Nurses' knowledge about pharmacological and nonpharmacological pain management in children

Child and adolescent psychiatry staff's knowledge on pain management

OBJECTIVE

To assess the level of child and adolescent psychiatric staff's knowledge regarding pain management, to determine group differences between the medically more educated (physicians, nurses) and the less educated (psychologists, educators, special therapists) and to investigate the influence of gender, age, or professional experience as well as staff's own pain experiences.

METHODS

A total of 193 staff members from different professional backgrounds from three independent child and adolescent psychiatry clinics in Northern Germany were tested using the German version of the Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain Shriner's revision (PNKAS-Sr).

RESULTS

In total, the staff scored correctly 66% of the inventory questions. There was no difference between medically more educated and less educated staff members regarding the knowledge of pain management. The main factors influencing PNKAS score were age, profession, and pain education training.

CONCLUSIONS

Although chronic pain is not one of the main aspects of continuing education in child and adolescent psychiatry, the resulting level of knowledge was comparable to results of similar surveys with paediatric staffs. Nevertheless, further education is needed to enhance knowledge and understanding of children's pain in child psychiatry staff in order to professionally treat patients with chronic somatic and mental illnesses.

Effect of using vacutainers with cartoon characters on the pain and fear levels of preschoolers during bloodletting

AIM

Our study aims to analyse the effect of using a vacutainer with cartoon characters on preschoolers' pain and fear levels during the bloodletting process.

METHODS

The experimental, randomised controlled clinical trial was conducted with 102 children aged 3-6 years, randomised into control and experimental groups. The bloodletting routine was applied to the control group. The vacutainer of each child in the experimental group was covered with the illustration of their chosen cartoon character and blood was drawn with it. The fear and pain levels during the bloodletting procedure were examined in both groups.

RESULTS

Pain and fear levels were significantly lower in the experimental group than in the experimental group (P < 0.05).

CONCLUSIONS

Our research highlighted that using a cartoon character sticker with a vacutainer can reduce preschoolers' pain and fear during bloodletting.

Are nurses utilizing the non-pharmacological pain management techniques in surgical wards?

The non-pharmacological pain management therapies have a valuable effect in managing moderate to mild pain intensity, especially if demonstrated in the pre-operative phase. The study aimed to explore the nurses’ practice toward using non-pharmacological pain management techniques in surgical wards. In a cross-sectional research design, a convenient sample of 47 nurses in the surgical wards in Egyptian hospital (Third Level) participated in the study. Data gathered using modified Non-pharmacological Methods Questionnaire. Results of the study indicated that nurse’s perception regarding applying the cognitive-behavioral methods as a distraction and Positive reinforcement techniques were more common (68.1%,53.2%), whereas most of them used emotional support (93.6%) and preferred to demonstrate physical methods. Meanwhile, nurses addressed the barriers to apply nonpharmacological pain management as lack of time, patient unwillingness, and patients’ health beliefs. Nevertheless, nurses reported the non-pharmacological pain management is less expensive and has fewer side effects than medication and can demonstrated post-discharge. Nurses play a key role in applying effective and different non-pharmacological therapies in surgical wards. Thus, nurses should be encouraged to demonstrate the non-pharmacological pain management therapies with patients undergoing surgical procedures.

General dental practitioners’ knowledge and attitudes on children’s pain and pain management—A questionnaire survey

The aim was to study general dental practitioners’ knowledge and attitudes on pain and pain management in children and adolescents, using a multidimensional questionnaire. There is little information on dentists’ views on pain in children. The research question was how attitudes and knowledge may correlate to the dentists’ age, sex, years of professional experience, the proportion of working time devoted to treating children and adolescents, as well as being a parent. At the time of the study, 387 general dentists working for the Public Dental Service participated in a web‐based, multidimensional validated questionnaire holding the categories (A) views on the care of children in pain, (B) physiology, (C) pain alleviation, (D) medication, (E) sociology/psychology, (F) Pain assessment instruments and methods, (G) non‐medication methods of pain alleviation, and (H) documentation of pain management. The age categories were given as; below 25, 25‐35, 36‐45, 46‐55 years, and older than 55 years of age. 71% of the responders were female. The dentists’ age cohort, as well as the years of professional experience, tended to make a difference as to the pain interventions in children and adolescents (P < 0.03). The female dentists, in comparison to the male dentists, conveyed different pain treatment strategies (P < 0.03). The proportion of working time devoted to treating children and adolescents, as well as being a parent, did not show significant differences regarding pain strategies. Associations were observed between the age of the dentists studied, the number of years as professionals and the knowledge and attitudes that benefit children's pain treatment. Being a parent was not significant. In this studied group, female dentists displayed significantly more care regarding pain management, than did their male colleagues. Furthermore, the study highlighted the need for a short questionnaire, user‐friendly yet with retained multidimensionality.

