cp\u003eAmong the total respondents, 289 (81.2%) of them agreed that pre-term newborns experience pain. Similarly, the majority of 276 (77.5%) respondents agreed that full-term newborns feel pain. The number of participants who agreed that the vital sign of neonates can be affected by pain was 323 (90.7%). There were also more than half 56.7% of respondents who reported they knew that light and noise affect newborns' reactions to pain. Among the participants, 249 (69.9%) respondents stated that nurses\u0026rsquo; have sufficient knowledge to manage pain in the neonate, and pain is considered one of the vital signs in newborns as stated by respondents 302 (84.8%). In general more than two-thirds, 249 (69.9%) of nurses have adequate knowledge regardingneonatalpainmanagement(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eObservation findings regarding neonatal pain management practice.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOut of 37 observed participants, majority 30 (81.1%) used pharmacological and non-pharmacological combined to relieve pain in newborns. More than two-fifth, 16 (43.2%) of the observed nurses did not document data related to pain management in patients chart. In general from observational findings, the proportion of nurses who were practicing proper pain management practice was 6 (16.2%) with 95%CI: 6.2%, 32.0% (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eObservational findings of the practice of neonatal pain management in public hospitals of Southern Ethiopia, 2024 (n\u0026thinsp;=\u0026thinsp;37).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDone\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNot done\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsing validated pain assessment scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (67.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (32.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe nurses perform at least one non pharmacological pain management interventions.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (75.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(24.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerforming pharmacological intervention (the nurse administered any analgesia to relief pain)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (59.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (40.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerform both pharmacological and non-pharmacological combined to relieve pain in newborns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (81.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(18.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDocumenting all data related to pain management in patients chart\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (56.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (43.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerform pain management according to protocol and national NICU guideline.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (32.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (67.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerform pain assessment according to standardized neonatal pain assessment scales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (83.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (16.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRe-assessed the pain after administration of analgesics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (40.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (59.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFactors associated with neonatal pain management practice.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn this study, socio-demographic factors; age, gender, marital status, level of education, work experience, environment and organizational factors such as the presence of guidelines, presence of analgesics and provision of training; and nurses related factors such as neonatal pain management knowledge, documentation of pain score in patients chart, and giving pharmacological \u0026amp; non-pharmacological treatment were utilized through bivariate logistic regression. From those predictors, knowledge level, documentation of pain score in patient\u0026rsquo;s charts, presence of protocols and guidelines in the unit, provision of in-service training, marital status, non-pharmacological pain management and work experience in NICU (p\u0026thinsp;\u0026lt;\u0026thinsp;0.25) were significantly associated with nurses practice on managing neonatal pain bivariate logistic regression analysis.\u003c/p\u003e \u003cp\u003eIn multivariable logistic regression analysis, age of nurses (AOR\u0026thinsp;=\u0026thinsp;3.020, 95%CI: 1.301,7.007), marital status (AOR\u0026thinsp;=\u0026thinsp;4.898, 95%CI: 2.087, 9.493), presence of pharmacological drug in the unit (AOR\u0026thinsp;=\u0026thinsp;7.24, 95%CI: 2.659, 11.692), presence of shortage of nursing staff in each shift (AOR\u0026thinsp;=\u0026thinsp;0.097, 95%CI: 0.034, 0.279), and inadequate knowledge level of nurses regarding neonatal pain management (AOR\u0026thinsp;=\u0026thinsp;0.227, 95%CI: 0.083, 0.623) were identified to be significantly associated with good neonatal pain management practice (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable analysis result for factors associated with practice of neonatal pain management among nurses working in public hospitals of South Ethiopia, 2024 (n\u0026thinsp;=\u0026thinsp;356)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNeonatal pain management practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP.value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;30 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42(20.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e159(79.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.52(0.87, 2.