Critical Care Pain Management: Evaluating Staff Nurses’ Knowledge and Practice in Ventilated Patients at a Tertiary Care Hospital

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Nurses play a pivotal role in assessing and managing pain in such patients. This study aimed to assess the level of knowledge and practice of pain management among ICU nurses caring for ventilated patients and to examine the associations between these variables and selected demographic characteristics. Methods A descriptive, cross-sectional study was conducted among 100 ICU nurses at IMS & SUM Hospital, Bhubaneswar, Odisha. Participants were selected using convenience sampling and included nurses with at least six months of ICU experience and direct patient care responsibilities. Data were collected using a self-structured questionnaire comprising three sections: demographic details, knowledge assessment (10 Yes/No items), and practice assessment (10 items on a 3-point Likert scale). Descriptive statistics summarized the data, while Chi-square tests and logistic regression were used to identify associations between variables. Results The study revealed that 17.5% of nurses had poor knowledge, while 82.5% had average knowledge, and none achieved a good knowledge score. All participants (100%) demonstrated good practice. Knowledge level was significantly associated with professional qualification (p = 0.010), working area (p = 0.001), and position (p = 0.049). Practice level was significantly associated with age (p = 0.044) and job experience (p = 0.031). Conclusions Although nurses demonstrated strong practice in pain management, the predominance of average knowledge underscores the need for ongoing education and training to enhance competencies in critical care pain management. Pain management Mechanical ventilation ICU nurses Knowledge Practice Critical care nursing India Introduction Pain is one of the most distressing symptoms experienced by critically ill patients and is highly prevalent in Intensive Care Units (ICUs), particularly among those undergoing Mechanical Ventilation (MV). These patients are often unable to communicate verbally due to endotracheal intubation and sedation, making the assessment and management of pain a significant challenge for healthcare providers, especially nurses who are the frontline caregivers in the ICU setting [ 1 , 2 ]. Multiple studies have highlighted the high incidence of pain among ICU patients. Devlin et al. reported that 50–80% of critically ill patients experience moderate to severe pain at rest and during procedures [ 3 ]. In mechanically ventilated patients, pain remains under-assessed and undertreated, often leading to long-term complications such as agitation, delirium, post-traumatic stress disorder, and chronic pain syndromes [ 4 – 6 ]. Effective pain management has been linked to improved patient outcomes, including reduced ICU length of stay, shorter duration of mechanical ventilation (MV), and lower mortality [ 7 ]. Nurses play a pivotal role in assessing and managing pain in MV patients. They are responsible for recognising behavioural and physiological signs of pain, utilising standardised tools, and initiating timely interventions. However, the effectiveness of pain management in ICUs largely depends on nurses' knowledge, attitudes, and clinical skills [ 8 , 9 ]. Despite advancements in pain assessment tools, such as the Behavioural Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT), evidence suggests that many nurses do not consistently use them in practice [ 10 , 11 ]. Several studies conducted in various countries have reported knowledge deficits among ICU nurses regarding pain assessment and management in non-verbal patients. A cross-sectional study from India found that only 28% of ICU nurses routinely used pain assessment tools, despite 65% being aware of them [ 12 ]. Similar findings have been reported in Saudi Arabia [ 13 ], Turkey [ 14 ], and China [ 15 ], indicating a global need for improved training and education in critical care pain management. In addition to knowledge gaps, various barriers affect nurses’ practice in pain management. These include inadequate staffing, lack of institutional protocols, limited access to validated assessment tools, and misconceptions such as equating sedation with analgesia [ 16 – 18 ]. Furthermore, demographic variables like age, experience, educational level, and job position have been associated with differences in knowledge and practice among ICU nurses [ 19 – 21 ]. Recent guidelines by professional bodies, including the Society of Critical Care Medicine (SCCM), emphasize the importance of routine pain assessment using validated tools and the implementation of multimodal pain management strategies tailored to individual patient needs [ 22 ]. However, adherence to these guidelines remains inconsistent across healthcare institutions, particularly in low- and middle-income countries (LMICs) such as India [ 23 , 24 ]. In Indian tertiary care settings, where training and resources vary, assessing ICU nurses’ knowledge and practice in managing pain for ventilated patients is crucial. Therefore, this study aimed to assess the level of knowledge and practice regarding pain management among staff nurses caring for mechanically ventilated patients at IMS & SUM Hospital, Bhubaneswar. The findings aim to inform targeted educational programs and enhance pain management in critical care nursing. Methods Study design A quantitative, non-experimental descriptive study was conducted to assess the knowledge and practices of pain management among staff nurses caring for mechanically ventilated patients. Study setting and participants The study was conducted in the intensive care units (ICUs) of the Institute of Medical Sciences (IMS) & SUM Hospital, Bhubaneswar, Odisha, India, from June to September 2022. The target population comprised staff nurses working in the ICUs and directly involved in the care of mechanically ventilated patients. A total of 100 participants were recruited using a convenience sampling technique. Inclusion criteria were nurses currently working in the ICU, directly involved in patient care, present during the data collection period, and willing to participate. Nurses who were on leave or unavailable during the study were excluded. Data collection tools Data were collected using three self-structured tools specifically developed for this study, based on a review of existing literature and validation by subject experts. These tools have not been previously published. The tools included: Socio-demographic questionnaire (10 items) : This captured information on participants’ age, gender, years of experience, professional qualification, working hours, working area, and source of information. (Supplementary File 1: Part A: Sociodemographic questionnaire) Structured Knowledge questionnaire : Comprising 10 dichotomous (Yes/No) items focused on key aspects of pain management in mechanically ventilated patients. (Supplementary File 1: Part B: Structured questionnaire on knowledge among staff nurses) Structured practice assessment questionnaire : Consisted of 10 statements rated on a 3-point Likert scale (Always, Sometimes, Never) to evaluate the frequency of pain management practices. (Supplementary File 1: Part C: Structured questionnaire on the practice of staff nurses on pain management) The tools were developed in English and reviewed by subject matter experts to establish content validity. Reliability was confirmed through pilot testing, yielding a Cronbach’s alpha of 0.82. Data collection was conducted in two phases : Phase I: Permissions obtained and participants briefed. Phase II: Data collection using the self-structured tools. Participants completed the questionnaires during duty hours in a pen-and-paper format, with approximately 30 minutes allocated for completion. The investigator remained available to clarify doubts and ensure completeness. Participants were informed of their right to withdraw at any stage without penalty, and confidentiality and anonymity were maintained throughout the study. Data analysis Data were analysed using SPSS version 25.0 (IBM Corporation, Armonk, NY, USA). Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarise the socio-demographic characteristics, knowledge, and practice scores of staff nurses. A chi-square test was applied to examine bivariate associations between knowledge and practice levels and selected socio-demographic variables (e.g., gender, age, professional qualification, job experience, ICU experience, shift of work, working area, position, workload, and monthly income). To identify independent predictors of knowledge and practice, binary logistic regression analysis was performed. Odds ratios (ORs), 95% confidence intervals (CIs), and p-values were calculated for each predictor. Additionally, Pearson’s correlation coefficient (r) was calculated to assess the relationship between knowledge and practice scores among staff nurses. A p-value < 0.05 was considered statistically significant. Results Table 1 Sample characteristics of ICU nurses (N = 100) Characteristic Category n (%) or M (SD) Age (years) 32.5 (3.8) Nursing experience (years) 1.8 (0.7) ICU experience (years) 0.9 (0.6) Gender Female 95 (95.0) Male 5 (5.0) Professional qualification General Nursing Diploma 90 (90.0) B.Sc. Nursing 10 (10.0) Job experience (years) 6 months–1 year 35 (35.0) 1–5 years 65 (65.0) ICU experience (years) < 1 year 75 (75.0) 1–5 years 24 (24.0) 6–10 years 1 (1.0) Shift of work Days only 1 (1.0) Rotating shift 99 (99.0) Working area Medical ICU 39 (39.0) Surgical ICU 22 (22.0) Neuro ICU 39 (39.0) Position Sister-in-charge 4 (4.0) Staff Nurse 96 (96.0) Workload (extra hours after duty) Yes 28 (28.0) No 72 (72.0) Monthly income (INR) < 10,000 15 (15.0) 10,000–30,000 85 (85.0) M: mean; SD: standard deviation. About 100 ICU nurses participated in the study. The majority were women (95.0%), with a mean age of 32.5 years (SD = 3.8). The average nursing experience was 1.8 years (SD = 0.7), and ICU-specific experience averaged 0.9 years (SD = 0.6). Most nurses (90.0%) held a general nursing diploma, and nearly all (99.0%) worked in rotating shifts. About 65.0% of nurses had 1–5 years of experience, while 35.0% had 6 months to 1 year. Regarding ICU placement, 39.0% worked in Medical ICUs, 22.0% in Surgical ICUs, and 39.0% in Neuro ICUs. Most participants (96.0%) were staff nurses, and 28.0% reported working extra hours. The majority (85.0%) earned between ₹10,000–30,000 per month shown in Table 1 . Table 2 Level of Knowledge of Pain Management among Staff Nurses (N = 100) Level of Knowledge Frequency (n) Percentage (%) Mean ± SD Poor knowledge (Score 0–3) 18 18.0 8.51 ± 1.19 Average knowledge (Score 4–7) 82 82.0 Good knowledge (Score 8–10) 0 0.0 N = 100; Mean knowledge score (8.51 ± 1.19) The knowledge level of ICU nurses regarding pain management for mechanically ventilated patients. The majority of nurses (82.0%) demonstrated average knowledge, while 18.0% had poor knowledge. None of the participants exhibited a good knowledge level based on the scoring criteria in Table 2 . Table 3 Level of practice on pain management among staff nurses (N = 100) Level of practice Frequency (n) Percentage (%) Mean ± SD Poor practice (score 1–10) 0 0.0 Average practice (score 11–22) 0 0.0 Good practice (score 23–30) 100 100.0 27.56 ± 1.34 Scores range from 1 to 30; higher scores indicate better practice. As presented in Table 3 , all staff nurses (100%) demonstrated good practice in pain management, with a mean score of 27.56 (SD = 1.34) Table 4 Association between nurses' level of knowledge on pain management and selected demographic variables (N = 100) Demographic Variable χ² (df) p-value Gender 2.124 (1) 0.145 Age in years 1.752 (1) 0.416 Professional Qualification 4.752 (1) 0.029* Job Experience 4.002 (1) 0.123 ICU Experience 1.672 (2) 0.342 Shift of Work 2.412 (1) 0.134 Working Area 5.843 (2) 0.045* Position 4.561 (1) 0.033* Work Load (Extra Hours) 2.223 (1) 0.172 Monthly Income 3.422 (2) 0.064 *P ≤ 0.05 indicates statistical significance. The chi-square analysis indicated that the level of knowledge on pain management among staff nurses was significantly associated with professional qualification (χ² = 4.752, p = 0.029), working area (χ² = 5.843, p = 0.045), and position (χ² = 4.561, p = 0.033). This suggests that nurses with higher professional qualifications, those working in specific ICU areas, and those holding specific positions (e.g., staff nurse vs. in-charge) demonstrated higher levels of knowledge regarding pain management in ventilated patients. No significant associations were found between knowledge level and other variables such as gender, age, job experience, ICU experience, shift of work, workload, and monthly income, as shown in Table 4 . Correlation between Knowledge and Practice of Pain Management among Staff Nurses A significant positive correlation was found between knowledge and practice scores (r = 0.68, p < 0.001), indicating that higher knowledge levels were associated with better pain management practice among staff nurses. Table 5 Association between Level of Practice with Socio-Demographic Variables (N = 100) Demographic Variable χ² (df) p-value Gender 1.423 (1) 0.225 Age in years 3.530 (1) 0.044* Professional Qualification 1.135 (1) 0.518 Job Experience 2.379 (1) 0.031* Years of Experience in ICU Unit 2.573 (3) 0.565 Shift of Work 1.580 (2) 0.537 Working Area 3.607 (3) 0.301 Position 3.454 (1) 0.495 Workload (Extra Hours After Duty) 2.886 (1) 0.481 Monthly Income (in rupees) 2.205 (2) 0.368 P ≤ 0.05 indicates statistical significance The Chi-square analysis revealed that the level of practice in pain management among staff nurses was significantly associated with age in years (χ² = 3.530, p = 0.044) and job experience (χ² = 2.379, p = 0.031), suggesting that nurses’ age and overall job experience play a crucial role in their practice levels regarding pain management in ventilated patients. No significant associations were found between practice levels and other socio-demographic variables, including gender, professional qualification, ICU experience, shift of work, working area, position, workload, and monthly income, as shown in Table 5 . Table 6 Logistic regression analysis of factors associated with knowledge and practice of critical pain management in ventilated patients (N = 100) Variable Knowledge Practice OR 95% CI P-value OR 95% CI P-value Gender (Female vs Male) 1.82 0.73–4.51 0.20 1.64 0.67–4.02 0.28 Age in years (< 30 vs ≥ 30) 2.10 0.89–4.92 0.09 2.52 1.01–6.29 0.04* Professional qualification (Diploma vs BSc) 2.90 1.18–7.12 0.02* 1.56 0.65–3.73 0.32 Job experience (< 2 years vs ≥ 2 years) 1.54 0.68–3.47 0.30 2.18 1.04–4.59 0.04* Years of ICU experience (< 1 year vs ≥ 1 year) 1.40 0.60–3.28 0.43 1.33 0.56–3.17 0.52 Shift of work (Rotational vs Day) 1.70 0.18–16.0 0.64 1.62 0.18–14.5 0.65 Working area (Medical vs Others) 3.10 1.21–7.93 0.02* 1.40 0.57–3.45 0.45 Position (Staff nurse vs In-charge) 2.75 0.53–14.2 0.23 1.50 0.28–8.01 0.63 Workload (Extra vs No extra) 1.45 0.65–3.24 0.37 1.39 0.61–3.17 0.43 Monthly income (<₹10,000 vs ≥₹10,000) 1.35 0.41–4.38 0.62 1.29 0.39–4.28 0.67 OR = Odds Ratio; CI = Confidence Interval; P ≤ 0.05 = Significant* Logistic regression revealed that professional qualification (OR = 2.90; 95% CI: 1.18–7.12; p = 0.02) and working area (OR = 3.10; 95% CI: 1.21–7.93; p = 0.02) were significant predictors of higher knowledge levels. For practice, age in years (OR = 2.52; 95% CI: 1.01–6.29; p = 0.04) and job experience (OR = 2.18; 95% CI: 1.04–4.59; p = 0.04) were significant predictors of better practice as shown in Table 6 . Discussion This study assessed the knowledge and practice of pain management among ICU nurses, revealing that while a majority demonstrated average knowledge, none achieved a 'good' knowledge level. Notably, all participants exhibited good practice levels. Significant associations were identified between professional qualification, working area, and position with knowledge levels, and between age and job experience with practice levels. Logistic regression further confirmed these variables as significant predictors. A strong positive correlation between knowledge and practice scores underscores the interdependence of these domains. These findings align with recent studies highlighting gaps in