Nurses' Beliefs Regarding Pain in Critically Ill Children: A Mixed-Methods Study

Abstract

Purpose The purpose of this study was to provide a current and comprehensive evaluation of nurses’ beliefs regarding pain in critically ill children. Design and Methods A convergent parallel mixed-methods design was used. Nurse beliefs were captured via questionnaire and interview and then compared. Results Forty nurses participated. Most beliefs reported via questionnaire were consistent with effective pain management practices. Common inaccurate beliefs included the need to verify pain reports with physical indicators and the pharmacokinetics of intravenous opioids. Beliefs commonly shared during interviews concerned the need to verify pain reports with observed behavior, the accuracy of pain reports, the need to respond to pain, concerns regarding opioid analgesics, and the need to “start low” with interventions. Convergent beliefs between the questionnaire and interview included the use of physical indicators to verify pain, the need to take the child’s word when pain is described, and concerns regarding negative effects of analgesics. Divergent and conflicting findings were most often regarding the legitimacy of a child’s pain report. Conclusions Findings from this study regarding the accuracy of nurses’ pain beliefs for critically ill children are consistent with past research. The presence of divergent and conflicting responses suggests that nurses’ pain beliefs are not static and may vary with patient characteristics. Practice Implications While most nurses appreciate the risks of unrelieved pain in children, many are concerned about the potential adverse effects of opioid administration. Interventions are needed to guide nurses in minimizing both of these risks.

Knowledge, compliance with good clinical practices and barriers to effective control of postoperative pain among nurses from hospitals with and without a “Hospital without Pain” certificate

“…Similar opinion was presented by nurses surveyed by Dongara et al. () and LaFond, Van Hulle Vincent, Oosterhouse, and Wilkie (). However, such assumption is erroneous taking into account the results published by Donovan, Dillon, and McGuire (); according to these authors, sleeping problems were reported mostly by patients with a mild subjective pain, whereas those with a severe subjective pain claimed that they slept normally.…”

“…Unfortunately, administration of opioid therapy in children is still consider less safe than in adults, probably due to an erroneous assumption that it may often result in respiratory depression. This myth is another barrier to effective pain control (LaFond et al., ) since having a choice between lower and higher dose of an opioid agent, most nurses will likely choose the lower one. Opioid treatment of pain is generally safe (Tomaszek et al., ) with 0.5% or less episodes of respiratory depression (Dahan et al., ; Walker, ).…”

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

“…In addition, LaFond et al. 's () study suggested 42.5% of nurses ( n = 40) believed that children did not reliably report pain. Vincent et al.…”

O manejo da dor em crianças percebido pela equipe de enfermagem [Pain management in children as perceived by the nursing team] [El manejo del dolor en niños, percibido por el equipo de enfermería]

“…A dor é um fenômeno subjetivo que sofre influências de variáveis fisiológicas e psicológicas, sendo uma experiência única para cada indivíduo 6 . A intensidade dos estímulos dolorosos pode sofrer interferências de aspectos culturais, bem como da percepção do observador, sendo importante estar atento às crenças e valores individuais e familiares durante a avaliação da dor 7 .…”

“…Para se identificar corretamente a dor na criança deve-se levar em consideração o nível cognitivo, bem como a condição clínica da mesma 9 . Devido ao seu caráter subjetivo, fica a critério da enfermeira considerar a genuinidade da queixa álgica, fator esse que interfere no cuidado prestado frente a essa queixa, pois é diretamente proporcional ao conhecimento, as atitudes e as crenças das profissionais, atuando como uma bússola 18 . Contudo, ao avaliar a dor na criança, a profissional deve atentar para as crenças errôneas, internalizando a ideia de que a intensidade da dor é menor do que em um adulto, ou que não se lembrarão da experiência de dor 2 .…”