Quantitative article.

Quantitative article.

Paper details

Resource:
Stanley, M., & Pollard, D. (2013). Relationship between knowledge, attitudes, and self- efficacy of nurses in the management of pediatric pain.

Pediatric Nursing, 39(4), 165-71. Retrieved from http://search.proquest.com/docview/1440019389?accountid=458

Develop a 10- to 15-minute presentation in which you address the following points:
• Strengths and weaknesses of the study
• Theoretical and methodological limitations
• Evidence of researcher bias
• Ethical and legal considerations related to the protection of human subjects
• Relationship between theory, practice, and research
• Nurse’s role in implementing and disseminating research
• How the study provides evidence for evidence-based practice
Identify the following for the research study:
• Quantitative Research Article Critique (pp. 422–446 of the text):
o Phase 1: Comprehension
o Phase 2: Comparison
o Phase 3: Analysis
o Phase 4: Evaluation

each slide with speaker notes. APA STYLE speaker notes

PEDIATRIC NURSING/July-August 2013/Vol. 39/No. 4 165
Pain management is a very im –
portant aspect of nursing care
of the pediatric patient. Ac –
cording to the Inter national
Association for the Study of Pain
(IASP), Special Interest Group on Pain
in Childhood (2005), pain relief is a
human right. Since 2001, pain management
standards require that pro –
viders be educated in the assessment
and management of pain, and that
they recognize the right of patients to
appropriate assessment and management
of pain (Joint Commission of
Accreditation of Healthcare Organi –
zations, 1999; The Joint Commission,
2011). Pain is a subjective experience
and can only be judged by the patient
experiencing it (McCaffrey & Pasero,
1999). Pain in children is a subjective
experience that “has sensory, emotional,
cognitive, and behavioral components
that are interrelated with
environmental, developmental, socio –
cultural, and contextual factors,” and
is often considered inadequately
assessed and undertreated (American
Academy of Pediatrics [AAP] &
American Pain Society [APS], 2001, p.
793). The role of the nurse in pain
management encompasses the entire
nursing process. The nurse assesses for
the presence of pain, plans pharmacological
and non-pharmacological pain
management strategies with the medical
team, implements the plan, and
evaluates the effectiveness of the
interventions (American Nurses Asso –
ciation [ANA], 2001).
Continuing Nursing Education
Pain management is a very important aspect of nursing care of the pediatric
patient. A nurse’s knowledge and attitude can affect his or her ability to adequately
provide pediatric pain management. This study examined the level of knowledge
of pediatric pain management, the attitudes of nurses, and the level of selfefficacy
of pediatric nurses in acute care. In addition, the relationship between
the years of experience and the levels of knowledge, attitudes, and self-efficacy
were examined. A cross-sectional, correlational design was used in a convenience,
non-probability sample of 25 pediatric nurses. Nurses volunteering to participate
in the study were asked to complete two instruments: Pediatric Nurses’
Knowledge and Attitudes Survey Regarding Pain (PNKAS-Shriners Revision)
(Manworren, 2000, 2001) and Nurses’ Self-Efficacy in Managing Children’s Pain
(Chiang, Chen, & Huang, 2006). There was no statistically significant relationship
between knowledge and self-efficacy (r = 0.039, p = 0.853) or knowledge and
years of nursing experience (r = 0.050, p = 0.822). There was a statistically significant
relationship between the level of knowledge and the years of pediatric
experience (r = 0.404, p = 0.05) and knowledge and the membership in a professional
nursing organization (t = 4.050, p = 0.004). Years of pediatric nursing
experience correlated with significantly higher knowledge levels, as did a membership
in a professional nursing organization. Further, education may benefit
pediatric nurses in regard to their management of pediatric pain. Research is
needed to examine the effects of self-efficacy on pediatric pain management and
how it relates to the level of knowledge.