Nurses' Knowledge and Attitudes Regarding Pediatric Pain Management in Western Australia

BACKGROUND AND AIM

Despite clinical guidelines, suboptimal pediatric pain management persists. A local audit found poor guideline compliance. Inadequate knowledge is a recognized barrier to the delivery of evidence-based care. The aim of the study was to investigate nurses' knowledge and attitudes regarding pain management at an Australian tertiary pediatric hospital. Design, Setting, Participants and Method: A cross-sectional, descriptive study using the Pediatric Pain Knowledge and Attitudes Questionnaire (Revised) was distributed to 590 nurses in an Australian pediatric hospital.

RESULTS

The mean knowledge score (n = 201) was 77.56 out of 100 (range 49.82-94.16, standard deviation [SD] 8.55); mean attitude score (n = 229) was 72.46 out of 100 (range 33.33-93.33, SD 11.76). Significant differences in mean knowledge scores were found between nurses' designations (p = .018), with the greatest mean difference (MD) between clinical nurses and enrolled nurses (10.5; p = .002). Nurses with experience in critical care had significantly higher mean knowledge scores (MD 3.1; p = .012). Senior registered nurses had the most positive mean attitude score (82.4, SD 6.2), which was significantly higher than clinical nurses (73.77, SD 10.0), registered nurses (71.64, SD 12.6), and enrolled nurses (68.89, SD 8.8) (p < .05). Nurses with specialist pediatric qualifications had significantly more positive attitude scores (mean 75.65, SD 11.6) than those without (mean 70.86, SD 11.7; p = .005). However, 51% of respondents believed that children tolerate pain better than adults do.

CONCLUSION

Although nurses' overall knowledge and attitude toward pediatric pain were among the highest reported, areas for targeted education using in-service education and workshops were identified alongside a need for exploration of the impediments to providing best care.

Paediatric pain management: knowledge, attitudes, barriers and facilitators among nurses - integrative review

AIMS

To identify and synthesize evidence regarding the knowledge and attitudes of nurses, and barriers and facilitators to effective pain assessment and management in infants and children.

BACKGROUND

Pain among children is a common experience. Relief from pain is a fundamental human right, yet hospitalized children continue to experience unrelieved pain. Provision of effective pain management is an integral part of the nurse's role.

METHODS

Guided by Whittemore & Knafl's five-stage framework, primary peer-reviewed studies published in English between 2000 and 2018 were searched using CINAHL, PubMed, ProQuest, PsycINFO and Scopus. The initial search yielded 292 papers. Twenty-seven papers were included in this review: quantitative (n = 18), qualitative (n = 5) and mixed-methods (n = 4).

RESULTS

Findings showed that nurses internationally have poor knowledge and attitudes of basic pain assessment and management principles. Barriers to effective pain management include the absence of pain education and assessment tools, parents' reluctance to report pain and insufficient prescription of analgesia by physicians. Facilitators for the effective management of pain include parental participation in care, trusting and respectful relationships between nurses and children, and adequate nurse-patient ratios.

CONCLUSION

The review findings suggest a need to improve education for nurses, doctors and the patients' family in relation to paediatric pain management, communication and interprofessional collaborations. There is a need to maximize facilitators and overcome barriers, such as those identified in this review, to ensure the quality of paediatric pain management.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nursing and health policy should mandate the prioritization of paediatric pain management and the clinical roles and responsibilities of the interdisciplinary team members. Undergraduate, postgraduate and in-service education for nurses and other health professionals should also address paediatric pain management. In-service education on paediatric pain management should be compulsory for all health professionals caring for children.

Pain in children with intellectual disabilities: a randomized controlled trial evaluating caregiver knowledge measures

Inadequate knowledge has contributed to inaccurate pain assessment and treatment for children with intellectual disabilities.

AIM

Develop and evaluate pain knowledge measures and accompanying self-report ratings; determine their sensitivity to change.

MATERIALS & METHODS

Young adults (n = 77; M_age = 18.89; standard deviation = 2.29; 67 females) were randomly assigned to one of two 'caring for children with intellectual disabilities' training programs (pain and visual supports). Participants completed pre-post-measures of pain knowledge and six self-report ratings of feasibility, confidence and perceived skill in pain assessment and treatment.

RESULTS

After controlling for pretraining scores, pain knowledge and self-report ratings were significantly higher following pain training versus visual support training.

CONCLUSION

These measures show promise for the evaluation of pain knowledge in secondary caregivers.

Attitudes to and knowledge about pain and pain management, of nurses working with children with cancer: A comparative study between UK, South Africa and Sweden

Pain is among the most common effects of cancer and its treatment. Children and young people with cancer often consider pain from procedures and treatment to be the worst aspect of their illness.

This study aimed to i) identify and describe knowledge and attitudes to pain and pain management amongst nurses working with children with cancer and ii) compare the perspectives on pain and pain management of nurses from UK, South Africa and Sweden.

106 nurses working with children with cancer in UK, South Africa and Sweden completed Salanterä's (1999) questionnaire on nurses' attitudes to pain in children.

