Evaluating Knowledge, Practices, and Barriers of Paediatric Pain Management among Nurses in a Tertiary Health Facility in the Northern Region of Ghana: A Descriptive Cross-Sectional Study

Effect of Educational Interventions for Improving the Nurses' Knowledge, Attitude, and Practice of Pediatric Pain Management: A Aystematic Review and Meta-Analysis

OBJECTIVE

This study aimed to evaluate the effectiveness of educational interventions in improving nurses' knowledge, attitude, and practice regarding pediatric pain management.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

A comprehensive search was conducted in MEDLINE, Scopus, Cochrane database, Google Scholar, and trial registries, supplemented by bibliography searches.

REVIEW/ANALYSIS METHODS

This review included randomized controlled trials, nonrandomized trials, and quasi-experimental trials with control groups. Eligible studies involved nurses (professionals or students) caring for pediatric patients and featured any form of educational intervention for pain management. Pooled effect estimates were calculated using a random effects model, and heterogeneity was assessed using the I-squared statistic.

RESULTS

The pooled results demonstrated a significant improvement in nurses' knowledge and attitudes toward pediatric pain management postintervention, with a Standardized Mean Difference (SMD) of 2.41 (95% CI: 0.58-4.23). Additionally, the pooled results indicated a higher likelihood of effective pain medication administration (OR = 1.98; 95% CI: 1.21-3.27). However, there was no significant difference in the utilization of pain assessment tools (OR = 19.85; 95% CI: 0.29-1352.98). Pooled OR was 3.42 (95% CI: 1.93-6.07), showing significantly higher odds of ability to administer nonpharmacological interventions. Sensitivity analyses confirmed the robustness of these findings.

CONCLUSIONS

Educational interventions significantly improve nurses' knowledge, attitudes, and ability to administer both pharmacological and nonpharmacological pediatric pain management interventions.

Nurses' knowledge and practice about neonatal pain management in public hospitals in West Oromia, Ethiopia, 2022: multi-centered cross-sectional study

BACKGROUND

In low-and middle-income countries inadequate neonatal pain management persists as a significant public health issue despite the availability of guidelines. Newborns often experience pain from routine medical and surgical procedures, with limited nurses' knowledge and suboptimal practices posing common obstacles to effective neonatal pain management in hospital settings. Hence, this study aimed to evaluate nurses' knowledge and practices related to neonatal pain management and the factors influencing them in public hospitals in West Oromia, Ethiopia, in 2022.

METHODS

A multicenter cross-sectional study was conducted among 203 nurses working in public hospitals in West Oromia from 8th May-6th June 2022. Data was gathered using structured, self-administered questionnaire and sampled through simple random sampling. The collected data were coded and entered into a computer using Epi-Data version 4.6 Statistical Software. They were analyzed using the Statistical Package for Social Science (SPSS; IBM Corporation) version 26. Binary logistic regression was used to identify significant independent variables at p < 0.05.

FINDINGS

In this study, 127 (62.6%) exhibited adequate knowledge, while 33 (16.3%) nurses demonstrated good practice in neonatal pain management. Attending lectures or receiving training about neonatal pain management was found to be significantly associated with nurses' knowledge of neonatal pain management [AOR, 2.31, 95%CI; 1.29-4.27]. On the other, having adequate knowledge of neonatal pain management [AOR, 3.3, 95%CI; 1.14-9.32]; the presence of a pain management policy in place [AOR, 5.44, 95% CI; 1.92-15.37] and attending lectures on neonatal pain management [AOR, 2.55, 95% CI; 1.09-5.97] were found to be significantly associated to nurses' practices.

CONCLUSION

Given the substandard level of nurses' practice in neonatal pain management. It is suggested to enhance the nurses' knowledge and practice about neonatal pain management by providing refreshment courses, training sessions, or facilitating nurses' opportunity access to reading resources about neonatal pain management.