Relationship Between Knowledge,
Attitudes, and Self-Efficacy of Nurses
In the Management of Pediatric Pain
Mercedes Stanley, Deborah Pollard
Objectives and instructions for completing the evaluation can be found on page 171.
Mercedes Stanley, BSN, RN, is a Pediatric
Staff Nurse, Novant Health, Hemby Children’s
Hospital, Charlotte, NC.
Deborah Pollard, PhD, RNC, CNE, is
Associate Professor, University of North
Carolina Wilmington, Wilmington, NC.
Statements of Disclosure: Please see page
171 for statements of disclosure.
Far too often, pediatric pain goes
undertreated. Although increased ef –
fort has been placed into pain management
improvement over the last
decade, research shows that up to 81%
of hospitalized children report moderate
to severe levels of pain (Pölkki,
Pietilä, & Vehviläinen-Julkunen, 2003)
and that nurses administer only 23%
to 43% of analgesics ordered (Jacob &
Puntillo, 1999; Vincent & Denyes,
2004). Walco, Cassidy, and Schechter
(1994) found that there are six main
barriers to treatment of pain in children:
1) the myth that children do not
feel pain the way adults do; 2) lack of
assessment and reassessment for the
presence of pain; 3) misunderstanding
of how to conceptualize and quantify
a subjective experience; 4) lack of
knowledge of pain treatment; 5) the
notion that addressing pain in children
takes too much time and effort;
and 6) fears of adverse effects of analgesic
medications, including respiratory
depression and addictions. The re –
searchers go on to say that the health
care team’s personal values and beliefs
about the meaning and value of pain
greatly affect the use of pain treatments.
For example, 55% to 90% of
nurses believe that children overreport
their pain (Manworren, 2000).
The purpose of this study was to
examine the level of knowledge of
pediatric pain management, the attitudes
of nurses, and the level of selfefficacy
of a group of pediatric nurses
in North Carolina.
Theoretical Framework
The theoretical framework guiding
this study is the concept of self-efficacy
as developed by Bandura’s Social
Cognitive Learning Theory. Bandura
(1994) defined self-efficacy as a person’s
belief in his or her capability to
successfully perform a specific task.
Self-efficacy is different than self-con166
PEDIATRIC NURSING/July-August 2013/Vol. 39/No. 4
fidence in that it is much more specific,
and it changes more quickly. Fur –
ther, just because one’s self-efficacy is
high in one area does not mean that
it is high in every area (Heslin &
Klehe, 2006).
According to Bandura (1994), selfefficacy
is affected through four main
psychological processes: cognitive,
motivational, affective, and selection.
These processes shape a person’s view
of their abilities and efficacy. There
are three central sources of self-efficacy:
enactive self-mastery, role-modeling,
and verbal persuasion. Enactive
self-mastery is by far the most powerful
source of gaining or losing self-efficacy
and is experienced through situations
that provide many opportunities
to succeed and few opportunities
to fail (Heslin & Klehe, 2006). For
example, regarding pediatric pain
management, a new pediatric nurse
would be given the ability to assess
and treat pain under the instruction
of an experienced nurse multiple
times before ever assessing or treating
the pain on his or her own.
Role-modeling would be experienced
by watching the practiced
nurse give pain medications on a regular
basis. This allows novices to picture
themselves in the situation and
to visualize being successful. From
this source, it is important that the
role-model be willing to accept setback
as a normal part of learning and
continue to be persistent in the development
of skill. Verbal persuasion is
mixed between positive self-talk and
words of encouragement and praise
from managers and others who have
the ability to approve of skill (Heslin
& Klehe, 2006).
In this study, the relationship
between knowledge and self-efficacy
was examined. By receiving coaching
and by participating in pain management,
nurses should have gained
knowledge through enactive self-mastery.
Based on Bandura’s Social Cog –
nitive Learning Theory, increased
knowledge should play a role in
increased self-efficacy for these nurses.
