Managing pain in children: where to from here?

Aims and objectives. The aims of this study are to review research published in the past 15 years to provide insight into the factors impacting on the management of pain in children and identify strategies that can be used to improve pain management practices. Background. The evidence to guide nurses' pain management practices is readily available, in the form of clinical guidelines. However, children's nurses' pain management practices continue to fall short of the ideal with children experiencing moderate to severe unrelieved pain. Several factors have been suggested as providing an explanation for this. There is a need to explore the impact each of these factors have on pain management practices further. With this in mind, a literature review was undertaken. Design. Literature review. Methods. A computerised literature search was carried out using CINAHL, Medline and the British Nursing Index. The search terms used were as follows: pain, pain assessment, pain management, education, quality and nurses. Articles published in the last 15 years were included in the review. Results. Several themes emerged from this review of the literature as possible explanations for why children's pain is still not managed effectively. These include knowledge deficits; incorrect or outdated beliefs about pain and pain management; the decision-making strategies used and organisational culture. Conclusions. Improving pain management requires a multifactorial approach encompassing: education, institutional support, attitude shifts and change leaders. Issues that need addressing include education, decision-making strategies and organisational practices. Further research needs to be carried out to determine other factors that impact on pain management practices. Relevance to clinical practice. Despite the evidence to guide practice being readily available children continue to experience unrelieved pain. The strategies identified in this article may help to ensure that pain is relieved effectively.