Postoperative Epidural Analgesia Management Across PACUs and Surgical Wards: Nurses' Learning Needs in Clinical Practice.

PURPOSE: To explore nurses' learning needs and competence development in postoperative epidural analgesia care across postanesthesia care units (PACUs) and surgical wards.

DESIGN

An exploratory qualitative study using semistructured focus group interviews.

METHODS

Seven focus groups were conducted with 31 registered nurses from 5 Danish hospitals. Participants had at least one year of experience caring for patients receiving postoperative epidural analgesia and worked in surgical wards, PACUs, or a high-dependency unit. Data were analyzed using framework analysis to support systematic comparison across clinical settings and levels of experience.

FINDINGS: Three analytical themes were identified: (1) Navigating clinical complexity, (2) Organizational factors shaping practice, and (3) Developing competence through learning. Nurses described postoperative epidural analgesia care as clinically complex, requiring ongoing interpretation of clinical signs and balancing competing priorities to maintain patient safety and effective pain relief. Organizational factors, including resource constraints, ambiguity in roles and responsibilities, and variable access to standardized guidance, influenced clinical decision-making and access to support. Competence development was largely based on informal workplace learning, with differences between PACU and surgical ward settings shaping responsibility, confidence, and learning opportunities.

CONCLUSIONS

Postoperative epidural analgesia care is shaped by clinical complexity, organizational conditions, and context-specific learning opportunities. Predominantly informal learning pathways and variation in support highlight the need for structured, ward-based training, standardized guidance, and clear escalation pathways to support safe and consistent practice.