Review of the Literature
Pain Assessment in Children
Many tools have been created in
the effort to aid nurses in the correct
pain assessments of their pediatric
patients. Pain is a subjective phenomenon,
but young children are often
not able to properly express their levatric
pain (Vincent, 2007). Other findings
conclude that even though much
importance is attributed to correct
pain management, it is not enough to
motivate nurses to improve in this
area. Because many nurses know that
some pain should be expected in
many situations, it is not abnormal
for a child to report a certain level of
pain. This study urges the importance
of exploring nurses’ attitudes and
beliefs toward pediatric pain management
(Twycross, 2008).
A qualitative study of 21 nurses
concluded that a barrier to pain management
is a lack of education about
pain assessment. Nurses reported that
if they were better prepared and
understood children’s pain behavior
better, they would be able to manage
it more effectively (Gimbler-Berglund,
Ljusegren, & Enskär, 2008). Not only
are nurses often undereducated on
pain management, Rieman and
Gordon (2007) identified that those
who are educated do not consistently
carry out proper pain management
techniques. In a study of 295 registered
nurses (RNs), a weakness most
nurses reported was the understanding
of pharmacology and its effects on
the respiratory system. Specifically,
many nurses reported a fear of respiratory
depression in their pediatric
patients (Rieman & Gordan, 2007).
The AAP and APS (2001) concur
that even though there is sufficient
knowledge supporting the correct
ways to treat pediatric pain, it is not
universally applied. In opposing literature,
a descriptive study by Griffin,
Polit, and Byrne (2008) surveyed a
convenience sample of 334 registered
nurses in the United States and concluded
that appropriate treatment is
generally given to pediatric patients.
The authors of the study clarify that
the surveys consisted of vignettes and
did not necessarily accurately portray
the clinical setting. They identified
overall barriers as nurses’ attitudes
toward pain management, the lack of
knowledge, and the lack of a universally
applied method for pain assessment
and management. In addition,
barriers related to work security, time
constraints, inconsistencies in practice,
and perceived lack of power by
nurses may impact their ability to
promote effective pain management
(Ellis et al., 2007; Ely, 2001).
Nurses’ Knowledge of Pain
Management
Inadequate pain management has
els of pain. The nurse must be aware
of the different methods to evaluate
pain: physiologic, self-report, behavioral,
and parent input (Merkel &
Malviya, 2000).
Physiologic indicators of acute
pain include an increase in heart rate,
blood pressure, or respirations. Numer –
ous self-report tools are available for
almost every age group and level of
development. Because self-report is
considered the golden standard for
pain assessment, it is necessary that it
be obtained as much as possible and
that there are reliable tools to measure
it (Merkel & Malviya, 2000).
Tools available for self-report
include Hester’s Poker Chip tool, the
Oucher Scale, the Wong-Baker FACES
Scale, the Visual Analog Scale (VAS),
and the Finger Span Scale. When selfreport
is not attainable, the nurse
should use a behavioral scale. This is
more often used for preterm and fullterm
infants who are unable to communicate.
The Face, Legs, Activity,
Cry, and Consolability (FLACC) Scale,
the Premature Infant Pain Profile
(PIPP), the Toddler-Preschooler Pain
Scale (TPPPS), and the Preverbal, Early
Verbal Pediatric Pain Scale (PEPPS) are
all behavior tools that have shown
effectiveness in behavioral pain asses –
sment. Lastly, asking the parents of
the child the usual pain responses of
their child may be beneficial. Each
method has strengths and weaknesses,
and it is important that the nurse
uses them in conjunction with each
other (Merkel & Malviya, 2000).
Although numerous reliable tools
are available for nurses to use in pediatric
pain management, many nurses
do not use them. In a study performed
by Simons and MacDonald (2004),
nurses’ views were explored concerning
children’s pain tools. The researchers
found that even though these nurses
were treating pain, they did not necessarily
use any pain tool. The nurses felt
they were not knowledgeable enough
about the tools to use them properly.
