Elsevier

Pain Management Nursing

Volume 12, Issue 3, September 2011, Pages 154-162
Pain Management Nursing

Original Article
Barriers to Pediatric Pain Management: A Nursing Perspective

https://doi.org/10.1016/j.pmn.2010.07.001Get rights and content

Abstract

This study describes strategies used by the Joint Clinical Practice Council of Children’s Hospital of Wisconsin to identify barriers perceived as interfering with nurses’ (RNs) ability to provide optimal pain management. A survey was used to ascertain how nurses described optimal pain management and how much nurses perceived potential barriers as interfering with their ability to provide that level of care. The survey, “Barriers to Optimal Pain management” (adapted from Van Hulle Vincent & Denyes, 2004), was distributed to all RNs working in all patient care settings. Two hundred seventy-two surveys were returned. The five most significant barriers identified were insufficient physician (MD) orders, insufficient MD orders before procedures, insufficient time to premedicate patients before procedures, the perception of a low priority given to pain management by medical staff, and parents’ reluctance to have patients receive pain medication. Additional barriers were identified through narrative comments. Information regarding the impact of the Acute Pain Service on patient care, RNs’ ability to overcome barriers, and RNs’ perception of current pain management practices is included, as are several specific interventions aimed at improving or ultimately eliminating identified barriers.

Section snippets

Literature Review

Although barriers to pediatric pain management were found embedded in the narrative sections of studies addressing other topics, such as content for nursing education (Twycross, 2001) or factors influencing emergency medicine (Rupp & Delaney, 2004), relatively few studies were found that purposefully addressed barriers to pain management from pediatric nurses’ perspectives, and even fewer were found identifying plans to improve or ultimately eliminate the identified barriers.

Ely (2001) reported

Purpose

Understanding the barriers pediatric RNs perceive as impeding their ability to provide optimal pain management in an organization is crucial to making worthwhile improvements. Members of the JCPC at Children’s Hospital of Wisconsin (CHW) queried RNs to learn how they describe optimal pain management and what obstacles they encounter on a day-to-day basis that interfere with their ability to provide that level of care.

The JCPC is an interdisciplinary patient care council consisting of ∼35-40

Study Design

This study was a cross-sectional design assessing the perceived barriers to optimal pain management in a 236-bed pediatric hospital. After approval by the Human Rights and Review Board, the surveys were distributed to RNs in each patient care area (all acute and critical care inpatient units, the emergency department–trauma center [EDTC] and outpatient clinics) by the manager, Advanced Practice Nurse (APN), or designee assigned to each area. Completion was voluntary, anonymous, and implied

Demographics

Table 1 presents the demographic information for the 272 respondents (representing a 28% response rate). The majority of surveys returned were from female RNs (83.1%) working on inpatient care units (79.1%) in a staff nurse role (84.2%). Fifty-nine percent of responding RNs had <10 years’ experience, and 75% had baccalaureate degrees. The majority of RNs (73.9%) rated themselves as 4 or 5 out of 5 (5 = not at all conservative) in terms of their level of conservativeness regarding personal pain

Discussion

Children’s Hospital of Wisconsin has a strong commitment to pain management, and resources are available to support this commitment. The goal of this study was to identify what (if anything) RNs perceive as interfering with their ability to consistently provide what they consider to be optimal pain management. These results were used by the JCPC to design interventions to improve or abolish those barriers, an essential “next step” needed to improve pain management for children.

Conclusions

With the current level of knowledge, skill, and technology available in today’s health care environment, pain assessment and management should be at a consistently high level, yet it is not. Although RNs are in an ideal position to assess and manage pain, they can not do so in isolation; support from parents/patients, physicians, and the organization are necessary. Results of the present study support earlier studies identifying a lack of MD orders and support as well as issues with procedural

Acknowledgments

The authors thank the Jane B. Pettit Pain and Palliative Care Center, the nurses at CHW who participated in this study, and Catherine Van Hulle Vincent for the use of her survey and continual support.

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