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The purpose of this study was to describe pediatric nurses' projected responses to children's pain as described in vignettes of hospitalized children and to explore nurse characteristics that might influence those responses. A survey was mailed to a national random sample of 700 RNs, and 334 nurses responded. The survey included case reports of three hospitalized school-aged children experiencing pain. Nurses were asked to rate their perceptions of the children's pain levels and to indicate how much analgesia they would recommend. Contrary to earlier studies, in response to the scenarios, nurses in this sample perceived high levels of pain, said they would administer doses of analgesia close to the maximum prescribed by physicians, and recommended an array of non-pharmacologic methods to treat pain. Variation in pain perceptions and decisions was not related to key personal and professional characteristics of the nurses, including their education level, race/ethnicity, age, years of clinical experience, and receipt of continuing education about pain. Findings from this large national study suggest that most nurses would make appropriate decisions relating to the treatment of children's pain, perhaps reflecting changes in the emphasis on pain management.
Pediatric nurses play a pivotal role in the management of children's pain. Effective treatments for alleviating pain and several valid and reliable pain measures for assessing pain in infants and children have been developed. Yet, concerns remain that nurses do not always make appropriate pain management decisions (Rush & Harr, 2001).
Some evidence exists that nurses do not use pain assessment tools consistently. In one survey of 260 pediatric nurses, only one-third used the pain assessment scale that their hospital had recommended (Jacob & Puntillo, 1999). Similar findings have been reported by other researchers (Reyes, 2003; Simons & MacDonald, 2004). Nurses' perceptions of children's pain levels do not always match children's self-reports, which are considered the most reliable indicators of pain (Broome & Huth, 2003). Vincent and Denyes (2004), for example, found that 55% of the pediatric nurses surveyed thought children over-reported their pain.
Several investigators have also suggested that nurses underutilize prescribed treatments (Boughton et al., 1998; Ellis et al., 2002). Vincent and Denyes (2004) found that nurses did not administer analgesics to 26% of the children who reported having pain, and gave only 23%...