They believed proper instruction on
the tools would not only aid in their
care of the child in pain, but it would
also help in their documentation
(Simons & MacDonald, 2004).
Barriers to Pain Assessment
As mentioned, self-report is considered
the gold standard for pain
assessment, yet a study of 20 nurses
found that only 65% of the group
relied on patient self-report as the
most important indicator for pedi-
Relationship Between Knowledge, Attitudes, and Self-Efficacy of Nurses in the Management of Pediatric Pain
PEDIATRIC NURSING/July-August 2013/Vol. 39/No. 4 167
been shown to affect patient outcomes
by potentially increasing hospital
length of stay and delaying
recovery (Schechter, Berde, & Yaster,
2003); thus, the management of pain
has major implications for nursing. A
nurse’s knowledge and attitude can
affect his or her ability to adequately
provide pediatric pain management.
In one study by Rieman and Gordon
(2007), although the level of knowledge
of pediatric pain management
did not differ significantly based on
education preparation, nurses with
more than two years of experience or
who participated in continuing education
courses had significantly higher
knowledge and attitude scores
regarding pediatric pain management.
Schechter (2008) noted that even
in nurses with the best intentions,
gradual erosion of the level of attention
to pain is often inevitable in the
face of increasing patient volume, frequent
understaffing, and continued
resource limitations. Faced with these
challenges, it is important to identify
the knowledge, attitudes, and confidence
of pediatric staff and address
these barriers through planned educational
activities. Without an acknow –
ledgement of ownership in each
nurse, any pain management technique
will not be complete (Schechter,
2008).
This review of the research literature
demonstrates some common
limitations in the literature, such as
the use of convenience samples, small
samples sizes (less than 20 participants),
and an unequal set of demographics.
A limited set of studies depicted
strengths, including larger sample
sizes, national random samples, and
pre- and post-test evaluations.
Research clearly points toward the
importance of correct pediatric pain
management. It is imperative that
nurses be knowledgeable in the area,
and forceful steps should be taken to
remove barriers in the clinical setting.
Although studies have noted that
knowledge and attitudes may affect
pediatric pain management, the relationship
between the two and selfefficacy
has not been examined.
Methodology
Design
A cross-sectional, correlational
design was used in a convenience,
non-probability sample of pediatric
strument packets were delivered to
staff, and 26 were returned for a
return rate of 43.3%. One packet was
incomplete, and thus, not used in the
statistical analysis.
Data Analysis
All statistical data were analyzed
using the Statistical Package for the
Social Sciences (SPSS), Version 18.
Descriptive and inferential statistics
were used to describe and synthesize
the data. Frequencies, percentages,
ranges, means, and standard deviations
were used for the demographic
variables and to describe the scores on
the study variables. The Pearson correlation
was used to examine any relationships
between the study variables.
The t-test was used to measure differences
between the mean scores on the
study variables of level of knowledge
and level of self-efficacy to examine
any differences between comparison
groups. The level of significance set
for the study was p < 0.05.
Findings
Sample Characteristics
Twenty-five nurses (N = 25) participated
in the study. Thirteen nurses (n
= 13) participated from a regional hospital
in western North Carolina
(Hospital 1) and 12 nurses (n = 12)
participated from a regional hospital
in southeast North Carolina (Hospital
2). As shown in Table 1, the mean age
of the participants was 36.64 years
(Range = 22 to 58 years, SD = 9.21).
The mean number of years since nursing
graduation was 9.39 years. The
years of nursing experience averaged
10.17 years, and pediatric nursing
experience was 7.92 years. The res –
pondents estimated they spent an
average of 59.44% of their time caring
for patients in pain.
The majority of the participants
were female (92%), worked full time
(84%), and had an associate degree in
nursing (52.4%); others had a bachelor’s
degree (42.9%), and one had a
diploma in nursing (4.8%). Of the
respondents, 56% served on a nursing
committee, 12% were a member of a
professional nursing organization,
and they reported reading an average
of 0.67 professional journals monthly.