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.0(1.30, 7.00)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(14.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e132(85.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWork experience in NICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;24months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(11.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e157(88.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.41(0.231, 0.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6(0.27, 1.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;24months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44(24.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e134(75.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(34.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46(65.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.12(1.72, 5.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e4.9(2.09,9.49)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41(14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e245(85.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAvailability of anti-pain drugs in the unit.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51(19.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e205(80.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.528(0.80, 2.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e7.24(2.18, 11.7)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86(86.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIn-service training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31(13.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e207(87.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.37(0.21, 0.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.571(0.25, 1.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34(28.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84(71.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eShortage of nursing NICU staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121(96.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.117(0.05, 0.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.10(0.03, 0.30)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60(26.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e170(73.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eKnowledge level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInadequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41(16.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e208(83.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.68(0.39, 1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.227(0.08, 0.62)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(22.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83(77.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to assessing nurse\u0026rsquo;s practice of neonatal pain management in public hospitals of southern-Ethiopia. The finding showed that 18.3%\u0026nbsp;(95%CI: 14.4%, 22.7%)\u0026nbsp;of nurses reported that they have good neonatal pain management practice, while 16.2% of nurses had good neonatal pain management practice on observation. Age of nurses, marital status, knowledge about neonatal pain management, adequate nursing staff in each shift, and availability of anti-pain drugs in the unit were factors identified in this study that showed significant association with good practice of neonatal pain management.\u003c/p\u003e\n\u003cp\u003eThe findings of this study were low compared to studies conducted in Malaysia, Ghana, Addis Ababa in which was 41.67%, 42.2%, and 32.2% of them had good practice in neonatal pain management respectively\u0026nbsp;(10, 12, 13). This could be due difference in health care infrastructures, \u0026nbsp;study setting or sampling variation that previous studies mainly based on self-report practice that may overestimate the practice.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOn other hand the finding of this study were higher compared to studies conducted in Rwanda and West Ormia in which was 15.2%, 16.3% of them had good practice in neonatal pain management respectively\u0026nbsp;(14, 15). This could be due to the difference in timing and sample size. In case of study done in Rwanda only 75 nurses were study participants while 206 nurses were participated on study conducted in West Oromia comparatively this study has large sample size\u0026nbsp;(14, 15).\u003c/p\u003e\n\u003cp\u003eThe nurse\u0026rsquo;s age and marital status significantly associated with good practice of neonatal pain management. Those nurses who were age \u0026le;30 years had three times higher have good neonatal pain management practice compared to counterpart and those nurse who were married had 4.9 times higher to have good neonatal pain management practice when compared to those unmarried nurses. This may be due to marriage provides individuals with a network of help others, and to fulfill their responsibility\u0026nbsp;(16).\u003c/p\u003e\n\u003cp\u003eThe odd of good practice of neonatal pain management was 0.10 times less among nurses where there was shortage of nursing staff in the unit than the counterpart. When nurse staffing is inadequate, the ability to practice ethically is questionable. This may be due to when there inadequate staff there was tight schedule at the NICU. This denotes that hiring adequate nursing staff in neonatal intensive care unit can improve neonatal pain management practice. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThose nurses where there had anti-pain drugs in their unit had seven times higher to good neonatal pain management practice than nurses where there were no anti-pain drugs in there unit. Giving anti-pain is one of pain management practice, when there was deficiency of anti-pain or analgesics in unit nurses\u0026rsquo; are prone to poor pain management practice.