Practice and factors associated with pediatrics pain management among nurses working in Bahir Dar city public hospitals: A mixed method study

BACKGROUND

Pain is the most misunderstood, underdiagnosed, and undertreated/untreated medical problem, particularly in children. The main aim of this study was to assess practice and factors associated with pediatrics pain management among nurses working in Bahir Dar city public hospitals, Amhara region, North West Ethiopia, 2022.

METHOD

An institutional-based cross-sectional concurrent mixed study design was conducted on randomly selected 421 nurses from November 1 to 30/2022. Purposively selected 8 nurses in different positions and qualifications were included in a qualitative study. A structured self-administered questionnaire and a semi-structured in-depth interview questionnaire were used for data collection. Epi info version 7.1 was used for data entry and SPSS version 25 was used for analysis. ATLAS ti version 7.0 and thematic analysis were used for qualitative study. Binary logistic regression was done to identify predictor variables associated with outcome variables at p <0.05 with a 95% confidence interval. Hosmer and Lemeshow's tests were checked for model goodness of fit, which was 0.71.

RESULT

The good practice of pediatric pain management among nurses for hospitalized children was 216 (53.6%) (95% CI- 48.4% to 58.3%). Knowledge [AOR = 3.95; 95%CI: (2.30, 6.79)], attitude [AOR = 2.57; 95% CI: (1.53-4.30)], qualified in BSC pediatrics and child health nurses [AOR = 6.53; 95%CI: (1.56-27.25)], year of experience in pediatrics unit [(AOR = 1.92; 95% CI: (1.03-3.56)] and gating pain management training [AOR = 3.31; 95% CI: (1.73-6.33)] were significant factors. Four themes inadequate knowledge of pain assessment and management practice, inadequate professional commitment, organization-related factors, and impacts of family knowledge, culture, and economic status were explored.

CONCLUSION

Only half of the participants had good practice. Knowledge, attitude, nurses qualified in BSC pediatrics and child health, years of experience in the pediatrics department, and pain management training were associated factors. From the qualitative findings, the unavailability of anti-pain drugs, lack of training, assessment tools, continuous monitoring and evaluation, updated protocols, shortage of resources, and others were the barriers to proper pain management. This study concludes that applying effective pain management practices to hospitalized children remains a challenge. Therefore, it is better to put further effort towards improving pediatric pain management practice.

A framework for capacity enhancement of Rwandan nurse educators and preceptors facilitating nursing students to learn pediatric pain management

INTRODUCTION

In low- and middle- income countries like Rwanda, children are most likely to suffer from painful and life-limiting conditions due to various factors predominant in these settings. Adequate pre-licensure pain management training can improve pain relief nursing practices. Educators and nurses in practice have a responsibility to teach the soon-to- be nurses for holistic competent nursing care of children, emphasizing the importance of and addressing child's suffering, yet inconsistencies were reported in what was taught regarding pediatric pain management from a theoretical perspective by nurse educators as compared to their counterparts in clinical settings in Rwanda.

DESIGN

This study applied a qualitative approach using group discussions based on nominal group technique (NGT) to develop and validate a conceptual framework supporting the capacity enhancement of nurse educators and preceptors facilitating students' learning about pediatric pain management in Rwanda.

METHODS

NGT meetings were conducted with academic nurses (n = 8), nurse clinicians (n = 4), and nursing students (n = 2) during a 2-day workshop to identify strategies, discuss the relevance of each strategy and to agree on key concepts of a framework for improving the ability of nurse educators and preceptors to teach PPM to nursing students. After four weeks another round of NGT meetings were done with nursing faculty (n = 6), academic nurse leaders (n = 3), nurse preceptors (n = 2), clinical nurse leaders (n = 2), a nurse leader from a regulatory body (n = 1), and nursing student (n = 1) to validate the developed framework.