Research Question 1:
Level of Knowledge
The PNKAS was used to measure
the level of knowledge of the pediatric
nurses in two regional hospitals in
North Carolina. Following Institu –
tional Review Board approval, nurses
meeting the following inclusion criteria
were invited to participate in the
study: registered professional nurses
and currently employed on a pediatric
acute care unit. Nurses volunteering
to participate in the study
were asked to complete two research
instruments: the Pediatric Nurses’
Knowledge and Attitudes Survey Regard –
ing Pain (PNKAS-Shriners Revision)
(Manworren, 2000, 2001) and Nurses’
Self-Efficacy in Managing Children’s
Pain (Chiang, Chen, & Huang, 2006).
Pediatric Nurses’ Knowledge and
Attitudes Survey Regarding Pain (PNKASShriners
Revision) (Manworren,
2000, 2001). This survey includes 40
questions measuring knowledge and
attitudes in managing pediatric pain.
The survey has an acceptable level of
stability with a test-restest reliability
of 0.67 and an acceptable level of internal
consistency with a Cronbach’s
alpha of 0.72 to 0.77. Content validity
was established by five national
content experts in pediatric pain
(Manworren, 2001). The Cronbach’s
alpha for this study was 0.82.
Nurses’ Self-Efficacy in Managing
Children’s Pain (Chiang et al.,
2006). This survey includes six questions
addressing self-efficacy in pediatric
pain management. The survey has
high internal consistency (Cronbach’s
alpha 0.88 at pre-test and 0.91 at posttest),
and content validity was established
by a panel of three pediatric
experts (Chiang et al., 2006). The
Cronbach’s alpha for this study was
0.81.
Procedure
Surveys were distributed in the
mailboxes of pediatric nurses at both
hospitals. Brochures were made and
distributed with the surveys and
placed throughout the units inviting
the nurses to join the study. A locked
drop-box was placed in the manager’s
office to ensure confidentiality for the
returned surveys. The study was presented
to the nurses at their staff
meetings and through multiple
e-mails, and a candy bowl was located
at the lock-box as an incentive and
thank you to the participants. The
data collection period for the study
was four weeks from the time the
brochures were distributed until the
due date for the completed surveys.
Participants were given four weeks for
survey completion. A total of 60 in –
168 PEDIATRIC NURSING/July-August 2013/Vol. 39/No. 4
nurses. As shown in Table 2, the total
mean of PNKAS was 26 (maximum
score = 39), indicating that the participants
answered an average of 66.6%
of the questions correctly. Between the
two groups, nurses at Hospital 1 (n =
13) scored significantly higher on the
PNKAS than the nurses at Hospital 2
(n = 12) (t = 2.044, p = 0.05).
Research Question 2:
Level of Self-Efficacy
The Nurses’ Self-Efficacy in Mana –
ging Children’s Pain (SET) tool was
used to measure the level of self-efficacy
of pediatric nurses. As shown in
Table 3, the total mean on the SET
was 26.28 (maximum score = 30),
indicating that overall, the participants
had a high level of self-efficacy
in regard to pediatric pain management.
There was no statistically significant
difference between the two
groups (t = -1.054, p = 0.303).
Research Question 3:
Correlation Between Years
Of Experience, Knowledge,
And Self-Efficacy
Pearson correlation analysis did
not reveal a statistically significant
the years of pediatric nursing experience
(r = 0.031, p = 0.885). However,
the analysis did show a statistically
significant positive relationship be –
tween the level of knowledge and the
years of pediatric nursing experience
(r = 0.404, p = 0.05). Nurses with more
years of pediatric experience scored
higher on the PNKAS.
relationship between the level knowledge
and years of nursing experience
(r = 0.050, p = 0.822) or the level of
knowledge and the self-efficacy score
(r = 0.039, p = 0.853). As shown in
Table 4, there was also no statistically
significant relationship between the
level of self-efficacy and the years of
nursing experience (r = -0.171, p =
0.425) or the level of self-efficacy and
Relationship Between Knowledge, Attitudes, and Self-Efficacy of Nurses in the Management of Pediatric Pain
Table 1.
