A cute pain after surgery is inevitable because of the associated trauma to many pain-sensitive structures. Breivik and Stubhaug (2008) observed that postoperative pain remains grossly undertreated, with up to 70% of patients reporting moderate to severe pain following surgery. Unrelieved pain activates the pituitary- adrenal axis, which can suppress the immune system and result in poor wound healing. Postoperative pain can impair the haematologic, immune, hormonal, cardiac, and respiratory systems. It can also limit Developing a pain assessment tool for patients after major abdominal surgery Ruth Wahila, Etienne Odimba and Catherine Ngoma mobility, interfere with sleep and rest, and contribute to agitation, psychosis, aggressive behaviours and delirium. Thus, the presence of postoperative pain often has a signifcant negative impact on patients’ activities of daily living. In addition, it can have a negative impact on hospital performance because of extended inpatient stays and readmissions, both of which increase care costs. The experience of pain is subjective, and the gold standard for pain assessment is patient self-reporting (Pasero, 2012). However, not all patients are able to self-report postoperative pain, which presents a signifcant challenge for the healthcare team who must ensure that any pain is recognised and treated. Precise and systematic pain assessment is therefore vital for making the correct diagnosis and determining the most efcacious treatment plan. Successful management of postoperative pain depends on a combination of adequate assessment, appropriate (individualised) treatment, and adequate reassessment. Local needs In Zambia, almost all cultures inhibit the expression of pain through self-reporting because there is a belief that an outward expression of pain is belittling to the individual. Self-reporting of pain in Zambia is thus likely to evoke scorn and the person will be stigmatised. Existing pain assessment tools used outside Zambia will therefore have limited applicability for use with patients from indigenous communities. Assessment of postoperative pain in Zambia currently depends primarily on the basic clinical skills of health professionals, that is, taking a detailed history and performing a thorough examination. However, it is not clear whether this type of assessment method is standardised among all practitioners. Some assess pain by observing behaviours associated with pain and discomfort. Such assessment approaches can result in practitioners, specifcally nurses, failing to assess the pain due to the lack of standardised guidance, for example in the form of a ratings tool. In such instances, other strategies must be used to determine and evaluate the presence of pain as cited by Fillingim (2000). One strategy is the use of pain assessment tools, and the choice of assessment method will depend on the patient situation. In Zambia, no pain assessment tool tailored to local beliefs and customs has yet been developed. The use of assessment tools has been shown to improve pain control (Kishner et al 2016). The ideal tool is user-friendly, refects the multidimensional aspects of pain (and, specifcally, the relevant pain state), is valid, reliable, and responsive to change. Generic pain assessment tools that are available worldwide, as already mentioned, may be ill-suited to assess postoperative pain in Zambia because the perception of pain is a 2 British Journal of Nursing, 2018, Vol 27, No 9 © 2018 MA Healthcare Ltd This is an open access article distributed under the terms of the Creative Commons Attribution Noncommercial License (CC BY-NC 4.0, http://creativecommons.org/licenses/by-nc-nd/4.0/). ABSTRACT The purpose of this study was to develop a pain assessment tool for use among postoperative patients in Zambia (Postoperative Pain Assessment tool for Zambia, or POPAZ). Phase 1 of this project was an epidemiological quantitative analytical study conducted at the University Teaching Hospitals, Lusaka in Zambia. The sample comprised of 30 nurses and surgeons who were actively involved in providing direct patient care to post-surgical patients. An adapted Clinical Decision Making Survey tool was used to collect the data. The study revealed fve relevant measures of postoperative pain: patient mobility/ activity, level of tolerance to activity, facial expressions, vital signs and overall patient behaviour. The fndings of this phase have thus provided a framework for the development of a postoperative pain assessment tool that can be used with postsurgical patients following major abdominal surgery. Key words: Pain ■ Assessment tools ■ Culturally appropriate care ■ Surgery Ruth Wahila, Nurse Lecturer, School of Nursing Sciences, and PhD student, University of Zambia, Lusaka, Zambia, ruthwahila@yahoo. co.uk Etienne Odimba, Professor of Surgery, School of Medicine, University of Zambia, Lusaka, Zambia Catherine Ngoma, Senior Nurse Lecturer/ Dean, School of Nursing Sciences, University of Zambia, Lusaka, Zambia Accepted for publication: April 2018