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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
The findings of this study also indicated that nurses’ heavy workload on the ward impacted on pain management. All the nurses felt that they had insufficient time to
deal with children’s pain effectively because they had many other pressing tasks such as administration and consultation with laboratories. Interestingly, results of this study
indicated that nurses’ attitude to pain relief was another factor that influenced pain management on the Pediatric surgical. There are some nurses on the ward who
believed that routine activities such as giving injections and wound care were their main task. It seemed that they were more task oriented than patient oriented. Results
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of this study are consistent with a previous study Woodgate Kristjanson 1996 which showed that paediatric nurses tended to focus on technical aspects of care
rather than assessing paediatric patients. If their work became more patient oriented rather than task oriented, nurses would spent more time with the patient and therefore
would be able to assess and manage pain more systematically and adequately Abu- Saad Hamers 1997. Thus, the way a ward is organised may affect nurses’
decisions in caring for paediatric patients.
Nurses’ role in dealing with children experiencing pain 10. Nurses have responsibility in dealing with children pain but it seemed to give
low priority to administering pain relief to children
The nurses participating in this study can be considered to be quite experienced with an average of 17 years of working experience in health care and 12 years of
working experience in paediatric nursing. All participants agreed that as nurses they have a responsibility and an important role in dealing with children’s pain. In
addition, nurses are the caregivers who have the most frequent contact with the patients and know the patients’ condition well. However, the findings of this study
indicated that the nurses seemed to give low priority to administering pain relief to paediatric patients. There was evidence that some of th
e Indonesian nurses undermedicated and underestimated paediatric patients’ pain.
This study revealed that a significant reason for the low priority given to analgesia by nurses appears to be their limited knowledge and education about pain
mechanism, pain assessment and management and this may influence the nurses’ role in dealing with paediatric patients’ pain. Ideally, nurses as a patient’s advocate, should
be able to interpret children’s experience of pain and provide effective pain
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management. However, this study revealed that some of the nurses tended to have been insufficiently prepared to take on increased responsibility for dealing with
paediatric patients’ pain. Therefore, this study suggests that it would be beneficial to increase nurses’ knowledge and provide higher quality pain education for nurses.
Conclusion
The following ten themes were found by exploring analysis of the data collected in the study:
1. Assessing pain in children is difficult because infant and younger children are usually crying
2. The assessment tools for pain in children are too times consuming to use 3. Pharmacological approaches are usually used first for dealing children’s pain
because more effective than non pharmacological approaches 4. Non-pharmacological interventions were used less often as a nursing
intervention because nurses felt more comfortable with using analgesia 5. Giving analgesic to children were in pain and stopped when the pain had gone
because it might be addictive for the children 6. There were no available standardised methods for assessing pain in children
and pain protocol on the ward
7. Nurses have limited knowledge about pain assessment and management