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study showed 177 (49.7%) study participants only use pharmacological method to relieve pain in newborns while over half 182 (51.1%) of respondents use pharmacological and non-pharmacological combined to relieve pain in neonates. This was in line with study conducted in Addis Ababa\u0026nbsp;(10). This implies using a combination of various non-pharmacological measures achieves high effectiveness than when one of these measures is used alone\u0026nbsp;(17).\u003c/p\u003e\n\u003cp\u003eNon-nutritive sucking 308 (86.5%), breastfeeding 130 (36.5%), positioning 88 (24.7), kangaroo mother care 90 (25.3%), are the most often employed non-pharmacological pain management techniques. Those findings was in line with study conducted in Rwanda(14), and Bangladesh(18). By contrast the first common non-pharmacological measure used in Brazil was providing oral glucose/sucrose\u0026nbsp;(17). This could be due to difference in healthcare infrastructure and study setting.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study, inadequate knowledge about neonatal pain management had shown a significant association with good practice of neonatal pain management. The odd of good practice of neonatal pain management was 22.7% times lower among nurses who had inadequate knowledge about neonatal pain management than the counterpart. This finding is consistent with recent studies conducted in Brazil\u0026nbsp;(17), Addis Ababa\u0026nbsp;(10), and West Oromia\u0026nbsp;(15). This implies as the knowledge of the nurse\u0026apos;s increases regarding neonatal pain management the practice will also advance and be effective in pain management. This might be due to the fact that good knowledge leads to confidence, skill and readiness of nurse to perform their routine activities. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study attempted to close the research gap, there are limited studies that showed nurses practice and factors affecting practice of neonatal pain management, therefore, this study aimed to fill these research gap in Ethiopia. The result of this study identified that there was a gap in the practice of neonatal pain management. The observational result served as a supplementary for the findings. This study had its limitations, and the results must interpret by considering those limitations.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study showed that the practice of nurses regarding neonatal pain management was low. Age of the nurses, marital status, presence of shortage of nursing staff in each shift, presence of pharmacological anti-pain drugs in the unit, and knowledge of nurse regarding neonatal pain management were found to be independent predictors for good neonatal pain management practice.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAOR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Adjusted Odds Ratio\u003c/p\u003e\n\u003cp\u003eCI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Confidence Interval\u003c/p\u003e\n\u003cp\u003eCOR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Crude Odds Ratio\u003c/p\u003e\n\u003cp\u003eIRB \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Institutional Review Board\u003c/p\u003e\n\u003cp\u003eNICU \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Neonatal Intensive Care Unit\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSPSS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Statistical package for social sciences\u003c/p\u003e\n\u003cp\u003eWHO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e:\u0026nbsp;We would like to express our sincere gratitude to the Arba Minch University College of Health and Medical Science for giving us the opportunity and support to perform this research. We would like to extend our deepest appreciation and thanks to our colleagues for their unlimited advice, constructive suggestions and motivation that helped us in this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis study was supported by the Arba Minch University; however, Arba Minch University has no role in manuscript preparation and publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e: All relevant data are within the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e:\u0026nbsp;Since the study involved human participant\u0026rsquo;s Ethical approval was obtained from ethical review Board of the Arba Minch University (reference number IRB/23111/2023). Written informed consent from the each study participants was obtained. Their name and other forms of personal identification were not entered into the data collection format to maintain confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors have declared that no competing interests exist.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eRaja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-82.\u003c/li\u003e\n \u003cli\u003eTarjoman A, Vasigh A, Safari S, Borji M. Pain management in neonatal intensive care units: A cross sectional study of neonatal nurses in Ilam City. Journal of Neonatal Nursing. 2019;25(3):136-8.\u003c/li\u003e\n \u003cli\u003eAlzghoul BI, Abdullah NAC. Pain management practices by nurses: an application of the knowledge, attitude and practices (KAP) model. Global journal of health science. 2016;8(6):154.\u003c/li\u003e\n \u003cli\u003eGolianu B, Krane E, Seybold J, Almgren C, Anand K, editors. Non-pharmacological techniques for pain management in neonates. Seminars in perinatology; 2007: Elsevier.\u003c/li\u003e\n \u003cli\u003eSmith MT, Muralidharan A. Pain pharmacology and the pharmacological management of pain. Pain-E-Book: Pain-E-Book. 2022:225.\u003c/li\u003e\n \u003cli\u003eHall RW, Anand KJ. Pain management in newborns. Clinics in perinatology. 2014;41(4):895-924.\u003c/li\u003e\n \u003cli\u003eAllegaert K, Van Den Anker JN. Neonatal pain management: still in search of the Holy Grail. International journal of clinical pharmacology and therapeutics. 