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happened because there are no available pain protocols in the hospital. This study revealed that it is important to have a pain protocol to assist in decision-making by
health care team members on the Pediatric surgical unit. When pain medications are prescribed on a standard basis and are based on pain protocols, nurses would not be
hesitant about administering analgesia treatment to patients Abu-Saad Hamers 1997. Doctors are responsible for prescribing appropriate analgesic medication
Llewellyn 1997 because offering pharmacological approaches is their authority. Findings of this study indicated that some of the nurses said they often consulted
with doctors in order to ensure adequate analgesia. As the child’s advocate nurses should consult with physicians prior to painful procedures in order to ensure adequate
analgesia orand sedation Jacob Puntillo 1999; Llewellyn 1997. Nurses’ ability to give appropriate medication will depend on the appropriate prescription of drugs by
physicians Allcock 1996. Nurses have responsibility for evaluating whether or not relief of pain in children is achieved.
7. Nurses have limited knowledge about pain assessment and management
Interestingly, all the nurses stated that pain management on the ward was not optimal yet because there were some restrictions that affected pain management for
the pediatric patients on the ward. The main barrier was limited knowledge about the pain mechanisms, assessment and pain management approaches in particular non-
pharmacological approaches. Findings of this study found that all the participants recognised their knowledge deficits and lacked confidence about pain assessment and
management. It was apparent that the participants had learned very little about pain theories, and they had never been specifically educated about pain management.
These results support the finding of previous studies Broome et al 1992; Clarke et al
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1996; Salantera 1999; Twycross 2000 which found that nurses felt that a knowledge deficit was a barrier to providing adequate pain management. This lack of adequate
knowledge about pain management is also confirmed by international literature which discusses how this knowledge deficit contributes to inadequate assessment and
management of patients’ pain Bradshaw Zeanah 1986; Ferrel et al 1993; Zalon 1995; Brunier et al 1995; Field 1996; Mackintosh Bowles 2000; Twycross 2001.
8. Lack of tools for measuring pain
Another barrier for effective pain management identified in this study was a lack of tools for measuring pain. There were no available standardised methods for
assessing pain in children on the ward. Even though many pain assessment tools have been developed for children, none were applied in this clinical setting. This might
influence effectiveness of pain relief in children. Similarly, facilities for music intervention and play therapy were not applied by
nurses in this study because they were not available on the ward.
9. There were heavy workloads on the ward
