title: Paediatric nurses' postoperative pain management practices in hospital based non-critical care settings: a narrative review.
abstract: OBJECTIVE
  To investigate paediatric nurses' postoperative pain management practices with the aim of identifying the factors associated with undermanaged paediatric postoperative pain.
  
  
  METHODS
  Systematic search and review.
  
  
  METHODS
  PsychInfo, CINAHL, PubMed, EMBASE and hand searching.
  
  
  METHODS
  English peer-reviewed quantitative, qualitative, or mixed methods research articles published between 1990 and 2012 exploring registered nurses' paediatric postoperative pain management practices were included. Articles with a primary focus on nurses' pain management practices in the neonatal or paediatric intensive care units, recovery room, and/or focused on children with cognitive impairment were excluded. The search terms used were: postoperative pain; nurs*; paediatrics; pediatrics; children; pain assessment; non-pharm*; analges*. Titles and abstracts were used for initial screening. Two researchers conducted data extraction and assessment of rigour for each paper.
  
  
  RESULTS
  From the initial 248 citations, 27 studies were included. Most studies were descriptive and examined relationships between personal factors and nurses' pain management practices. Observational data from four papers added insights beyond that provided in self-report studies. Two articles used experimental designs with vignettes. Data were categorised into four topics: pain assessment; pharmacological practices; non-pharmacological practices; and factors affecting practices. Despite improvements in analgesic administration over the past 20 years, practices remain suboptimal. Children's behaviour appears to influence nurses' pain assessment more than validated measures. A significant proportion of children did not have pain scores recorded in the first 24-h postoperatively. Children receive more analgesia when ordered around the clock compared to as required. However, around the clock analgesia prescription did not guarantee administration. Nurses reported using several non-pharmacological strategies routinely but some are not evidence based.
  
  
  CONCLUSIONS
  The results of this review indicate nurses' assessment and management of children's pain is not consistent with published guidelines. Results of studies exploring nurse and child related factors are inconclusive. Research needs to examine the impact of organisational factors on nurses' pain care practices. Intervention studies are needed to determine the most effective strategies to support and improve nurses' pain care for children.
authors: London South Bank University, United Kingdom. Electronic address: a.twycross@lsbu.ac.uk.
authors: Alison
authors: A
authors: Twycross
authors: University of Ottawa, Canada. Electronic address: paula.forgeron@uottawa.ca.
authors: Paula
authors: P
authors: Forgeron
authors: Centre for Nursing and Allied Health Research, Great Ormond Street Hospital for Children NHS Foundation Trust, United Kingdom. Electronic address: anna.williams@gosh.nhs.uk.
authors: Anna
authors: A
authors: Williams
mesh_terms: D002648:Child; D006801:Humans; D009741:Nursing Staff, Hospital; D010149:Postoperative Pain / Q000451:nursing*; D010371:Pediatric Nursing
keywords: Children; Nurses; Paediatric; Pain; Pain assessment; Pain management; Postoperative