Nurses had good levels of knowledge and positive attitudes to pain management, with Swedish nurses' having higher levels of knowledge and a more positive attitude to pain management than nurses from UK or South Africa.

A high level of knowledge was correlated to a more positive attitude to pain management. Knowledge levels need to be improved to ensure more positive attitudes to pain management, especially for nurses in South Africa. Swedish nurses' level of knowledge about non-pharmacological pain management strategies has scope for improvement. British nurses may need to focus more on the sociology and psychology of pain.

Health Care Workers' Knowledge, Attitude, and Practice About Chronic Pain Management, Shiraz, Iran

Background

Pain can adversely affect every aspect of a patient’s daily activity, and consequently, it has a great influence on the quality of life. Studies have shown that health care professionals have little knowledge of and inadequate attitudes toward the assessment of pain and its treatment with analgesics.

Objectives

This cross-sectional study was designed to evaluate the knowledge, attitudes, and practice of health care professionals regarding chronic pain management. It was carried out in six different educational hospitals affiliated with Shiraz University of Medical Sciences in Shiraz, Iran.

Patients and Methods

Participants were given a questionnaire containing 46 questions and demographic characteristics to fill out independently. In total, 213 health care professionals (114 nurses and 99 medical residents) volunteered to take part in this study. In order to ease further analysis, the questions were grouped into three categories: narcotic drugs, non-narcotic drugs, and non-drug-related questions.

Results

The mean correct response rate was 43.13% ± 11.10. Medical residents scored 51.23% ± 9.02% and nurses 36.10% ± 7.31% (P < 0.001). There was no statistically significant relation between field of specialty and the mean scores of medical residents. Narcotic drug questions received the lowest (39.02%) and non-narcotic drug questions received the highest (57.32%) percentages of correct responses. Only 9.3% of participants believed that they had received adequate education about pain and its management.

Conclusions

The findings of this study support concern about inadequate knowledge, attitudes, and practice regarding chronic pain management. We believe that further education and practical training will be needed for adequate pain management.

Experienced nurses' use of non-pharmacological approaches comprise more than relief from pain

This study investigated the use of, and reasoning by, experienced nurses regarding non-pharmacological pain approaches to care for children in hospitals, with the aim of increasing our understanding, and hence optimizing, these approaches. Three focus-group interviews with 14 experienced nurses, were conducted in 2009. Our findings emphasized the role of non-pharmacological methods in building and maintaining cooperation with the child and in caring for the child by individualizing the use of non-pharmacological methods.

[Organization of pediatric pain management: Austrian interdisciplinary recommendations for pediatric perioperative pain management]

BACKGROUND

Postoperative pain management is still in need of vast improvement, especially for children. The aim of this article is to demonstrate which structures and processes must be optimized to ultimately improve patient satisfaction and safety.

RESPONSIBILITIES

Basic prerequisites are among others personnel continuity and good cooperation in a multiprofessional team. A clear assignment of responsibilities is also of essential importance.

PATIENT HISTORY AND INFORMED CONSENT

On admission every patient should be questioned on the currently existing pain. Patients or the parents must be informed about the pain therapy in a comprehensible manner. Possible complications, chances of success, advantages and disadvantages of the planned procedure and alternative forms of treatment must be discussed.

IMPLEMENTATION

The implementation needs a great deal of consideration. The introduction of clearly defined pathways and thorough schooling contribute more to successful pain management than the establishment of pain measurement or the use of special techniques alone.

EVALUATION AND DOCUMENTATION

Because pain intensity can only be described indirectly it is difficult to assess in children. Assessment is made by another person until children are 5 years old. The gold standard in pain measurement is, however, self-estimation using appropriate scales which is possible for older children. The routinely carried out representation of pain values and prompt documentation of all pain therapeutic measures are indispensible for the control and optimization of pain therapy.

QUALITY OF RESULTS

Whether improvements in acute pediatric pain therapy will actually be achieved can only be realized by standardized compilation and analysis of the quality of therapy. For this purpose QUIPSInfant was developed.

Nurses' aims when managing pediatric postoperative pain: is what they say the same as what they do?

PURPOSE

The purpose of this study was to explore nurses' aims when managing postoperative pain and whether reported aims reflect actual practices.

DESIGN AND METHODS

Participant observation was used to collect data regarding nurses' (n = 17) pain management practices. Nurses (n = 19) were asked: When managing postoperative pain, what is your overall aim?

RESULTS

Around half the participants (n = 10) aimed for patients to be comfortable while others aimed for a pain score of 2-3 (n = 7), or below 5 (n = 2). Observed practices matched aims for just more than half the participants (n = 9).

PRACTICE IMPLICATIONS

There is evidence of individual variation in practices. This may impact on the care provided.

Nurses' experiences of caring for children in pain

AIM

To describe nurses' experiences when caring for children in pain.

BACKGROUND

Earlier studies have shown that nurses are key actors in pain management and that there is a need to focus on the nurses' own experiences of caring for children in pain.