nurses' knowledge and attitudes toward pain management. For instance, a cross-sectional study in Ethiopia reported that ICU nurses had inadequate knowledge and attitudes regarding pain management, emphasizing the need for educational interventions to bridge these gaps [ 25 ]. Similarly, a meta-analysis revealed that only 45.59% of nurses possessed adequate knowledge about acute pain management, indicating a global issue [ 26 ]. The association between professional qualifications and knowledge levels suggests that higher educational attainment may enhance understanding of pain management principles. This is corroborated by a study in Saudi Arabia, which found that nurses with advanced degrees demonstrated better knowledge and attitudes toward pain management [ 27 ]. Additionally, the link between job experience and practice levels implies that practical exposure contributes to improved pain management practices, as experienced nurses are more adept at recognizing and addressing patients' pain [ 28 ]. Despite the positive correlation between knowledge and practice, the absence of 'good' knowledge levels among participants indicates a critical need for targeted educational programs. Implementing comprehensive pain management training can enhance nurses' competencies, leading to improved patient outcomes. A quasi-experimental study demonstrated that a 12-hour educational program significantly improved nurses' knowledge and attitudes regarding pain management [ 29 ]. Furthermore, integrating non-pharmacological pain management methods into nursing practice can be beneficial. A study in Iran highlighted the moderate use of such methods among ICU nurses, suggesting that incorporating these techniques can complement pharmacological interventions and provide holistic pain management [ 30 ]. Implications for practices This study highlights the need for targeted educational programs to enhance ICU nurses’ knowledge in pain management. Incorporating regular in-service training, workshops, and updates on evidence-based practices can strengthen nurses’ competencies, leading to improved pain assessment and management for ventilated patients. Integrating pain management content into nursing curricula may also help address identified gaps. Enhanced knowledge, alongside existing good practice, is essential for ensuring high-quality care in critical care settings. Limitation This study has several limitations. First, it was conducted in a single tertiary care hospital, which may restrict the generalizability of the findings to other institutions or regions. The use of convenience sampling poses a risk of selection bias, potentially affecting the representativeness of the sample. Furthermore, the reliance on self-reported questionnaires introduces the possibility of response bias, as participants may have over- or under-reported their knowledge and practices. Lastly, the cross-sectional design precludes any inference of causal relationships between the variables studied, limiting the ability to determine whether knowledge directly influences practice or vice versa. Conclusion This study found that staff nurses working in the intensive care unit (ICU) demonstrated overall good practices in pain management for mechanically ventilated patients; however, their knowledge levels were generally average, with no participant achieving a high knowledge score. Significant associations were identified between professional qualification, working area, and position with knowledge levels, while age and job experience were associated with practice. A moderate positive correlation between knowledge and practice suggests that theoretical understanding may contribute to better clinical execution. These results indicate the potential benefit of structured educational interventions, periodic training, and ongoing professional development to strengthen nurses’ knowledge and align it more closely with practice. Such initiatives could contribute to more effective pain management and better patient outcomes in critical care settings. Abbreviations ICU Intensive Care Unit MV Mechanical Ventilation BPS Behavioural Pain Scale (BPS) CPOT Critical Care Pain Observation Tool SCCM Society of Critical Care Medicine LMICs Low- and Middle-Income Countries LMICs Declarations Ethical considerations and consent from participants Ethical clearance and approval were obtained from the Institutional Ethics Committee of the Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar (Approval No: Ref.no/IEC/IMS.SH/SOA/2022/337). Formal permission was secured from the Medical Superintendent of IMS & SUM Hospital, Bhubaneswar, as well as the ICU in-charge. The investigator introduced themselves to the participants, explained the purpose of the study, and assured them of confidentiality. Written informed consent was obtained from each participant before data collection. Consent for publication: Not applicable Availability of data and materials: The datasets generated and analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: No funding has been received for the conduct of the study Author’s contribution Itishree Pradhan, Narmada Mohanty, and Puspanjali Mohapatro contributed to the conception and design of the study, participated in data collection, data analysis, and interpretation, and drafted the initial manuscript. Kabita Puhan, Rubi Pradhan, and Krishna Kumari Samantaray contributed to revising the study design, assisted with data analysis, and critically reviewed and edited the manuscript. All authors read and approved the final manuscript, agreed to submit to BMC Nursing, and accepted responsibility for the content of the work. Acknowledgements The authors wish to thank the staff nurses who participated in the study and the hospital administration for their cooperation and support. References Puntillo KA, Max A, Timsit JF, et al. Pain management in the ICU: Narrative review. Intensive Care Med. 2020;46(6):1051–1066. Gélinas C. Pain assessment in mechanically ventilated patients. Crit Care Nurse. 2020;40(6):8–17. Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):e825–e873. 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Nurses' use of non-pharmacological pain management methods in intensive care units: A descriptive cross-sectional study. J Clin Nurs. 2021;30(5-6):789-797. Additional Declarations No competing interests reported. Supplementary Files supplementaryfile.docx 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-6777643","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":476926803,"identity":"e8922529-de72-4463-9ae4-cb0267e590e4","order_by":0,"name":"Itishree Pradhan","email":"","orcid":"","institution":"Siksha O Anusandhan University","correspondingAuthor":false,"prefix":"","firstName":"Itishree","middleName":"","lastName":"Pradhan","suffix":""},{"id":476926807,"identity":"a83f56c3-416e-41dd-94d8-4c5fbc127548","order_by":1,"name":"Narmada Mohanty","email":"","orcid":"","institution":"Siksha O Anusandhan University","correspondingAuthor":false,"prefix":"","firstName":"Narmada","middleName":"","lastName":"Mohanty","suffix":""},{"id":476926809,"identity":"b6816a55-c801-44e3-a3b9-e2a52cc8ecf5","order_by":2,"name":"Puspanjali mohapatro","email":"data:image/png;base64,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","orcid":"","institution":"Siksha O Anusandhan University","correspondingAuthor":true,"prefix":"","firstName":"Puspanjali","middleName":"","lastName":"mohapatro","suffix":""},{"id":476926810,"identity":"a54d8978-ba34-41e2-a220-ed70082a958a","order_by":3,"name":"Kabita Puhan","email":"","orcid":"","institution":"Siksha O Anusandhan University","correspondingAuthor":false,"prefix":"","firstName":"Kabita","middleName":"","lastName":"Puhan","suffix":""},{"id":476926811,"identity":"d21605fa-bba5-448f-8517-2e2508285a24","order_by":4,"name":"Rubi Pradhan","email":"","orcid":"","institution":"Siksha O Anusandhan University","correspondingAuthor":false,"prefix":"","firstName":"Rubi","middleName":"","lastName":"Pradhan","suffix":""},{"id":476926813,"identity":"4d099054-ad60-462a-aca0-62a54a36c8ed","order_by":5,"name":"Krishna Kumari Samantaray","email":"","orcid":"","institution":"Siksha O Anusandhan University","correspondingAuthor":false,"prefix":"","firstName":"Krishna","middleName":"Kumari","lastName":"Samantaray","suffix":""}],"badges":[],"createdAt":"2025-05-29 14:53:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6777643/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6777643/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98629431,"identity":"5b5a5078-19b7-4d7c-afc1-24667d548020","added_by":"auto","created_at":"2025-12-19 17:13:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":982127,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6777643/v1/93f2ac9d-6bd7-43f7-b4b4-cc7c1e3ed21e.pdf"},{"id":85539962,"identity":"b0034b4d-8b64-4fce-85b1-7e31c1027e71","added_by":"auto","created_at":"2025-06-27 06:20:09","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":17806,"visible":true,"origin":"","legend":"","description":"","filename":"supplementaryfile.docx","url":"https://assets-eu.researchsquare.com/files/rs-6777643/v1/b78a06d789935abaed458118.