Health system factors influencing nurses’ ethical-decision making for postoperative pain management in Ghana

Postoperative pain remains a challenge in many healthcare settings. It is unethical if pain is not managed adequately. However, there is inadequate literature on nurses’ ethical decision making on pain management. Thus, this study aimed at exploring the factors influencing ethical decision making for postoperative pain management among nurses in Ghana. Qualitative exploratory descriptive design was used and participants were purposively sampled from the surgical wards of the study hospital. Semi-structured interview guide was used for data collection and saturation was reached at the 14th participant. Thematic analysis was done and three themes emerged: Institutional factors influencing ethical decision making, leadership roles in nurses’ ethical decision making, and inter-professional relationships influencing ethical decision making. Lack of protocols on pain management, no disciplinary and ethics committees, and unavailability of analgesics were perceived to negatively influence ethical decision-making for postoperative pain management. Nurses stated that establishing ethics committee would address ethical issues on pain management. Constructive feedback from clinical unit leaders was also perceived to influence decision making for postoperative pain management positively. The study concluded that, there is need for the nurse to place emphasis on ethically sound decisions when managing postoperative pain since it is a fundamental human right for patients to have their pain managed properly.