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enhancing adaptive coping behavior McGrath 1990. The effectiveness of these strategies in reducing pain and distress in children has been investigated and
confirmed by several studies Good et al 2001; Mediani et al 1997; Vessey Carlson 1996. However, strategies such as music intervention, play therapy, hypnosis and
acupuncture were not used in this study due to lack of facilities on the ward. According to some participants, they had tried to use music intervention with
postoperative patients when they were involved in a previous study Mediani et al 1997, which suggests that it effectively reduced intensity of postoperative pain in
children. But music therapy was not applied anymore on the ward because facilities were unavailable. The nurses only used other non-pharmacological techniques such as
distraction, relaxation and comfort measures to reduce pain.
4. Non-pharmacological interventions were used less often as a nur sing
intervention because nurses felt more comfortable with using analgesia
Interestingly, this study indicated that some of the nurse participants believed that non-pharmacological actions were not always used on the ward because they
were considered time consuming to use, and some nurses belie ved that
pharmacological agents provided simpler and quicker pain relief. The participants stated that some nurses on the ward may feel more confidence when using analgesic
medication. These nurses may also have considered that pain in children would not be manageable with non-pharmacological strategies. Similarly, an earlier study Coffman
et al 1997 found that non-pharmacological interventions were used less often as a nursing intervention because nurses felt more comfortable with intravenous analgesics
and administered them more frequently. They also indicated that nurses considered that critically ill children would not tolerate non-pharmacological methods.
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Although the nurse participants in this study seemed to know a little about non- pharmacological methods and had applied some of these interventions, it was
apparent that nurses on the ward might not realise that non-pharmacological modalities are useful for minimising children’s pain. It may be because the nurses on
the ward possessed limited knowledge and lacked of interest in non-pharmacological approaches.
Because pain is a multidimensional experience, nursing interventions to deal with children’s pain should include non-pharmacological approaches, because the
pharmacological approaches fail to recognise the impact of an individual’s thoughts and feelings about their pain perception Llewellyn 1997. Therefore, the nurses need
to apply non-pharmacological pain management strategies consistently to achieve adequate pain management for pediatric patients.
5. Giving analgesic to children were in pain and stopped when the pain had gone because it might be addictive for the children
Regarding pharmacological approaches, most nurses in this study suggested that they always administered pain relief medication to pediatric patients as written up by
the doctors in patient notes, but some of the nurses evaluated the patients’ experience first before giving analgesia. They administered analgesic medication to the patients if
they thought they were in pain and really needed it, and stopped administering it when they though the pain had gone. Interestingly, one nurse did not always administer
prescribed analgesic treatment to postoperative patients because she believed that it might be addictive for children and that the anesthesia was still working. Thus the
findings of this study indicated that there was discrepancy between the pain medication that was prescribed and the medication that was actually administered.
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Further, this study found that some nurses administered pain medication in accordance with their perceptions of patients’ pain and also that some nurses have
misconceptions about analgesic treatment. Therefore, this study revealed a tendency for some nurses in an Indonesian hospital to administer insufficient doses of
prescribed medication to children as well as underestimating children’s pain. Further, this study also indicated that inappropriate beliefs about analgesia may influence
nurses’ decisions in administering pain relief to paediatric patients. These findings are supported by previous studies Eland Anderson 1977; Gadish et al 1988; Ross,
Bush Crummette 1991; Hamilton Edgar 1992; Clarke et al 1996; Abu-Saad Hamers 1997; Hamers et al 1998; Jacob Puntillo 1999; Twycross 2000
This study suggests that a significant reason for the inconsistent administering of prescribed medications to pediatric patients may be due to the nurses’ lack of
understanding and education regarding therapeutic analgesia and causes of addiction and also inappropriate beliefs concerning pain management. Because nurses
administer analgesic treatment to the patients, factors such as nurses’ knowledge, beliefs and attitudes may influence their decisions in managing children’s pain and
play an important role in the effectiveness of pain relief.
Barriers to managing pain effectively 6. There were no available standardised methods for assessing pain in children and
pain protocol on the ward
The participants also reported that some doctors did not alw ays offer
pharmacological agents to pediatric patients post operatively. In addition some doctors also have a tendency to undermedicate children’s pain. This may have
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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
