Nurses' Beliefs Regarding Pain in Critically Ill Children: A Mixed-Methods Study

Abstract

A convergent parallel mixed-methods design was used. Nurse beliefs were captured via questionnaire and interview and then compared. Forty nurses participated. Most beliefs reported via questionnaire were consistent with effective pain management practices. Common inaccurate beliefs included the need to verify pain reports with physical indicators and the pharmacokinetics of intravenous opioids. Beliefs commonly shared during interviews concerned the need to verify pain reports with observed behavior, the accuracy of pain reports, the need to respond to pain, concerns regarding opioid analgesics, and the need to "start low" with interventions. Convergent beliefs between the questionnaire and interview included the use of physical indicators to verify pain, the need to take the child's word when pain is described, and concerns regarding negative effects of analgesics. Divergent and conflicting findings were most often regarding the legitimacy of a child's pain report. Findings from this study regarding the accuracy of nurses' pain beliefs for critically ill children are consistent with past research. The presence of divergent and conflicting responses suggests that nurses' pain beliefs are not static and may vary with patient characteristics. While most nurses appreciate the risks of unrelieved pain in children, many are concerned about the potential adverse effects of opioid administration. Interventions are needed to guide nurses in minimizing both of these risks.