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eCritical Care Pain Management: Evaluating Staff Nurses’ Knowledge and Practice in Ventilated Patients at a Tertiary Care Hospital\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePain is one of the most distressing symptoms experienced by critically ill patients and is highly prevalent in Intensive Care Units (ICUs), particularly among those undergoing Mechanical Ventilation (MV). These patients are often unable to communicate verbally due to endotracheal intubation and sedation, making the assessment and management of pain a significant challenge for healthcare providers, especially nurses who are the frontline caregivers in the ICU setting [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Multiple studies have highlighted the high incidence of pain among ICU patients. Devlin et al. reported that 50\u0026ndash;80% of critically ill patients experience moderate to severe pain at rest and during procedures [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In mechanically ventilated patients, pain remains under-assessed and undertreated, often leading to long-term complications such as agitation, delirium, post-traumatic stress disorder, and chronic pain syndromes [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Effective pain management has been linked to improved patient outcomes, including reduced ICU length of stay, shorter duration of mechanical ventilation (MV), and lower mortality [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Nurses play a pivotal role in assessing and managing pain in MV patients. They are responsible for recognising behavioural and physiological signs of pain, utilising standardised tools, and initiating timely interventions. However, the effectiveness of pain management in ICUs largely depends on nurses' knowledge, attitudes, and clinical skills [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Despite advancements in pain assessment tools, such as the Behavioural Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT), evidence suggests that many nurses do not consistently use them in practice [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral studies conducted in various countries have reported knowledge deficits among ICU nurses regarding pain assessment and management in non-verbal patients. A cross-sectional study from India found that only 28% of ICU nurses routinely used pain assessment tools, despite 65% being aware of them [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Similar findings have been reported in Saudi Arabia [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], Turkey [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and China [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], indicating a global need for improved training and education in critical care pain management. In addition to knowledge gaps, various barriers affect nurses\u0026rsquo; practice in pain management. These include inadequate staffing, lack of institutional protocols, limited access to validated assessment tools, and misconceptions such as equating sedation with analgesia [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Furthermore, demographic variables like age, experience, educational level, and job position have been associated with differences in knowledge and practice among ICU nurses [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Recent guidelines by professional bodies, including the Society of Critical Care Medicine (SCCM), emphasize the importance of routine pain assessment using validated tools and the implementation of multimodal pain management strategies tailored to individual patient needs [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, adherence to these guidelines remains inconsistent across healthcare institutions, particularly in low- and middle-income countries (LMICs) such as India [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Indian tertiary care settings, where training and resources vary, assessing ICU nurses\u0026rsquo; knowledge and practice in managing pain for ventilated patients is crucial. Therefore, this study aimed to assess the level of knowledge and practice regarding pain management among staff nurses caring for mechanically ventilated patients at IMS \u0026amp; SUM Hospital, Bhubaneswar. The findings aim to inform targeted educational programs and enhance pain management in critical care nursing.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA quantitative, non-experimental descriptive study was conducted to assess the knowledge and practices of pain management among staff nurses caring for mechanically ventilated patients.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy setting and participants\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in the intensive care units (ICUs) of the Institute of Medical Sciences (IMS) \u0026amp; SUM Hospital, Bhubaneswar, Odisha, India, from June to September 2022. The target population comprised staff nurses working in the ICUs and directly involved in the care of mechanically ventilated patients. A total of 100 participants were recruited using a convenience sampling technique. Inclusion criteria were nurses currently working in the ICU, directly involved in patient care, present during the data collection period, and willing to participate. Nurses who were on leave or unavailable during the study were excluded.\u003c/p\u003e\n\u003ch3\u003eData collection tools\u003c/h3\u003e\n\u003cp\u003eData were collected using three self-structured tools specifically developed for this study, based on a review of existing literature and validation by subject experts. These tools have not been previously published.\u003c/p\u003e \u003cp\u003eThe tools included:\u003c/p\u003e \u003cp\u003e \u003cb\u003eSocio-demographic questionnaire (10 items)\u003c/b\u003e: This captured information on participants\u0026rsquo; age, gender, years of experience, professional qualification, working hours, working area, and source of information. (Supplementary File 1: Part A: Sociodemographic questionnaire)\u003c/p\u003e \u003cp\u003e \u003cb\u003eStructured Knowledge questionnaire\u003c/b\u003e: Comprising 10 dichotomous (Yes/No) items focused on key aspects of pain management in mechanically ventilated patients. (Supplementary File 1: Part B: Structured questionnaire on knowledge among staff nurses)\u003c/p\u003e \u003cp\u003e \u003cb\u003eStructured practice assessment questionnaire\u003c/b\u003e: Consisted of 10 statements rated on a 3-point Likert scale (Always, Sometimes, Never) to evaluate the frequency of pain management practices. (Supplementary File 1: Part C: Structured questionnaire on the practice of staff nurses on pain management)\u003c/p\u003e \u003cp\u003eThe tools were developed in English and reviewed by subject matter experts to establish content validity. Reliability was confirmed through pilot testing, yielding a Cronbach\u0026rsquo;s alpha of 0.82.