A Survey of Registered Nurses Knowledge and Attitudes Regarding Paediatric Pain Assessment and Management: An Irish Perspective

A Survey of Registered Nurses’

Knowledge and Attitudes Regarding

Paediatric Pain Assessment

and Management: An Irish Perspective

Thursday 26th March 2009

RCN International Research Conference Cardiff, Wales.

Eileen Tiernan

Research Question

What is the knowledge base and

attitudes of registered nurses

regarding paediatric pain assessment

and management who work in an Irish

Data Collection Tool



Self report questionnaire



Manworren (2001) Paediatric Nurses’

Knowledge and Attitude Survey

(PNKAS)

Sample



Registered nurses in one paediatric

hospital in Ireland



Variety of paediatric units/ wards to cover

all specialities



Simple Random Sampling



Gatekeepers employed - Clinical Nurse

(Education) Facilitators

Inclusion Criteria

 All registered nurses working on designated units.  Paediatric qualification not essential

Exclusion Criteria

 Gatekeepers

 Nurses undertaking paediatric nurse training

 Agency nurses

 Newly appointed nurses (orientation /

preceptorship , < 4 months)

 Clinical Nurse Specialists

 CNM 3 and above (Middle Management)

Response Rate



292 questionnaire distributed by

gatekeepers



Response rate of 60% (n = 174)

Demographics

 52.6% (n = 49) qualified between 6-15 years

 75.7% (n = 89) qualified < 20 years

 Paediatric Experience

 28.7% (n = 50) 6-10 years

 56.3% (n = 98) < 10 years experience

 Nursing Grade

 1:4 Ratio – Clinical Nurse Manager 2 (Ward Sister Grade) :

Country of Initial

Registration

Nursing Specialities

A/E Dept Burns Cardiology Day Unit / Radiology Infants (Medical / Surgery)

Medicine - Children Oncology Orthopaedics OPD / IV / Pheb PICU - General / HDU

PICU - Cardiac Surgery - Children Renal / Urology Theatre - Recovery / Anaesthetics TCU Specialit y 0 5 10 15 20 25 Frequency 7 4.02% 11 6.32% 18 10.34% 11 6.32% 18 10.34% 6 3.45% 16 9.2% 8 4.6% 8 4.6% 23 13.22% 16 9.2% 11 6.32% 1 0.57% 11 6.32% 9 5.17%

Nursing Qualifications

Highest Academic Education

Certificate Diploma Degree Higher

Diploma

Post Graduate

Diploma Academic Qualification

Results



Total mean score on the PNKAS scale

was

62%



Majority of nurses scored

<80%

which has been identified as a

satisfactory level for practice

standards

Knowledge Deficits



Pharmacology and Pharmacokinetics –

Also most requested for continuing

education by nurses



Opiates & Incidence of:

 Respiratory Depression  Risk of Addiction

Opiates

(chronic pain in child,

receiving opiates for 2 month old)

Risk of Respiratory Depression

 29.9% (n = 52) answered correctly risk < 1%  61.5% (n = 107) believed the risk to be higher

 11% (n = 19) of nurses believed it to be extremely

high i.e. > 40%

Risk Of Addiction

 42% of nurses answered correctly risk of opioid

addiction < 1%

 52.3% (n = 91) believed risk to be higher

Pain Assessment

Over-Report of Pain



The majority of nurses 53% (n = 92)

believed that children over reported the

amount of pain



43.7% (n = 76) believed the percentage to

be 20-50%



9.2% (n = 16) of respondents believed the

Pain Assessment -Self Report

Vignettes

Pain Assessment

 Childs’ self report – ‘Gold Standard’ of

pain assessment intensity (RCNI, 1999)

Contradiction

 83.3% (n = 145) respondents – child/ adolescent,

most accurate judge of own pain

 Study supports Coyne et al (2006) – Irish children's

views

 Children's reports of pain are not believed and

 No differences were demonstrated between

 Nurses’ age

 Years of nursing experience  Years of paediatric experience  Nursing grade

 Highest academic qualification

 Pain education during hospital orientation on the mean PNKAS

score

 A statistically significant difference (p = <0.001) of moderate to

large effect was demonstrated between nurses whose main

qualification was Registered Children’s Nurse (RCN) compared to RGN on the mean PNKAS score

 Also between nurses who worked in different specialities on the

mean PNKAS score (p = 0.003)

 Nurses who had received pain education within the previous two

years demonstrated a positive difference (p = 0.003) of

Continuing Education

 68% nurses (n = 127) did not have pain education in

previous 2 years

 Nurses motivated to learn - 87%

(n = 151) wanted pain education

 Presently ad hoc – need for structure / pathway

(post –graduate)

 Pain education needs reinforcement at regular

intervals – nurses requesting mandatory study days / in-service

Paediatric Pain Education

Requested by Nurses



Pharmacology



Pain Assessment



Pain- management specific groups of

patients



Non-pharmacological Interventions



Twycross (2001) Delphi study

 Pain Assessment

 Pharmacological Interventions  Non-pharmacological



Simons (2002) Action research

Perceived Barriers

 Unsatisfactory analgesic prescriptions

 Unsatisfactory pain assessment

 Attitudes and beliefs of nurses and doctors

 Lack of knowledge

 Fears

 Environmental Factors (time, shortage of staff,

Summary

 Findings support concerns regarding unsatisfactory pain

assessment, management, attitudes and knowledge in nurses.

 Registered Children’s Nurse (RCN) qualification and

continuing education within previous 2 years including nurses area of expertise had a positive influence on nurses’

knowledge.

 There is a need for intensive continuing education for nurses

regarding paediatric pain management and special

consideration in relation to non-paediatric qualified nurses.

 Education is needed in: pain assessment, including self report;

pharmacology and pharmacokinetics of analgesia especially in

relation to opiates to dispel fears and non-pharmacological

interventions.

 Educational strategies i.e. problem based learning and

Acknowledgements

 Nurses who completed questionnaires, colleagues

who assisted in testing the reliability of the tool, the expert content panel and the gatekeepers.

 Special thanks to my supervisor:

Carmel Doyle

School of Nursing and Midwifery, Faculty of Health Sciences,

Trinity College Dublin, Ireland.

References

 Burnard, P. (1991) A method of analyzing interview transcripts in qualitative

research. Nurse Education Today 11: 461-466.

 Coyne, I. Hayes, E. Gallagher, P. and Regan, G. (2006) Giving Children a Voice:

Investigation of Children’s Experiences of Participation in Consultation and Decision Making in Irish Hospitals. Dublin: Office of the Minister for Children.

 Manworren, R.C.B. (2001) Development and testing of the pediatric nurses’

knowledge and attitudes, survey regarding pain. Pediatric Nursing 27 (2): 151-158.

 McCaffrey, M. and Ferrell, B.R. (1997) Nurses’ knowledge of pain assessment: how

much progress have we made? Journal Of Pain and Symptom Management 14 (3): 175-188.

 Simons, J.M. (2002) An action research study exploring how education may

enhance pain management in children. Nurse Education Today 22, 108-117.

 Twycross, A. (2001) Achieving consensus about pain content for child