METHOD

Semi-structured interviews were conducted with 21 nurses at one paediatric clinic. The data were analysed by means of content analysis.

RESULTS

The interviews suggested that when a child's pain followed an expected pattern and they complied with treatment, the nurses trusted their knowledge and felt comfortable. On the other hand, in unpredictable situations the nurses felt fearful, powerless, abandoned and distrustful.

CONCLUSION

The nurses were comfortable in predictable situations, but if a situation was unpredictable, they felt they had lost control over it. IMPLICATIONS FOR PAIN MANAGEMENT: To reduce feelings of abandonment, work shifts should be organized so that more experienced nurses can work side by side with those who are less experienced. Pain assessment tools and guidelines for pain management should be introduced into the daily work, and systematic reflection should be used for nurses' professional development.

An online self-help CBT intervention for chronic lower back pain

OBJECTIVES

Research has shown that cognitive and behavioral therapies can effectively improve quality of life in chronic pain patients. Unfortunately, many patients lack access to cognitive and behavioral therapy treatments. We developed a pilot version of an interactive online intervention to teach self-management skills for chronic lower back pain, a leading cause of disability and work absenteeism. The objective of this randomized, controlled trial was to evaluate its efficacy.

METHODS

Individuals with chronic lower back pain were recruited over the Internet, screened by phone, and randomly assigned to receive access to the intervention (Wellness Workbook; WW) either immediately (intervention group) or after a 3-week delay (wait-list control). Participants (n=141, 83% female, 23% minority) were asked to complete the WW over 3 weeks. Self-report measures of pain, disability, disabling attitudes and beliefs, self-efficacy for pain control, and mood regulation were completed at baseline, week 3, and week 6.

RESULTS

Controlling for baseline individual differences in the outcome measures, multivariate analysis of covariance revealed that, at week 3, the intervention group scored better than the wait-list control group on all outcomes, including pain severity ratings. At week 6, after both groups had been exposed to the WW, there were no differences between groups.

DISCUSSION

Use of this pilot intervention seems to have had positive effects on a number of pain-related outcomes, including disability. Future research will evaluate the effectiveness of the completed intervention, with particular attention to quality of life and disability.

Nurses' views about the barriers and facilitators to effective management of pediatric pain

Children continue to experience moderate to severe pain during hospitalization. This paper presents data from two modified focus groups undertaken as part of a larger study exploring pediatric pain management practices in one hospital in the south of England. Thirty nurses took part in the focus groups and were asked questions about their views about the barriers and facilitators to effective pain management in the hospital. Participants identified a number of barriers which related to the staff, children and parents and the organization. Nurses indicated that they and the medical staff lacked knowledge about pain management. They also felt that staff shortages and a heavy workload detracted from the quality of the care they could provide. Several participants indicated that insufficient analgesic drugs were sometimes prescribed. Many of the barriers identified related to parents and children. It appears that nurses may not take as active a role as they could do in managing pediatric pain rather seeing it as the parents and child's responsibility to let them know when they are experiencing pain. Nurses also felt that parents exaggerate their child's pain and ask for analgesic drugs before their child needs them. There is a need to explore the interactions between nurses, children and parents in this context in more detail.

Turkish pediatric surgical nurses' knowledge and attitudes regarding pain assessment and nonpharmacological and environmental methods in newborns' pain relief

Effective pain management requires accurate knowledge, attitudes, and assessment skills. The purpose of the present study was to describe Turkish pediatric surgical nurses' knowledge and use of pain assessment and nonpharmacologic and environmental methods in relieving newborn's pain in hospital. The sample consisted of 111 pediatric surgical nurses employed in pediatric surgical unit in 15 university hospitals located in Turkey. A questionnaire was used to measure the nurses' knowledge and use of pain assessment, nonpharmacologic, and environmental methods. Data were analyzed with the use of descriptive statistics. Of the nurses that participated in the study, 83.8% were between the ages of 20 and 35 years, 54.1% had a bachelor degree, and 75.7% had a nursing experience ≤10 years. 50.5% stated that physiologic and behavioral indicators used in the assessment of pain in infants. The most commonly used nonpharmacologic methods were giving nonnutritive sucking, skin-to-skin contact, and holding. The most commonly used environmental methods were avoiding talking loudly close to the baby, minimal holding, care when opening and closing of the incubator, avoiding making noise when using wardrobe, drawers, trash, or nearby devices, such as radio and television, avoiding sharp fragrances, such as alcohol, perfume, near the baby, and reducing light sources. Although Turkish pediatric surgical nurses used some of the nonpharmacological and environmental methods in infant's pain relief, there remains a need for more education about pain management and for more frequent use of these methods in clinical care.

[Pediatric pain management: what do German nurses know?]

BACKGROUND

In order to provide efficient pain treatment clinicians need to know the latest developments in pain management and to implement this knowledge into clinical practice. The knowledge of pediatric nursing staff with regards to pediatric pain management has not yet been investigated. In this study we therefore investigated nurses' knowledge of pediatric pain management strategies.