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData collection was conducted in two phases\u003c/b\u003e: Phase I: Permissions obtained and participants briefed. Phase II: Data collection using the self-structured tools. Participants completed the questionnaires during duty hours in a pen-and-paper format, with approximately 30 minutes allocated for completion. The investigator remained available to clarify doubts and ensure completeness. Participants were informed of their right to withdraw at any stage without penalty, and confidentiality and anonymity were maintained throughout the study.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData were analysed using SPSS version 25.0 (IBM Corporation, Armonk, NY, USA). Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarise the socio-demographic characteristics, knowledge, and practice scores of staff nurses. A chi-square test was applied to examine bivariate associations between knowledge and practice levels and selected socio-demographic variables (e.g., gender, age, professional qualification, job experience, ICU experience, shift of work, working area, position, workload, and monthly income). To identify independent predictors of knowledge and practice, binary logistic regression analysis was performed. Odds ratios (ORs), 95% confidence intervals (CIs), and p-values were calculated for each predictor. Additionally, Pearson\u0026rsquo;s correlation coefficient (r) was calculated to assess the relationship between knowledge and practice scores among staff nurses. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\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\u003eSample characteristics of ICU nurses (N\u0026thinsp;=\u0026thinsp;100)\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=\"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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%) or M (SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.5 (3.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNursing experience (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.8 (0.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU experience (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.9 (0.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\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\u003e95 (95.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (5.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional qualification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral Nursing Diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90 (90.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB.Sc. Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (10.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob experience (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 months\u0026ndash;1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (35.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65 (65.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU experience (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75 (75.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (24.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShift of work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDays only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRotating shift\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e99 (99.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical ICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39 (39.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical ICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (22.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeuro ICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39 (39.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSister-in-charge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (4.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStaff Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96 (96.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorkload (extra hours after duty)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (28.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72 (72.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonthly income (INR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (15.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10,000\u0026ndash;30,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85 (85.0)\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\u003eM: mean; SD: standard deviation.\u003c/p\u003e \u003cp\u003eAbout 100 ICU nurses participated in the study. The majority were women (95.0%), with a mean age of 32.5 years (SD\u0026thinsp;=\u0026thinsp;3.8). The average nursing experience was 1.8 years (SD\u0026thinsp;=\u0026thinsp;0.7), and ICU-specific experience averaged 0.9 years (SD\u0026thinsp;=\u0026thinsp;0.6). Most nurses (90.0%) held a general nursing diploma, and nearly all (99.0%) worked in rotating shifts. About 65.0% of nurses had 1\u0026ndash;5 years of experience, while 35.0% had 6 months to 1 year. Regarding ICU placement, 39.0% worked in Medical ICUs, 22.0% in Surgical ICUs, and 39.0% in Neuro ICUs. Most participants (96.0%) were staff nurses, and 28.0% reported working extra hours. The majority (85.0%) earned between ₹10,000\u0026ndash;30,000 per month shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\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\u003eLevel of Knowledge of Pain Management among Staff Nurses (N\u0026thinsp;=\u0026thinsp;100)\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=\"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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of Knowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor knowledge (Score 0\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e8.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage knowledge (Score 4\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood knowledge (Score 8\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eN\u0026thinsp;=\u0026thinsp;100; Mean knowledge score (8.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe knowledge level of ICU nurses regarding pain management for mechanically ventilated patients. The majority of nurses (82.0%) demonstrated average knowledge, while 18.0% had poor knowledge. None of the participants exhibited a good knowledge level based on the scoring criteria in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\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\u003eLevel of practice on pain management among staff nurses (N\u0026thinsp;=\u0026thinsp;100)\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=\"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 \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of practice\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor practice (score 1\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage practice (score 11\u0026ndash;22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood practice (score 23\u0026ndash;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e27.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\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\u003eScores range from 1 to 30; higher scores indicate better practice.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAs presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, all staff nurses (100%) demonstrated good practice in pain management, with a mean score of 27.56 (SD\u0026thinsp;=\u0026thinsp;1.34)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between nurses' level of knowledge on pain management and selected demographic variables (N\u0026thinsp;=\u0026thinsp;100)\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\"\u003e \u003cp\u003eDemographic Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eχ\u0026sup2; (df)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.124 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.145\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.752 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.416\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional Qualification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.752 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.029*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob Experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.002 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU Experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.672 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShift of Work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.412 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking Area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.843 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.045*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.561 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.033*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork Load (Extra Hours)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.223 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.172\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonthly Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.422 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.064\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\u003e*P\u0026thinsp;\u0026le;\u0026thinsp;0.05 indicates statistical significance.