FINDINGS

Four main strategies corresponding to the key concepts were mapped in a framework. Participants had a consensual agreement on the importance of the developed framework, they confirmed its completeness and practicality. In addition, participants found that the developed framework is logical, and confirmed that it is applicable for its purpose.

CONCLUSION

The developed framework presents an opportunity to respond to the gaps in nursing pain education in the context of limited resources settings such as Rwanda. It can also be applied in nursing practice and nursing research, aligning with the need of improving the quality of care of suffering children. Furthermore, the framework can be adapted and utilized to meet the needs of healthcare professionals other than nurses.

CLINICAL RELEVANCE

Strategies are suggested to improve the ability of nurse educators and preceptors in clinical settings to facilitate the acquisition of pediatric pain management competencies by the next generation of nurses. Future Rwandan nurses could then use the competencies acquired to provide optimal health care to children with pain in the best way possible during their practices.

Nurses' Attitudes Concerning Analgesia Administration for Pediatric Patients with Sickle Cell Disease in Jordan: A Cross-Sectional Study

BACKGROUND

Pain management of vaso-occlusive crises is a fundamental priority in the lifelong care of children and adolescents with sickle cell disease.

AIM

This study examined nurses' attitudes towards caring for children with sickle cell disease (SCD) and SCD pain management in those with vaso-occlusive pain.

METHOD

A structured, self-reporting survey was provided to a convenience sample of 298 nurses across 10 hospitals serving Jordan's northern and middle regions. Descriptive and inferential statistics were applied for data analysis.

RESULTS

Most nurses (77%) perceived their experience caring for children with SCD as positive. Many nurses (65%) felt frustrated about caring for these children during painful episodes. Participants identified workload and inadequate time as limiting their ability to address the analgesic needs of children with SCD. Receiving structured education specialized in pain management and more years of experience in nursing significantly predicted less hesitancy in administering opioid-based analgesia.

CONCLUSIONS

The results of this study provided further insight into factors that potentially contribute to vaso-occlusive pain crises frequently being poorly managed and inadequately addressed among pediatric patients. Nurses' attitudes and understanding of SCD pain management must be addressed to advance the clinical practice of managing pain in children with SCD.

Review of the Current Situation of Postoperative Pain and Causes of Inadequate Pain Management in Africa

Postoperative pain is one of the most prevalent complications following surgery, and more than 47% of surgical patients endure postoperative discomfort worldwide. In Africa, due to resource shortages and other issues, postoperative pain is substantially more common when compared to developed countries. Severe postoperative pain has many negative effects, including possibly death, which can burden both individuals and society as a whole. Therefore, effectively controlling postoperative pain is becoming increasingly important. To enhance the effectiveness of future pain management, a thorough analysis of the current reasons for inadequate postoperative pain management is necessary. In this article, the present situations of occurring postoperative pain, children's postoperative pain, and pain management in Africa are reviewed, based on relevant and recent literature. In particular, the reasons for inadequate postoperative pain management in Africa are detailed in this article from five perspectives: the inadequate assessment of postoperative pain, the knowledge gap among medical professionals, the patients' misconceptions, the scarcity of resources, and the lack of medications. Additionally, we offer appropriate solutions following various factors.

Knowledge and attitude towards pediatric pain management among nurses at Ethiopian tertiary hospitals; a multi-center study

Background

Pain is the most disturbing and annoying symptom experienced by children. However, it obtains poor attention in low- and middle-income countries particularly. The objective of this study was to assess knowledge, attitude and factors associated with pediatric pain management among nurses in tertiary hospitals in Northwest Ethiopia.

Methodology

: A multi-center cross-sectional study was conducted from March 1 to April 30, 2021. The knowledge and attitude of nurses were measured by using Nurses’ Knowledge and Attitudes Survey regarding Pain (P-NKAS). Descriptive and binary logistic regression analyses were performed to determine factors associated with knowledge and attitude. The strength of the association was presented by using adjusted odds ratio with 95% confidence interval and p-value < 0.05 was considered as statistically significant.