2016;54(7):514.\u003c/li\u003e\n \u003cli\u003eOrovec A, Disher T, Caddell K, Campbell-Yeo M. Assessment and management of procedural pain during the entire neonatal intensive care unit hospitalization. Pain Management Nursing. 2019;20(5):503-11.\u003c/li\u003e\n \u003cli\u003eGuedj R, Danan C, Daoud P, Zupan V, Renolleau S, Zana E, et al. Does neonatal pain management in intensive care units differ between night and day? An observational study. BMJ open. 2014;4(2):e004086.\u003c/li\u003e\n \u003cli\u003eWari G, Wordofa B, Alemu W, Habte T. Knowledge and practice of nurses and associated factors in managing neonatal pain at selected public hospitals in Addis Ababa, Ethiopia, 2020. Journal of multidisciplinary healthcare. 2021:2275-86.\u003c/li\u003e\n \u003cli\u003eKebede SM, Degefa M, Getachew T, Lami M, Tadesse B, Bekele H. Neonatal pain management practice in the neonatal intensive care unit of public hospitals: a survey of healthcare providers in eastern Ethiopia. International Health. 2023:ihad095.\u003c/li\u003e\n \u003cli\u003eQasim YK, Abdeljawad H, Abusafia AH. Nurses\u0026apos; knowledge and practice in assessment and management of neonatal pain at Governmental Hospitals in Gaza Strip: A cross sectional study. Clinical Journal of Nursing Care and Practice. 2021;5(1):038-42.\u003c/li\u003e\n \u003cli\u003eWuni A, Salia SM, Mohammed Ibrahim M, Iddriss I, Abena Nyarko B, Nabila Seini S, et al. Evaluating knowledge, practices, and barriers of paediatric pain management among nurses in a tertiary health facility in the northern region of Ghana: A descriptive cross-sectional study. Pain Research and Management. 2020;2020.\u003c/li\u003e\n \u003cli\u003eMuteteli C, Tengera O, Gowan M. Neonatal pain management among nurses and midwives at two Kigali hospitals. Rwanda Journal of Medicine and Health Sciences. 2019;2(2):138-46.\u003c/li\u003e\n \u003cli\u003eMekonen MWM, Muhye MAB, Gobeza MMB. Knowledge, Practice, and factors associated with neonatal pain management among nurses working at West Oromia Public Hospitals, Ethiopia: A cross-sectional study. 2022.\u003c/li\u003e\n \u003cli\u003eCherlin AJ. The weakening link between marriage and the care of children. Family Planning Perspectives. 1988:302-6.\u003c/li\u003e\n \u003cli\u003eCosta T, Rossato LM, Bueno M, Secco IL, Sposito NPB, Harrison D, et al. Nurses\u0026apos; knowledge and practices regarding pain management in newborns. Revista da Escola de Enfermagem da USP. 2017;51:e03210.\u003c/li\u003e\n \u003cli\u003eHossain MS. Nurses\u0026rsquo; knowledge and attitudes, and pain management practice of post-operative children in Bangladesh: Prince of Songkla University; 2010.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Practice, Pain, Neonatal intensive care unit, Nurses","lastPublishedDoi":"10.21203/rs.3.rs-5440099/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5440099/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eNeonatal pain management is an integral part of nurse’s practices working in neonatal intensive care units. Improper neonatal pain management can have negative consequence for the health and development of newborns. In Ethiopia, neonatal pain management practices among nurses working in neonatal intensive care unit were not well known. Hence, this study assessed neonatal pain management practice and associated factors among nurses working in the neonatal intensive care units of public hospitals in Southern Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eAn institution-based cross-sectional study design was conducted among 369 randomly selected nurses working in the neonatal intensive care units of public hospitals in southern Ethiopia. Data were collected using a pre-tested, structured, and self-administered questionnaire accompanied with an observation checklist. The collected data were reviewed, coded and entered using Epi-data version 3.1 and exported to SPSS version 26 for analysis. Bivariate and multivariable logistic regression analyses were used to identify the associations between outcome and predictor variables. The degree of association was estimated with odds ratio with 95% confidence level and P-values \u0026lt; 0.05 were considered to detect statistical significance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe study revealed that 18.3% (95%CI: 14.4, 22.7) of the nurses had good neonatal pain management practice. On observation 16.2% (95%CI: 6.2, 32.0) of nurses were practicing proper neonatal pain management. Respondents with age ≤ 30 years [AOR = 3.02, 95%CI (1.30, 7.01)], married nurses [AOR = 4.90, 95%CI(2.09, 9.49)],availability of anti-pain drug in the unit [AOR = 7.24, (2.66, 11.69)], shortage of nursing staff at each shift [AOR = 0.097, (0.034, 0.279), and poor knowledge about neonatal pain [AOR = 0.23, (0.08, 0.62)] were factors significantly associated with good neonatal pain management practice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe overall practice of neonatal pain management is relatively low. Improving practice of neonatal pain management requires; hiring of adequate nursing staff, improving acess to anti-pain drugs in the unit, and enhancing nurse’s knowledge regarding neonatal pain management.\u003c/p\u003e","manuscriptTitle":"Neonatal Pain Management Practice and Associated Factors among Nurses Working in Public Hospitals of Southern Ethiopia: A Multicenter Cross- sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-19 10:44:30","doi":"10.21203/rs.3.rs-5440099/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2cd841af-aa91-448e-bdc7-e3fbaf21f1dc","owner":[],"postedDate":"December 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-01T16:10:18+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-19 10:44:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5440099","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5440099","identity":"rs-5440099","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}