METHODS

Nursing staff knowledge was analyzed using the German version of the PNKAS-Sr2002. This questionnaire was distributed to 310 pediatric nurses and the response rate was 51.3% (n=159). Analyses of variance (ANOVA) were conducted to examine whether educational level and work experience had an influence on knowledge. Independent from work experience the educational level of nurses is important for their knowledge in pediatric pain management.

RESULTS

On average nurses obtained a mean individual test score of 69.3%. Nurses with advanced qualification and nurses with 6-10 years work experience obtained the highest scores.

CONCLUSION

Pediatric nurses must be trained more efficiently in pediatric pain management so that an adequate pain management is available for children and adolescents.

Unresolved pain in children: a relational ethics perspective

It is considered the right of children to have their pain managed effectively. Yet, despite extensive research findings, policy guidelines and practice standard recommendations for the optimal management of paediatric pain, clinical practices remain inadequate. Empirical evidence definitively shows that unrelieved pain in children has only harmful consequences, with no benefits. Contributing factors identified in this undermanaged pain include the significant role of nurses. Nursing attitudes and beliefs about children's pain experiences, the relationships nurses share with children who are suffering, and knowledge deficits in pain management practices are all shown to impact unresolved pain in children. In this article, a relational ethics perspective is used to explore the need for nurses to engage in authentic relationships with children who are experiencing pain, and to use evidence-based practices to manage that pain in order for this indefensible suffering of children to end.

Implementation of a standardized pain management in a pediatric surgery unit

Postoperative pain is still a major complication causing discomfort and significant suffering, especially for children. Therefore, every effort should be made to prevent pain and treat it effectively once it arises. Under-treatment of pediatric pain is often due to a lack of both knowledge about age-specific aspects of physiology and pharmacology and routine pain assessment. Factors for long term success require regularly assessing pain, as routinely as the other vital signs together with documentation of side effects. The fear of side effects mostly prevents the adequate usage of analgesics. Essential is selecting and establishing a simple concept for clinical routine involving a combination of non-pharmacological treatment strategies, non-opioid drugs, opioids and regional anesthesia.

What is the impact of theoretical knowledge on children's nurses' post-operative pain management practices? An exploratory study

Despite the availability of the evidence to guide pain management practices, practices are often sub-optimal with children experiencing moderate to severe pain post-operatively. Limited theoretical knowledge about managing pain has been suggested as one reason for this. Several studies have identified gaps in nurses' theoretical knowledge. However, the affect of theoretical knowledge on pain management practices has not been explored. This explored whether there is a relationship between nurses' theoretical knowledge and the quality of their practices. Nurses (n=13) on one children's surgical ward were shadowed for a five-hour period during two-four shifts. Data about post-operative pain management practices were collected using a pain management checklist and field notes. Nurses (n=12) also completed the revised pain management knowledge test. Questionnaire scores were compared to the observational data. No positive relationship was found between nurses' level of theoretical knowledge and how well they actually managed pain. Nurses did not appear to routinely apply theoretical knowledge in practice. This may explain, at least in part, why pain management practices remain poor despite the evidence to guide practice being readily available. The hypothesis, put forward in other studies, that increasing nurses' theoretical knowledge about pain will improve practices may be overly simplistic.

Student nurses' knowledge, attitudes, and self-efficacy of children's pain management: evaluation of an education program in Taiwan

The purpose of this study was to examine the effectiveness of a pediatric pain education program (PPEP) for student nurses. The sample consisted of 181 licensed student nurses who were enrolled in a nursing school in Taiwan. Student nurses attended a 4-hour PPEP that involved case scenario discussion, video, and lecture. Data were collected by an extensive questionnaire that assessed student nurses' knowledge of, attitudes toward, and self-efficacy in pediatric pain assessment and pharmacological and nonpharmacological pain management. The results demonstrated that student nurses gained significant knowledge of pediatric pain, expressed more appropriate attitudes, and reported greater self-efficacy in children's pain management after attending PPEP. Their knowledge of analgesic pharmacotherapy did not significantly improve. These results suggest that PPEP should be integrated into pediatric nursing curricula to enhance knowledge and skills regarding children's pain management during the early stage of a nursing career.

Children's nurses' post-operative pain management practices: an observational study

BACKGROUND

Children continue to experience unrelieved moderate to severe pain post-operatively despite the evidence to guide practice being readily available. Previous studies have relied on self-report measures; there is a need to establish exactly how nurses manage children's pain in practice.

OBJECTIVES

To ascertain how nurses actually manage post-operative pain in children and whether pain management practices adhere to current best practice guidelines.

DESIGN

An observational study was carried out. Structured and unstructured data were collected.

SETTING

A children's surgical ward in the English Midlands caring for children from birth to 16 years.

PARTICIPANTS

Registered nurses (n=13) took part in the study.