Result

A total of 234 (86.03% response rate) nurses were included and 67.1% of nurses had good knowledge and 89.3% had favorable attitudes towards pediatric pain management. The factors associated with good knowledge were having Bachelor’s Degree and above [AOR = 2.1, P = 0.015], having in-service training [AOR = 2.4, P = 0.008] and favorable attitude [AOR = 3.3, CI = 0.008]. The nurses who demonstrated good knowledge [AOR = 3.3, P = 0.003] and those who had Bachelor’s Degree and above [AOR = 2.8, P = 0.03] were found to have favorable attitude.

Conclusion

The nurses who were working in pediatrics care areas had good knowledge and favorable attitude towards pediatrics pain management. However, improvements are needed to eradicate misconceptions; particularly, on pediatrics pain perception, opioid analgesia, multimodal analgesia, and non-pharmacologic pain therapies. Nurses who had higher level of education, in-service training, favorable attitude were found to be knowledgeable. Furthermore, nurses who had higher levels of education and knowledge were found to have favorable attitude.

Neurocritical Patients: Review of the Scope of Nursing Diagnoses and Care in the Intensive Care Unit

Objective

To identify the diagnoses and nursing care for neurocritical patients in the intensive care unit.

Method

This is a scope review study, based on the Joanna Briggs Institute, led by the following guiding question: what are the diagnoses and nursing care for neurocritical patients in the intensive care unit? Data collection was carried out in February 2022 in a paired manner, in the following databases: EMBASE, MEDLINE, PubMed, and SCOPUS. For sample selection, the following search strategy was used: "Neurology" AND "Nursing Care" OR "Nursing Diagnosis" AND "Critical Care." Studies were independently selected, blinded by two reviewers.

Result

It was possible to identify 854 studies, which after analysis by title and abstract, only 27 articles passed the eligibility, of which 10 were part of this review.

Conclusion

According to the analysis of the studies, it was found that nursing care, combined with a care plan for neurocritical patients, allows for better results, with a view to the quality of life and health promotion.

The impact of education on the knowledge and attitudes of Ghanaian nurse tutors towards the assessment and management of pain in children: A quantitative study

BACKGROUND

Undertreatment of pain in children is an international problem as many children reports unresolved moderate to severe pain. One key factor which may contribute to under treatment of pain in children by nurses is lack of knowledge. In Ghana opportunities for nurses to learn about pediatric pain have been limited due to gaps in the undergraduate curriculum and inadequate continuing professional education post qualification.

OBJECTIVE

To assess tutors' knowledge and attitudes to pediatric pain management before and after an educational workshop.

DESIGN

Single group pre-test-post-test design.

SETTING

One Ghanaian Nursing Training College.

PARTICIPANTS

All (37) nursing tutors in the college.

METHOD

Total population sampling was used to access 37 tutors, data were collected using the Knowledge and Attitude Survey Regarding Pain at 3 stages; pre-intervention, immediately after the train-the-trainer based Pediatric Pain Educational Workshop and at 3-months follow-up. Data from the survey were analyzed using descriptive and inferential statistics.

RESULTS

Results at pre-intervention showed low scores in the survey. However, post-intervention results at both the immediate and 3-months follow-up stages revealed a significant increase from pre-intervention: Mean (SD) of 20.35 (4.56), to immediate follow-up Mean (SD) 26.93 (5.02), and 3-months follow-up Mean (SD) 25.19 (5.80) and a p-value of <0.001.

CONCLUSION

The results suggest tutors' knowledge and attitudes regarding pediatric pain management can be directly improved through a nurse tutor focused educational program. However, knowledge declines with time and as such there is the need for regular update through Continuing Professional Development activities.

Pain management in hospitalized children: A cross-sectional study

OBJECTIVE

To characterize pain management in hospitalized children.