Characteristics of the Sample (N = 25)
Variable Range Mean SD Frequency
Age 22 to 58 36.64 9.214
Years Since Nursing Graduation 1 to 30 9.39 8.038
Years of Nursing Experience 1 to 30 10.17 7.772
Years of Pediatric Experience 1 to 30 7.92 7.265
Estimated Percentage of Day Spent Caring for Patients in Pain (%) 10 to 100 59.44 29.670
Number of Professional Journals Read Monthly 0 to 3 0.67 0.868
Gender
Male 2 (8.0%)
Female 23 (92.0%)
Degree
Diploma 1 (4.8%)
AD 11 (52.4%)
BSN 9 (42.9%)
Full-Time Status
0.8 to 1.0 FTE 21 (84.0%)
0.5 to 0.7 FTE 4 (16.0%)
Registered Nurse 25 (100.0%)
Currently Providing Nursing Care 24 (100.0%)
Member of a Professional Organization 22 (88.0%)
Serves on a Nursing Committee 14 (56.0%)
Table 2.
Level of Knowledge of Pediatric Nurses
Group % Correct Mean PNKAS SD t-Score
Hospital 1 69.0% 27.08 2.90 t = 2.044
Hospital 2 63.6% 24.83 2.58 p = 0.050
All 66.6% 26.00 2.93
Table 3.
Level of Self-Efficacy of Pediatric Nurses
Group Mean SET SD I-Score
Hospital 1 25.69 3.093 t = -1.054
Hospital 2 26.92 2.712 p = 0.303
All 26.28 2.923
PEDIATRIC NURSING/July-August 2013/Vol. 39/No. 4 169
Additional Findings
Although not statistically significant,
nurses with an associate degree
(AD) had a lower knowledge but a
higher level of self-efficacy than nurses
with a bachelor’s degree (BSN) (t =
-1.212, p = 0.245), as shown in Figure
1. In reverse, nurses with a BSN had a
higher level of knowledge but a lower
level of self-efficacy (t = 1.526, p =
0.150). This may be that increased
education allows recognition of
knowledge deficits. There was a statistically
significant difference between
groups of nurses who either participated
or who did not participate in
professional organizations. Nurses
who participated in professional
organizations scored higher on the
PNKAS (t = 4.050, p = 0.004).
As in previous studies, the strengths
and weaknesses of the nurses in
regard to knowledge of pain management
were acknowledged by identifying
the top 11 questions answered
correctly (see Table 5) and the top 10
questions answered incorrectly (see
Table 6) by the nurses who took the
PNKAS.
Discussion
The overall purpose of this study
was to assess the relationship between
knowledge and self-efficacy of pain
management for pediatric nurses.
Although no relationship was found
between the level of pediatric pain
knowledge and the level of self-efficacy,
it is important to note that practicing
pediatric nurses may feel a high
level of self-efficacy without the corresponding
high level of knowledge in
regard to pain management. Feeling
overly confident could potentially be
dangerous to patients in need of pain
management.
The findings of this study were
mostly consistent with findings of
Rieman and Gordon (2007) regarding
the level of knowledge of pediatric
pain management. A range from 53.8
to 82% on the PNKAS may suggest a
need for increased education for pediatric
nurses. Patients have a right to
receive adequate pain assessment and
management, and it is important for
hospitals to be aware of their nurses’
abilities to perform these tasks.
Also noted was that the years of
nursing experience did not demonstrate
a relationship with the level of
pain management knowledge or selfefficacy.
However, the years of pediatric
experience demonstrated a posi-
Table 4.