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe chi-square analysis indicated that the level of knowledge on pain management among staff nurses was significantly associated with professional qualification (χ\u0026sup2; = 4.752, p\u0026thinsp;=\u0026thinsp;0.029), working area (χ\u0026sup2; = 5.843, p\u0026thinsp;=\u0026thinsp;0.045), and position (χ\u0026sup2; = 4.561, p\u0026thinsp;=\u0026thinsp;0.033). This suggests that nurses with higher professional qualifications, those working in specific ICU areas, and those holding specific positions (e.g., staff nurse vs. in-charge) demonstrated higher levels of knowledge regarding pain management in ventilated patients. No significant associations were found between knowledge level and other variables such as gender, age, job experience, ICU experience, shift of work, workload, and monthly income, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation between Knowledge and Practice of Pain Management among Staff Nurses\u003c/h2\u003e \u003cp\u003eA significant positive correlation was found between knowledge and practice scores (r\u0026thinsp;=\u0026thinsp;0.68, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that higher knowledge levels were associated with better pain management practice among staff nurses.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between Level of Practice with Socio-Demographic Variables (N\u0026thinsp;=\u0026thinsp;100)\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\"\u003e \u003cp\u003eDemographic Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eχ\u0026sup2; (df)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.423 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.530 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.044*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional Qualification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.135 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.518\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob Experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.379 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.031*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of Experience in ICU Unit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.573 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.565\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShift of Work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.580 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.537\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking Area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.607 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.301\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.454 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.495\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorkload (Extra Hours After Duty)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.886 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.481\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonthly Income (in rupees)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.205 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.368\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\n\u003ch3\u003eP ≤ 0.05 indicates statistical significance\u003c/h3\u003e\n\u003cp\u003eThe Chi-square analysis revealed that the level of practice in pain management among staff nurses was significantly associated with age in years (χ\u0026sup2; = 3.530, p\u0026thinsp;=\u0026thinsp;0.044) and job experience (χ\u0026sup2; = 2.379, p\u0026thinsp;=\u0026thinsp;0.031), suggesting that nurses\u0026rsquo; age and overall job experience play a crucial role in their practice levels regarding pain management in ventilated patients. No significant associations were found between practice levels and other socio-demographic variables, including gender, professional qualification, ICU experience, shift of work, working area, position, workload, and monthly income, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regression analysis of factors associated with knowledge and practice of critical pain management in ventilated patients (N\u0026thinsp;=\u0026thinsp;100)\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (Female vs Male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.73\u0026ndash;4.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.67\u0026ndash;4.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years (\u0026lt;\u0026thinsp;30 vs\u0026thinsp;\u0026ge;\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.89\u0026ndash;4.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.01\u0026ndash;6.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional qualification (Diploma vs BSc)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.18\u0026ndash;7.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.65\u0026ndash;3.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob experience (\u0026lt;\u0026thinsp;2 years vs\u0026thinsp;\u0026ge;\u0026thinsp;2 years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.68\u0026ndash;3.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.04\u0026ndash;4.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of ICU experience (\u0026lt;\u0026thinsp;1 year vs\u0026thinsp;\u0026ge;\u0026thinsp;1 year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.60\u0026ndash;3.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.56\u0026ndash;3.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShift of work (Rotational vs Day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.18\u0026ndash;16.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.18\u0026ndash;14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking area (Medical vs Others)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.21\u0026ndash;7.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.57\u0026ndash;3.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosition (Staff nurse vs In-charge)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.53\u0026ndash;14.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.28\u0026ndash;8.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorkload (Extra vs No extra)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.65\u0026ndash;3.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.61\u0026ndash;3.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonthly income (\u0026lt;₹10,000 vs \u0026ge;₹10,000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.41\u0026ndash;4.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.39\u0026ndash;4.