METHOD

This is an observational, cross-sectional, retrospective and descriptive study of quantitative approach, carried out in a secondary hospital in the city of São Paulo, through analysis of 1,251 medical records of children admitted to the pediatric department. Data were tabulated and analyzed through descriptive statistics.

RESULTS

A total of 88.8% of children were assessed for pain with standardized instruments and 86% had analgesia prescribed. Among the assessments, 37.8% of the children had pain; of these, 26% had severe pain, greater in orthopedic conditions; 18.3% were not medicated, even with the presence of pain and prescribed analgesia; 4.3% had no analgesics prescribed; only 0.4% received non-pharmacological measures, and 40.3% had a report of reassessment. Professionals provided greater analgesia to children with surgical and orthopedic conditions compared to clinical conditions (p < 0.05).

CONCLUSION

Pain management in hospitalized children is ineffective, from initial assessments to reassessments after interventions, with prioritization of medication actions guided by professional judgment in the face of pain complaints.

Manejo da dor em crianças hospitalizadas: Estudo transversal

RESUMO Objetivo: Caracterizar o manejo da dor em crianças hospitalizadas. Método: Estudo observacional do tipo transversal, com abordagem quantitativa, de caráter retrospectivo e descritivo, realizado em um Hospital secundário do Município de São Paulo, por meio de análise de 1.251 prontuários de crianças internadas na divisão pediátrica. Os dados foram tabulados e analisados por meio de estatística descritiva. Resultados: Um total de 88,8% das crianças foi avaliado para dor com instrumentos padronizados e 86% tinham analgesia prescrita. Dentre as avaliações, 37,8% das crianças apresentaram dor; dessas, 26% apresentaram dor intensa, maior nas afecções ortopédicas; 18,3% não foram medicadas, mesmo com presença de dor e analgesia prescrita; 4,3% não tinham analgésicos prescritos; apenas 0,4% receberam medidas não farmacológicas e 40,3% tinham registro de reavaliação. Os profissionais propiciaram maior analgesia a crianças com afecções cirúrgicas e ortopédicas em comparação às afecções clínicas (p < 0,05). Conclusão: O manejo da dor em crianças hospitalizadas mostra-se ineficaz, desde as avaliações iniciais até as reavaliações após intervenções, com priorização de ações medicamentosas guiadas pelo julgamento profissional frente a queixa álgica.

Educational Intervention to Strengthen Pediatric Postoperative Pain Management: A Cluster Randomized Trial

BACKGROUND

Pediatric postoperative pain is still undertreated.

AIMS

To assess whether educational intervention increases nurses' knowledge and improves pediatric postoperative pain management.

DESIGN

Cluster randomized controlled trial with three measurement points (baseline T1, 1 month after intervention T2, and 6 months after intervention T3).

PARTICIPANTS/SUBJECTS

The study was conducted in postanesthesia care units at six hospitals in Norway. Nurses working with children in the included units and children who were undergoing surgery were invited to participate in this study.

METHODS

Nurses were cluster randomized by units to an intervention (n = 129) or a control group (n = 129). This allocation was blinded for participants at baseline. Data were collected using "The Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain: Norwegian Version" (primary outcome), observations of nurses' clinical practice, and interviews with children. The intervention included an educational day, clinical supervision, and reminders.

RESULTS

At baseline 193 nurses completed the survey (75% response rate), 143 responded at T2, and 107 at T3. Observations of nurses' (n = 138) clinical practice included 588 children, and 38 children were interviewed. The knowledge level increased from T1 to T3 in both groups, but there was no statistically significant difference between the groups. In the intervention group, there was an improvement between T1 and T2 in the total PNKAS-N score (70% vs. 83%), observed increase use of pain assessment tools (17% vs. 39%), and children experienced less moderate-to-severe pain.

CONCLUSIONS

No significant difference was observed between the groups after intervention, but a positive change in knowledge and practice was revealed in both groups. Additional studies are needed to explore the most potent variables to strengthen pediatric postoperative pain management.