Correlation Between Years of Experience, Knowledge,
and Self-Efficacy
Variables Test Statistic p-Value
PNKAS and Years of Nursing Experience r = 0.050 p = 0.822
PNKAS and Years of Pediatric Nursing Experience r = 0.404 p = 0.050
SET and Years of Experience r = -0.171 p = 0.425
SET and Years Pediatric Nursing Experience r = 0.031 p = 0.885
PNKAS and SET r = 0.039 p = 0.853
Table 5.
Top 11 Questions Answered Correctly by Nurses
% Correct Question [Correct Answer]
96.2 Observable changes in vital signs must be relied upon to verify a
child’s/adolescent’s statement that he has severe pain. [False]*
96.2 The child/adolescent should be advised to use non-drug techniques
alone rather than concurrently with pain medications. [False]
92.3 Comparable stimuli in different people produce the same intensity of
pain. [False]
92.3 Giving children/adolescents sterile water by injection (placebo) is often
a useful test to determine if the pain is real. [False]*
88.5 Infants/children/adolescents may sleep in spite of severe pain. [True]*
88.5 Parents should not be present during painful procedures. [False]
88.5 The child/adolescent with pain should be encouraged to endure as
much pain as possible before resorting to a pain relief measure. [False]
88.5 Children less than 8 years cannot reliably report their pain intensity, and
therefore, the nurse should rely on the parents’ assessment of the
child’s pain intensity. [False]
88.5 After the initial recommended dose of opioid analgesic, subsequent
doses should be adjusted in accordance with the individual patient’s
response. [True]
88.5 The recommended route of administration of opioid analgesics to
children with brief, severe pain of sudden onset (e.g. trauma or
postoperative) pain is: [intravenous].*
88.5 The most likely explanation for while a child/adolescent with pain would
request increased doses of pain medication is: [The child/adolescent is
experiencing increased pain.]
Note: Due to a tie in numbers, 11 questions are reported here.
*There were four questions on this list not reported in the top 10 questions answered
correctly by nurses completing the PNKAS
Source: Copyright 2002 Shriners Revision. From Rieman & Gordon, 2007. Used with
permission.
Figure 1.
Level of Knowledge and Self-Efficacy Related to Degree Held
AD BSN
24
25
26
27
28
25.36
27.00
27.27
25.33
PNKAS SET
170 PEDIATRIC NURSING/July-August 2013/Vol. 39/No. 4
tive relationship to knowledge but
not self-efficacy. Nurses generally re –
ported a high level of self-efficacy but
scored lower than comparison studies
on knowledge of pain management.
Limitations to this study included
the small sample size (N = 25) that the
respondents were from only two hospitals,
and the education provided for
nurses on pain management and the
presence of pain management protocols
was not considered. Respondents
With the level of knowledge being
lower than deemed acceptable by
most nursing standards (less than
85%), further research should be conducted
to verify these low levels in
regard to pediatric pain management.
Continued validity of the PNKAS and
SET tool is imperative, as is the need
for potential other tools used to assess
the level of knowledge and the level
of self-efficacy. In regard to the level
of self-efficacy, it is important that
nurses are not overly confident in
their abilities to assess and treat pain.
Education on pediatric pain management
would be suggested for pediatric
units. Nurses are continually
faced with the challenge of treating
pain, and to ensure the best quality of
care for patients, nurses need effective
knowledge, skills, and attitudes to
address pediatric pain needs. To meet
nurses’ educational needs, it is essential
to provide ongoing education that
focuses on their individual needs and
is provided in a method of delivery
that is receptive to and effective for
the practicing nurse. Further research
should also focus on the implementation
of pediatric pain education programs
and their effectiveness. There is
a need for continued examination on
the effects of self-efficacy in pediatric
pain management and how it relates
to the level of knowledge.
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Ellis, J., McCleary, L., Blouin, R., Dube, K.,
Rowley, B., MacNeil, M., & Cooke, C.