METHODS

Each participant was observed continuously for a period of 5 hours per shift for two to four shifts each. The role of the observer as participant was adopted whereby the researcher could shadow the nurse and act primarily as an observer. Data were collected for 36 shifts (185 hours).

RESULTS

While nurses administered analgesic drugs when a child complained of pain, in most other areas practices did not conform to current recommendations and are in need of improvement. Nurses did not, for example, routinely assess a child's pain, nor use non-drug methods of pain relief on a regular basis.

CONCLUSIONS

The sub-optimal pain management practices may be attributable to several factors. The professional culture of nursing and/or ward culture may result in poor pain management practices being perpetuated. Nurses may not have the requisite theoretical knowledge to manage pain effectively. A lack of priority may also be attributed to pain management. These areas need exploring further.

Chinese parent's use of nonpharmacological methods in children's postoperative pain relief

Parental participation in paediatric postoperative care is common in China. However, the knowledge is limited on what methods parents use to relieve their children's postoperative pain in hospital. The purpose of this study was to describe what nonpharmacological methods parents use to relieve their children's postoperative pain and factors related to this. A previously validated Scandinavian questionnaire survey was conducted in five provincial hospitals in Fujian, China, in 2004. Parents (n = 206) whose children had undergone operation were asked to complete questionnaires concerning nonpharmacological methods for children's pain relief. The response rate was 88%. Results show that the most commonly used methods by parents were emotional support strategies, helping with daily activities, distraction and imagery. Breathing technique was the method used least frequently. Fathers and parents who were older, more educated, employed and with earlier hospitalization experience with their children used pain alleviation methods more frequently than mothers and parents without these characteristics. Moreover, parents used some methods more frequently with boys, younger children, as well as children admitted for selective operations, with longer duration of hospitalization and with moderate or severe pain. Parents utilized various nonpharmacological methods for children's pain relief, especially those easy to use. This study may serve to focus healthcare providers' efforts on educating parents with respect to various nonpharmacological pain alleviation methods available for postoperative pain. Furthermore, this study provides parents an opportunity to be aware of their role in their children's pain management.

Pain experiences and non-pharmacological strategies for pain management after tonsillectomy: a qualitative interview study of children and parents

Tonsillectomy is one of the most common paediatric surgical procedures. This study aimed to investigate children's experience of pain and the nonpharmacological strategies that they used to manage pain after tonsillectomy. A further aim was to investigate parental views on these same phenomena. Six children (aged seven to 18 years) and their parents (four mothers and two fathers) were interviewed separately on the day after tonsillectomy. The data were analysed using a qualitative approach. Pain experiences were divided into the categories of physiological pain and psychological pain. Children rated their 'worst pain' during the past 24 hours between 6 and 10 (visual analogue scale, 0-10). The non-pharmacological strategies used most frequently to manage pain were thermal regulation (physical method) and distraction (cognitive-behavioural method) according to the framework used. Specific non-pharmacological strategies for pain management relative to different surgical procedures need to be considered.

Teaching Behavioral Pain Management to Healthcare Professionals: A Systematic Review of Research in Training Programs

Pain is a common and potentially debilitating condition. Whereas there is vast literature on developmentally appropriate behavioral techniques for pain management, results of curriculum evaluations and knowledge surveys reveal a dearth of awareness of these strategies in healthcare professionals. As a result, the development and evaluation of pain management training programs are important endeavors. Results of studies evaluating such programs are promising and suggest that training might be an effective means of impacting healthcare professionals' knowledge, attitudes, and even patient care. These results must be interpreted with caution, however, because the literature contains several conceptual and methodologic limitations. These limitations, in combination with the wide diversity in program components, format of delivery, and research methods, preclude definitive conclusions on the most practical and effective means to provide training. To address this question, further systematic work on the development and evaluation of pain management training programs is warranted.

PERSPECTIVE

To address the problems of dissemination of behavioral pain management techniques, the development and evaluation of pain management training programs are important endeavors. The current article presents a systematic review of studies evaluating such programs and provides recommendations for future systematic work in this area.

Pain evaluation and management: a survey of Italian radiotherapists

GOALS

The objective of this study was to assess the knowledge possessed and the attitudes held by Italian radiotherapists regarding evaluation and treatment of pain.

METHODS

One hundred and twenty-six radiotherapists completed a 16-item questionnaire that was specifically designed to investigate three main topics: the attention paid to pain, the use of analgesics, and pain in children. Chi-square or Fisher's exact text was employed to evaluate differences based on position (staff/resident), age (<35 or >35 years old), availability of consultants in pain therapy and/or palliative care, colleagues with main interest in palliative care among their own staff, and region of residence (north/center/south of Italy).

RESULTS

Overall percentage of correct answers was 76.6% (range 34.9-94.4%). Correct answers by groups of items were: attention paid to pain 77.3%, use of analgesics 81.5%, and pain in children 63.7%.

CONCLUSION

Results of the survey demonstrate that knowledge and attitudes of Italian radiotherapists towards the approach to and treatment of pain can be considered satisfactory.