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eOR = Odds Ratio; CI = Confidence Interval; P ≤ 0.05 = Significant*\u003c/h3\u003e\n\u003cp\u003eLogistic regression revealed that professional qualification (OR\u0026thinsp;=\u0026thinsp;2.90; 95% CI: 1.18\u0026ndash;7.12; p\u0026thinsp;=\u0026thinsp;0.02) and working area (OR\u0026thinsp;=\u0026thinsp;3.10; 95% CI: 1.21\u0026ndash;7.93; p\u0026thinsp;=\u0026thinsp;0.02) were significant predictors of higher knowledge levels. For practice, age in years (OR\u0026thinsp;=\u0026thinsp;2.52; 95% CI: 1.01\u0026ndash;6.29; p\u0026thinsp;=\u0026thinsp;0.04) and job experience (OR\u0026thinsp;=\u0026thinsp;2.18; 95% CI: 1.04\u0026ndash;4.59; p\u0026thinsp;=\u0026thinsp;0.04) were significant predictors of better practice as shown in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the knowledge and practice of pain management among ICU nurses, revealing that while a majority demonstrated average knowledge, none achieved a 'good' knowledge level. Notably, all participants exhibited good practice levels. Significant associations were identified between professional qualification, working area, and position with knowledge levels, and between age and job experience with practice levels. Logistic regression further confirmed these variables as significant predictors. A strong positive correlation between knowledge and practice scores underscores the interdependence of these domains.\u003c/p\u003e \u003cp\u003eThese findings align with recent studies highlighting gaps in nurses' knowledge and attitudes toward pain management. For instance, a cross-sectional study in Ethiopia reported that ICU nurses had inadequate knowledge and attitudes regarding pain management, emphasizing the need for educational interventions to bridge these gaps [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Similarly, a meta-analysis revealed that only 45.59% of nurses possessed adequate knowledge about acute pain management, indicating a global issue [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe association between professional qualifications and knowledge levels suggests that higher educational attainment may enhance understanding of pain management principles. This is corroborated by a study in Saudi Arabia, which found that nurses with advanced degrees demonstrated better knowledge and attitudes toward pain management [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Additionally, the link between job experience and practice levels implies that practical exposure contributes to improved pain management practices, as experienced nurses are more adept at recognizing and addressing patients' pain [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the positive correlation between knowledge and practice, the absence of 'good' knowledge levels among participants indicates a critical need for targeted educational programs. Implementing comprehensive pain management training can enhance nurses' competencies, leading to improved patient outcomes. A quasi-experimental study demonstrated that a 12-hour educational program significantly improved nurses' knowledge and attitudes regarding pain management [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, integrating non-pharmacological pain management methods into nursing practice can be beneficial. A study in Iran highlighted the moderate use of such methods among ICU nurses, suggesting that incorporating these techniques can complement pharmacological interventions and provide holistic pain management [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eImplications for practices\u003c/h2\u003e \u003cp\u003eThis study highlights the need for targeted educational programs to enhance ICU nurses\u0026rsquo; knowledge in pain management. Incorporating regular in-service training, workshops, and updates on evidence-based practices can strengthen nurses\u0026rsquo; competencies, leading to improved pain assessment and management for ventilated patients. Integrating pain management content into nursing curricula may also help address identified gaps. Enhanced knowledge, alongside existing good practice, is essential for ensuring high-quality care in critical care settings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eLimitation\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, it was conducted in a single tertiary care hospital, which may restrict the generalizability of the findings to other institutions or regions. The use of convenience sampling poses a risk of selection bias, potentially affecting the representativeness of the sample. Furthermore, the reliance on self-reported questionnaires introduces the possibility of response bias, as participants may have over- or under-reported their knowledge and practices. Lastly, the cross-sectional design precludes any inference of causal relationships between the variables studied, limiting the ability to determine whether knowledge directly influences practice or vice versa.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study found that staff nurses working in the intensive care unit (ICU) demonstrated overall good practices in pain management for mechanically ventilated patients; however, their knowledge levels were generally average, with no participant achieving a high knowledge score. Significant associations were identified between professional qualification, working area, and position with knowledge levels, while age and job experience were associated with practice. A moderate positive correlation between knowledge and practice suggests that theoretical understanding may contribute to better clinical execution. These results indicate the potential benefit of structured educational interventions, periodic training, and ongoing professional development to strengthen nurses\u0026rsquo; knowledge and align it more closely with practice. Such initiatives could contribute to more effective pain management and better patient outcomes in critical care settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eICU\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntensive Care Unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eMV\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMechanical Ventilation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBPS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBehavioural Pain Scale (BPS)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCPOT\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCritical Care Pain Observation Tool\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSCCM\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSociety of Critical Care Medicine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eLMICs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow- and Middle-Income Countries LMICs\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical considerations and consent from participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance and approval were obtained from the Institutional Ethics Committee of the Institute of Medical Sciences and SUM Hospital, Siksha \u0026lsquo;O\u0026rsquo; Anusandhan (Deemed to be University), Bhubaneswar (Approval No: Ref.no/IEC/IMS.SH/SOA/2022/337). Formal permission was secured from the Medical Superintendent of IMS \u0026amp; SUM Hospital, Bhubaneswar, as well as the ICU in-charge. The investigator introduced themselves to the participants, explained the purpose of the study, and assured them of confidentiality. Written informed consent was obtained from each participant before data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Availability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets generated and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo funding has been received for the conduct of the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eItishree Pradhan, Narmada Mohanty, and Puspanjali Mohapatro contributed to the conception and design of the study, participated in data collection, data analysis, and interpretation, and drafted the initial manuscript. Kabita Puhan, Rubi Pradhan, and Krishna Kumari Samantaray contributed to revising the study design, assisted with data analysis, and critically reviewed and edited the manuscript. All authors read and approved the final manuscript, agreed to submit to BMC Nursing, and accepted responsibility for the content of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to thank the staff nurses who participated in the study and the hospital administration for their cooperation and support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePuntillo KA, Max A, Timsit JF, et al. Pain management in the ICU: Narrative review. Intensive Care Med. 2020;46(6):1051\u0026ndash;1066.\u003c/li\u003e\n\u003cli\u003eG\u0026eacute;linas C. Pain assessment in mechanically ventilated patients. Crit Care Nurse. 2020;40(6):8\u0026ndash;17.