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Nurses' competence in pain management in children
Jönköping University, School of Health Science, HHJ. CHILD.
2011 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: It is a well known fact that children suffer from pain due to treatment and procedures in health care and historically, their procedural pain due to medical treatment has been undertreated and under-recognized. Children’s understanding of pain and their ability to express their feelings depend on their stage of development and the nature and diversity of their prior pain experiences. The goal of pain management is to reduce pain, distress and anxiety, and the nurse is the key person to help and support the child in pain. Nurses’ professional competence form the foundation for pain management procedures, and there is a need to investigate whether the care and procedures nurses perform for children in pain lead to desired outcomes.

Aim: The overall purpose was to describe nurses’ competence in pain management in children. The specific aims were to

- identify and describe knowledge about and attitudes to pain and pain management

- identify factors influencing pain management in children and

- describe nurses’ experiences of caring for children in pain.

Methods and material: Forty-two nurses participated in a survey on knowledge about and attitudes to pain management in children, and 21 nurses were interviewed about their experiences fromcaring for children in pain. All the data were analyzed using approved methods of analysis.

Results: The results showed that the nurses had good knowledge about and positive attitudes to pain management in children. Collaboration with physicians was considered important in providing children with sufficient pain relief. Parents were regarded as a resource, and the nurses described communication with parents as important. The nurses’ own experience led to a better understanding of the children’s situation.

The nurses stated that pain is a subjective experience and that if a child says he or she is in pain they should be believed. Pain was seen as a complex phenomenon, and the nurses had difficulty distinguishing between pain of different origins. In predictable situations, when the child had a clear medical diagnosis with physical pain and the child’s pain followed an expected pattern, the nurses trusted their knowledge and knew how to act. On the other hand, in unpredictable situations, when the child did not respond to the treatment despite all efforts, this created feelings of insufficiency, fear and abandonment, and even distrust.

Conclusions: The conclusions of this thesis are that pain management in children is a challenge for clinical nurses in unpredictable situations. Professional competence in nursing deals with both personal abilities and the organization. Reflective practices and dialogues with colleagues would improve nurses’ work satisfaction, and guidelines and better routines would improve nurses’ pain management when caring for children.

Place, publisher, year, edition, pages
Jönköping: School of Health Sciences , 2011. , 36 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 16
Keyword [en]
Nurses, competence, children, pain
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-16786ISBN: 978-91-85835-15-7 (print)OAI: oai:DiVA.org:hj-16786DiVA: diva2:459354
Opponent
Supervisors
Available from: 2011-11-25 Created: 2011-11-25 Last updated: 2014-05-20Bibliographically approved
List of papers
1. 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
Open this publication in new window or tab >>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
Show others...
2007 (English)In: Journal of Research in Nursing, ISSN 1744-9871, Vol. 12, no 5, 501-515 p.Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
Barn, smärta, omvårdnad
National Category
Pediatrics Other Social Sciences not elsewhere specified Cancer and Oncology Nursing
Identifiers
urn:nbn:se:hj:diva-3742 (URN)
Available from: 2007-10-10 Created: 2007-10-10 Last updated: 2015-11-19Bibliographically approved
2. Factors influencing pain management in children
Open this publication in new window or tab >>Factors influencing pain management in children
2008 (English)In: Paediatric Nursing, ISSN 0962-9513, Vol. 20, no 10, 21-24 p.Article in journal (Other academic) Published
Abstract [en]

Aim: To identify factors that influence nurses' pain management in children.

Method: A qualitative design was used. Twenty-one nurses working in one paediatric department were interviewed using semi-structured interviews. Data were analysed by means of content analysis.

Findings: The way nurses manage pain in children is affected by factors such as co-operation between nurses and physicians and between nurses and patients, children's behaviour, routines in the organisation, and the experience and knowledge of nurses.

Conclusion: Pain management in children could be improved through increased co-operation between nurses, physicians and parents. Planning time and good routines could facilitate pain management. Education about pain management and children's pain behaviour might also improve nurses' ability to manage pain in children.

Keyword
children, pain, pain management
National Category
Nursing Other Social Sciences not elsewhere specified
Identifiers
urn:nbn:se:hj:diva-6871 (URN)19119745 (PubMedID)
Available from: 2008-12-09 Created: 2008-12-04 Last updated: 2014-03-11Bibliographically approved
3. Nurses' experiences of caring for children in pain
Open this publication in new window or tab >>Nurses' experiences of caring for children in pain
2012 (English)In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 38, no 4, 464-470 p.Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
children, experiences, nurse, pain, reflection
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-16787 (URN)10.1111/j.1365-2214.2011.01262.x (DOI)
Available from: 2011-11-25 Created: 2011-11-25 Last updated: 2017-12-08Bibliographically approved

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