Factors influencing nurses’ use of nonpharmacological pain alleviation methods in paediatric patients

The purpose of this study was to describe the factors promoting and hindering nurses' use of nonpharmacological methods in children's surgical pain relief, and demographic variables related to this. The data were collected by a Likert-type questionnaire, which was completed by nurses (n = 162) who were working in one of the paediatric surgical wards located in university hospitals in Finland. The response rate was 99%. Factor analysis was used to analyse the data. According to the results, five promoting factors (nurse's competence, versatile use of pain alleviation methods, workload/time, child's age/ability to cooperate, and parental participation), as well as five hindering factors (nurse's insecurity, beliefs regarding parental roles/child's ability to express pain, heavy workload/lack of time, limited use of pain alleviation methods, and work organizational model/patient turnover rate) were found to influence the nurses' use of nonpharmacological methods. Almost all of the nurses (98%) hoped to make progress in their career and to learn different pain alleviation methods, but less than half of them (47%) agreed that they had obtained sufficient education regarding these methods. Demographic variables such as the nurse's age, education, and work experience were significantly related to certain factors influencing the use of nonpharmacological methods. In conclusion, paediatric patients' surgical pain relief in the hospital was affected more by the nurses' personal characteristics, than by work-related factors or characteristics of the child or the child's parents. The nurses had positive attitudes towards learning different pain alleviation methods, which constitute the basis for the development of pain management in paediatric patients.

Are nurses prepared to manage cancer pain? A national survey of nurses' knowledge about pain control in Taiwan

Nurses play a crucial role in cancer pain control, but little is known about how well-prepared nurses are to manage cancer pain in Taiwan. The purpose of this study was to examine the level of knowledge about pain management among Taiwanese nurses with different background characteristics and to determine the predictor(s) of nurses' pain management knowledge. Nurse subjects were recruited by a cross-sectional nationwide survey with stratified sampling from nine hospitals distributed in the four major geographic regions of Taiwan. The Nurses' Knowledge and Attitudes Survey-Taiwanese version (NKAS-T) and a background information form were used to collect the data. Of 1900 surveys distributed, 1797 valid questionnaires (94.5%) were analyzed. The average correct response rate was 50.5%, with rates ranging from 7-86% for each survey question. Results from stepwise regression showed that nurses with higher mean correct answer scores had BS or higher degrees, had received pain education at professional conferences, had more prior hours of pain education, had longer clinical care experiences, and always worked with cancer patients. Nurses who worked in intensive care units, however, had significantly lower mean correct scores. The results strongly suggest an urgent need to strengthen pain education in Taiwan. The results also provide the direction for developing pain education.

Hospitalized children's descriptions of their experiences with postsurgical pain relieving methods

The purpose of this study was to describe children's (aged 8-12 yr) experiences with postsurgical pain relieving methods, and their suggestions to nurses and parents concerning the implementation of pain relief measures in the hospital. The data were collected by interviewing children (N = 52) who were inpatients on a pediatric surgical ward in the university hospital of Finland. Content analysis was used to analyze the data. The children rated the intensity of pain on a visual analogue scale. The results indicated that all of the children used at least one self-initiated pain relieving method (e.g. distraction, resting/sleeping), in addition to receiving assistance in pain relief from nurses (e.g. giving pain killers, helping with daily activities) and parents (e.g. distraction, presence). The children also provided suggestions, especially as it relates to nurses (e.g. creating a more comfortable environment), regarding the implementation of effective surgical pain relief. However, some cognitive-behavioral and physical methods were identified that should be implemented more frequently in clinical practice. Furthermore, most children reported their worst pain to be severe or moderate, which indicates that pain management in hospitalized children should be more aggressive.

Parents' roles in using non-pharmacological methods in their child's postoperative pain alleviation

Increasingly nowadays, parents participate more fully in the care of their hospitalized children. The purpose of this study was to describe parents' utilization of selected non-pharmacological methods in relieving their hospitalized child's (aged 8-12 years) postoperative pain, and factors related to this function. Data were collected by a questionnaire survey completed by parents (n=192) with a child hospitalized on a paediatric surgical ward in the five university hospitals of Finland. The response rate was 90%. Results indicated that non-pharmacological methods, such as emotional support and helping with daily activities, were well utilized whereas cognitive-behavioural and physical methods were less frequently used strategies. Certain background factors specific to the parents and their hospitalized children were significantly related to the non-pharmacological methods used by the parents. The hospitalized child's gender, the time of the surgical procedure, and the parents' assessments of their child's pain intensity, were especially significantly related to many of these strategies. The findings of this study could be used in clinical practice to improve guidance provided to parents regarding interventions for children's pain relief.