(2007). Implementing best practice pain
management in a pediatric hospital.
Journal for Specialists in Pediatric
Nursing, 12(4), 264-277.
Ely, B. (2001). Pediatric nurses’ pain management
practice: Barriers to change.
Pediatric Nursing, 27(5), 473-480.
Gimbler-Berglund, I., Ljusegren, G., &
Enskär, K. (2008). Factors influencing
pain management in children.
Paediatric Nursing, 20(10), 21-24.
were self-selected and may relate to
their interest in pain management.
Therefore, those who had little to no
interest in pain may not have taken
the survey, indicating that the actual
level of knowledge may be much
lower than what was found. Further,
the PNKAS does not correlate to actual
clinical practice, and consequently,
may not identify actual clinical abilities
(Manworren, 2000; Rieman &
Gordon, 2007).
Relationship Between Knowledge, Attitudes, and Self-Efficacy of Nurses in the Management of Pediatric Pain
Table 6.
Top 10 Questions Answered Incorrectly by Nurses
% Incorrect Question [Correct Answer]
96.2 Acetaminophen 650 mg PO is approximately equal in analgesic
effect to codeine 32 mg PO. [True]
80.8 Respiratory depression rarely occurs in children/adolescents who
have been receiving opiods over a period of months. [True]
76.9 A child with background (continuous, persistent) pain has been
receiving daily opioid analgesics for 2 months. The doses increased
during this time period. Yesterday the child was receiving morphine
20 mg/hour intravenously. Today he has been receiving 25 mg/hour
intravenously for 3 hours. The likelihood of the child developing
clinically significant respiratory depression is [less than 1%].
76 What do you think is the percentage of patients who over report the
amount of pain they have? [0 or 10%]*
73.1 Beyond a certain dosage of morphine, increases in dosage will
NOT provide increased pain relief. [False]
73.1 Which of the following drugs are useful for treatment of pain in
children? [All of the above – Ibuprophen, morphine, amitriptyline]
73.1 Narcotic/opioid addiction is defined as psychological dependence
accompanied by overwhelming concern with obtaining and using
narcotics for psychic effect, not for medical reasons. It may occur
with or without physiological changes of tolerance to analgesia or
physical dependence (withdrawal).
Using this definition, how likely is it that opioid addiction will occur
as a result if treating pain with opioid analgesics? [Less than 1%]*
61.5 Research shows that promethazine (Phenergan®) is a reliable
potentiator of opioid analgesics. [False]
61.5 Which of the following analgesic medications is considered the drug
of choice for the treatment of prolonged moderate to severe pain in
children? [Morphine]
61.5 Patient A: Andrew is 15 years old, and this is his first day following
surgery. As you enter his room, he smiles at you and continues
talking and joking with his visitor. Your assessment reveals the
following information: BP = 120/80; HR = 80; R = 18; on a scale of
0 to 10 (0 = no pain/discomfort, 10 = worst pain/discomfort), he
rates his pain as 8.
On the patient’s record you must mark his pain on the scale below.
Circle the number that represents your assessment of Andrew’s
pain. [8]*
*There were three questions on this list not reported in the top ten questions answered
incorrectly by nurses completing the PNKAS.
Source: Copyright 2002 Shriners Revision. From Rieman & Gordon, 2007. Used with
permission.
PEDIATRIC NURSING/July-August 2013/Vol. 39/No. 4 171
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Instructions For
Continuing Nursing Education
Contact Hours
Relationship Between
Knowledge, Attitudes,
And Self-Efficacy of Nurses
In the Management of Pediatric
Pain
Deadline for Submission:
August 31, 2015
PED 1306
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Goal
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Objectives
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management in the nursing care of the
pediatric patient.
2. Discuss the relationship between the
years of nursing experience and the
levels of knowledge, attitudes, and selfefficacy
in relation to pediatric pain
management.
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