title: Nurses' report of in-hospital pediatric pain assessment: examining challenges and perspectives.
abstract: Pain is a symptom pediatric nurses commonly encounter in the hospital setting. Untreated pain can lead to adverse physiologic and psychological effects. This study examines in-hospital pain assessment methods nurses report using and assesses challenges, difficulties, and barriers nurses report to assessing pain in hospitalized children. Cross-sectional study of 82 pediatric nurses from all pediatric departments of a tertiary hospital in Israel. A self-report questionnaire was developed to examine how nurses assess children's in-hospital pain and barriers to in-hospital pain assessment. Nearly all nurses (90%) reported having enough knowledge to assess children's pain in the hospital, relying on child's self-report (86%) and being familiar with commonly used validated pain scales (90%). However, a majority (75%) reported not using pain scales recently and only half (58%) reported using an alternative method involving the child. Most nurses (86%) reported relying on their own overall impression of the child's pain and only a third (34%) reported involving the parents in their pain assessments. Nurses included comments stressing the importance of pain assessments and their frustration with the current validated measures available. This study adds to a growing body of literature demonstrating a gap between recommended pediatric pain assessment guidelines and reported practice, with nurses showing a resistance to relying on single-item or unidimensional measures to assess and evaluate the rich and complex pain experience. A multidimensional approach involving child self-report, parent report, and nurses' own overall impression based on clinical assessment skills of pain is discussed.
authors.affiliation: Hadassah Hebrew University Medical Center, Ein Kerem; Henrieta Szold Hadassah-Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel. Electronic address: yaffazisk@gmail.com.
authors.forename: Rachel Yaffa
authors.initials: RY
authors.lastname: Zisk-Rony
authors.affiliation: Hadassah Hebrew University Medical Center, Ein Kerem.
authors.forename: Jodi
authors.initials: J
authors.lastname: Lev
authors.affiliation: Hadassah Hebrew University Medical Center, Ein Kerem.
authors.forename: Hagit
authors.initials: H
authors.lastname: Haviv
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007557:Israel; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role / Q000523:psychology*; D010146:Pain / Q000503:physiopathology*; D010147:Pain Measurement / Q000451:nursing*; D010149:Postoperative Pain / Q000451:nursing*; D010371:Pediatric Nursing / Q000379:methods*; D011795:Surveys and Questionnaires