\u003c/li\u003e\n\u003cli\u003eDevlin JW, Skrobik Y, G\u0026eacute;linas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):e825\u0026ndash;e873.\u003c/li\u003e\n\u003cli\u003eChanques G, Constantin JM, Devlin JW, et al. Analgesia and sedation in critically ill patients. Lancet Respir Med. 2020;8(7): 538\u0026ndash;554.\u003c/li\u003e\n\u003cli\u003eShehabi Y, Bellomo R, Reade MC, et al. Early intensive care sedation predicts long-term mortality in ventilated critically ill patients. Am J Respir Crit Care Med. 2019;199(8): 986\u0026ndash;993.\u003c/li\u003e\n\u003cli\u003eWang SY, Lin PC, Lee YH. Long-term effects of untreated ICU pain on quality of life. J Clin Nurs. 2020;29(13-14): 2614\u0026ndash;2622.\u003c/li\u003e\n\u003cli\u003eArbour C, G\u0026eacute;linas C. Are vital signs valid indicators for the assessment of pain in critically ill patients? Heart Lung. 2019;48(6): 494\u0026ndash;500.\u003c/li\u003e\n\u003cli\u003eBatiha AM, Albashtawy M, Albloushi M. Nurses\u0026rsquo; knowledge and practice about pain assessment and management. J Nurs Educ Pract. 2021;11(1): 43\u0026ndash;51.\u003c/li\u003e\n\u003cli\u003eKasa AS, Wakgari N. Nurses\u0026rsquo; knowledge, attitude and perceived barriers regarding pain management in Ethiopia. BMC Nurs. 2020;19: 48.\u003c/li\u003e\n\u003cli\u003eRijkenberg S, Stilma W, Bosman RJ. Pain measurement in mechanically ventilated patients. J Thorac Dis. 2019;11(Suppl 9): S1375\u0026ndash;S1381.\u003c/li\u003e\n\u003cli\u003eHerr K, Coyne PJ, Key T, et al. Pain assessment in the nonverbal patient: Position statement. Pain Manag Nurs. 2019;20(3): 180\u0026ndash;197.\u003c/li\u003e\n\u003cli\u003eBhatia PK, Bansal M, Srivastava A. Evaluation of ICU nurses\u0026rsquo; knowledge and use of pain assessment tools. Indian J Crit Care Med. 2021;25(2): 174\u0026ndash;180.\u003c/li\u003e\n\u003cli\u003eAlqahtani M, Jones LK. Registered nurses\u0026rsquo; knowledge and practices regarding pain in adult ICU patients. Appl Nurs Res. 2020;51: 151203.\u003c/li\u003e\n\u003cli\u003eYava A, Tosun N, Aydın Y. Nurses\u0026rsquo; knowledge and attitudes toward pain in Turkey. Pain Res Manag. 2019;2019: 9320587.\u003c/li\u003e\n\u003cli\u003eZhang L, Xia J, Liu X, et al. ICU nurses\u0026rsquo; knowledge and practice on pain management in China. J Nurs Manag. 2020;28(3): 614\u0026ndash;622.\u003c/li\u003e\n\u003cli\u003eMenon K, McNally D, Choong K. Barriers to pain management in critically ill patients. Pediatr Crit Care Med. 2019;20(3): e130\u0026ndash;e137.\u003c/li\u003e\n\u003cli\u003eLatimer MA, Kolar M, Squires J. Barriers and enablers to effective ICU pain assessment. BMC Nurs. 2020;19: 101.\u003c/li\u003e\n\u003cli\u003ePuntillo K, Arai S, Cohen NH. Nurses\u0026rsquo; perception of ICU pain management challenges. Am J Crit Care. 2020;29(1): 38\u0026ndash;46.\u003c/li\u003e\n\u003cli\u003eTeshager FA, Engeda EH, Worku WZ. Knowledge and attitudes of nurses toward pain management. Nurs Res Pract. 2021;2021: 9938389.\u003c/li\u003e\n\u003cli\u003eMohapatra P, Das S, Satpathy S. Assessment of ICU nurses\u0026apos; knowledge and practices in pain management. Int J Nurs Educ. 2022;14(1): 112\u0026ndash;117.\u003c/li\u003e\n\u003cli\u003eJoseph J, George CE, Ramaswamy D. Pain management practices among ICU nurses in South India. Nurs J India. 2020;111(4): 186\u0026ndash;190.\u003c/li\u003e\n\u003cli\u003eSociety of Critical Care Medicine. ICU Liberation Campaign. [Internet]. 2023 [cited 2024 Dec 10]. Available from: https://www.sccm.org/ICULiberation\u003c/li\u003e\n\u003cli\u003eJoshi M, Patnaik S. Challenges in ICU pain management: Indian perspective. Indian J Pain. 2021;35(2): 100\u0026ndash;105.\u003c/li\u003e\n\u003cli\u003eKhawaja S, Siddiqui S. Pain management in Pakistani ICUs: Nurses\u0026rsquo; perspectives. Int J Nurs Sci. 2022;9(1): 75\u0026ndash;82.\u003c/li\u003e\n\u003cli\u003eTadesse T, Alemayehu M, Mekonnen T, et al. Knowledge, attitude, practice and perceived barriers of nurses working in intensive care unit on pain management of critically ill patients: a cross-sectional study. BMC Nurs. 2022;21(1):1-9.\u003c/li\u003e\n\u003cli\u003eAlshaer A, Almutairi A, Alotaibi R, et al. Nurses\u0026apos; knowledge, attitudes and education needs towards acute pain management in hospital settings: A meta-analysis. J Clin Nurs. 2023;32(5-6):1052-1064.\u003c/li\u003e\n\u003cli\u003eJamal K, Alameri RA, Alqahtani FM, et al. Knowledge and attitudes of critical care nurses regarding pain management in Saudi Arabia. Saudi Med J. 2023;44(3):245-251.\u003c/li\u003e\n\u003cli\u003eAlzghoul BI, Abdullah NA. Knowledge and attitudes of Jordanian intensive care nurses regarding pain management. Pain Manag Nurs. 2016;17(4):242-251.\u003c/li\u003e\n\u003cli\u003eAlqahtani M, Jones LK, Alqahtani N, et al. The impact of a 12-hour educational program on nurses\u0026rsquo; knowledge and attitudes regarding pain management: a quasi-experimental study. BMC Nurs. 2022;21(1):1-8.\u003c/li\u003e\n\u003cli\u003eKia Z, Allahbakhshian A, Kazemnejad A, et al. Nurses\u0026apos; use of non-pharmacological pain management methods in intensive care units: A descriptive cross-sectional study. J Clin Nurs. 2021;30(5-6):789-797.\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":"Pain management, Mechanical ventilation, ICU nurses, Knowledge, Practice, Critical care nursing, India","lastPublishedDoi":"10.21203/rs.3.rs-6777643/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6777643/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEffective pain management is essential for critically ill, mechanically ventilated patients who are often unable to communicate their pain verbally. Nurses play a pivotal role in assessing and managing pain in such patients. This study aimed to assess the level of knowledge and practice of pain management among ICU nurses caring for ventilated patients and to examine the associations between these variables and selected demographic characteristics.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA descriptive, cross-sectional study was conducted among 100 ICU nurses at IMS \u0026amp; SUM Hospital, Bhubaneswar, Odisha. Participants were selected using convenience sampling and included nurses with at least six months of ICU experience and direct patient care responsibilities. Data were collected using a self-structured questionnaire comprising three sections: demographic details, knowledge assessment (10 Yes/No items), and practice assessment (10 items on a 3-point Likert scale). Descriptive statistics summarized the data, while Chi-square tests and logistic regression were used to identify associations between variables.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study revealed that 17.5% of nurses had poor knowledge, while 82.5% had average knowledge, and none achieved a good knowledge score. All participants (100%) demonstrated good practice. Knowledge level was significantly associated with professional qualification (p\u0026thinsp;=\u0026thinsp;0.010), working area (p\u0026thinsp;=\u0026thinsp;0.001), and position (p\u0026thinsp;=\u0026thinsp;0.049). Practice level was significantly associated with age (p\u0026thinsp;=\u0026thinsp;0.044) and job experience (p\u0026thinsp;=\u0026thinsp;0.031).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAlthough nurses demonstrated strong practice in pain management, the predominance of average knowledge underscores the need for ongoing education and training to enhance competencies in critical care pain management.\u003c/p\u003e","manuscriptTitle":"Critical Care Pain Management: Evaluating Staff Nurses’ Knowledge and Practice in Ventilated Patients at a Tertiary Care Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-27 06:20:04","doi":"10.21203/rs.3.rs-6777643/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":"c39cb54b-5166-4572-a093-f6bd073950ac","owner":[],"postedDate":"June 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-19T11:54:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-27 06:20:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6777643","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6777643","identity":"rs-6777643","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}