Survey of pediatric nurses' knowledge and attitudes regarding pain

Abstract

Background: Children commonly expenence pain resulting from injury, illness or medical procedures. The pediatric pain experience involves the interaction of physiological, behavioral, developmental, and situational factors. It is often associated with anxiety, fear, stress and distress. Since children are developmentally, physiologically and pharmaco-dynamically different from adults, the assessment and management of children's pain is a particular challenge for healthcare professionals. Objective: To evaluate current knowledge and attitudes in pediatric pain management among pediatric nurses and also to identify gaps in knowledge and attitudinal barriers that warrant further education. Methods: A modified version of Manworren's Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain tool was used for this study. The questionnaire was distributed to pediatric nurses by research assistants. The data collected was analyzed by use of Microsoft Excel spreadsheet and Statistical Package for Social Sciences. PNKAS scores were expressed as percent (%) correct responses. Differences in PNKAS scores between groups were determined by analysis of variance (ANOVA). Statistical significance was established at p< 0.05. Results: Data collection was completed between March 20,2009 and May 19,2009. The response rate was 54.9%. Education qualifications included Hospital Certificate (n=7, 14%), Diploma (n=28, 56%), Bachelor's Degree (n=6, 12%), and Post Graduate (n=7, 14%). Most respondents were between 30-34 years of age. More than 60% of the nurses had worked in the pediatric unit for 5 years or less. 32% of respondents had not received any education in any aspect of pain management either before or since commencing work in the pediatric setting. 28% occasionally attended in service sessions on pain and 18% frequently read journal articles on pain. 1 66% of respondents felt comfortable in basic pain assessment. Most respondents reported that they are greatly influenced by facial expressions (n=45), vital signs (n=42), family report of an infant's or child's discomfort (n=39) or the child's own report of pain using a pain rating tool (n=33). Nurses' individual scores on the PNKAS ranged from 8.7-82.6 % with a mean of 49.6%. Overall, no significant differences in PNKAS scores were found among the groups formed by age (F= 1.096, p= 0.379), among the groups by years of nursing experience (F=0.513, p= 0.726), among groups formed by years of pediatric nursing experience (F=1.16, p=0.334) and among groups formed by highest level of education (F=0.214, p=0.886). Conclusion: Areas of weakness identified by this study centered on pharmacology, the potential side effect of respiratory depression and pain assessment. Areas of weakness can be used to structure educational programs for improving nurses' knowledge, attitudes and subsequent practice of pediatric pain management.