Nurses' perceptions of parental guidance in pediatric surgical pain relief

The aim of this study was to describe nurses' perceptions of how they guide parents in the relief of their child's (aged 8-12 years) surgical pain in the hospital, and factors related to this function. The convenience sample consisted of 162 nurses working on the pediatric surgical wards of five university hospitals in Finland. The data was collected with a Likert-type instrument designed for this purpose. The results of this study indicated that nurses felt parents were mostly well informed about their child's surgical procedure, including both cognitive and sensory information, and about the non-pharmacological methods employable for relieving their child's pain. However, some deficiency was identified in the preparatory information, as well as in the cognitive-behavioral and physical methods. Factors related to the nurses' background, such as age, education, work experience and the nurse's own experiences with prior hospitalizations of their children, appeared to have some effects on their perceptions regarding parental guidance.

Knowledge and attitudes of Italian medical staff towards the approach and treatment of patients in pain

This study is part of the project, "Towards a Pain-Free Hospital," which aims at improving the approach and treatment of the patient in pain. The objective of the study was to evaluate the knowledge and attitudes of doctors and nurses on the wards of a 1000-bed general hospital located in a rather densely-populated, industrialized area of Italy regarding the following topics: attention paid to pain, the use of analgesic drugs, and pain in children. In total, 669 nurses and 225 doctors completed a 16-item questionnaire evaluating knowledge and beliefs about pain. The overall percentage of correct answers was 61% (9.7/16). The score varied among the different wards and ranged from 48% (7.8/16) to 76% (12.3/16). Physicians scored 65% and nurses 59% (p < 0.001). The percentage of correct answers varied widely among the different items (from 30% to 96%). From these results, we conclude that there are still significant knowledge deficits and erroneous beliefs that may hamper treatment of the patient in pain. These results will help in conducting educational programs aimed at improving pain treatment in the different departments of the hospital.

Nonpharmacological methods in relieving children's postoperative pain: a survey on hospital nurses in Finland

AIM OF THE STUDY

The aim of this study was to describe nurses' use of selected nonpharmacological methods in relieving 8-12-year-old children's postoperative pain in hospital.

METHODS

The convenience sample consisted of 162 nurses working on the paediatric surgical wards in the five Finnish university hospitals. An extensive questionnaire, including a five-point Likert-scale, on the nurses' use of selected nonpharmacological methods and demographic data was used as a method of data collection. The response rate was 99%. Descriptive statistics as well as nonparametric Kruskall-Wallis ANOVA and the chi-squared test were used as statistical methods.

RESULTS

The study indicates that emotional support, helping with daily activities and creating a comfortable environment were reported to be used routinely, whereas the cognitive-behavioural and physical methods included some less frequently used and less well known strategies. The results also show that attributes, such as the nurses' age, education, and work experience, the number of children the nurses had, the nurses' experiences of hospitalization of their children as well as the hospital and the place of work, were significantly related to the use of some nonpharmacological methods.

CONCLUSIONS

The nurses used versatile nonpharmacological methods in children's postoperative pain relief, although some defects could be observed. More research is needed on the methods used by nurses to relieve children's pain in different patient groups and the factors which hinder or promote nurses' use of pain alleviation methods in the clinical practice.

Defending against patients' pain: a qualitative analysis of nurses' responses to children's postoperative pain

OBJECTIVE

Cognitive approaches to clinical communication attribute deficits in communication to lack of skill. We examined, instead, emotional influences on communication by finding out how nurses construed patients who were in pain, and how these constructions were related to the emotional challenge of patients' pain and to deficits in clinical communication.

METHODS

Data, analyzed qualitatively, included: (i) direct observations of verbal interactions of 13 nurses with 16 children after orthopedic surgery; (ii) standardized open-ended interviews with the nurses, patients and parents.

RESULTS

Nurses tried to prevent children from displaying pain behavior. When pain behavior did occur, they construed pain as unreal, unwarranted or not deserving help. These findings were apparent in observations of, and interviews with, nurses and also in parents' and children's accounts of nurses' behavior.

CONCLUSION

We identified behavioral and cognitive strategies whereby clinicians defend themselves emotionally against patients' pain, and which compromise communication with patients in pain.

Nursing students' knowledge of and views about children in pain

It is important to evaluate the outcomes of the given education to gain knowledge about the abilities of our students to meet the needs of nursing practice. Pain associated with different illnesses and procedures is one of the most common symptoms that children experience in the hospital. The purpose of this study was to evaluate the views and knowledge base of graduating nursing students in the area of taking care of children in pain. The data were collected with a purpose-designed Likert-type instrument from all nursing students that graduated during one year from the child nurse specializing program in Finland (n = 85), with a response rate of 86%. Results indicate that students have mainly positive views and attitudes towards taking care of children in pain. The views and attitudes differ when older and younger students and students from different schools are compared. Students lack knowledge especially in the area of pain medications as well as in the assessment of pain. In the knowledge section, the results did not differ greatly when different schools, younger and older students or previous working experience and no working experience were compared. In some of the researched schools, many of the students felt a lack of confidence about their knowledge. There is a need for more detailed education in the area of taking care of children with pain.