A Study to Evaluate the Effectiveness of Pain Management Guidelines in Terms of Knowledge, Attitude and Practices of Nursing Personnel Working in Pediatric Units of a Selected Hospital of Delhi

Uma Shanker Agrawal, Santosh Mehta, Daisy Thomas


Introduction: Pain management in pediatric population is a very important and crucial aspect of nursing
care. Though there is improved understanding of the physiological and psychological effects of unrelieved
pain in children, still so many research evidences show that pediatric nurses are having inadequate
knowledge, unfavorable attitude and poor practices regarding assessment and management of pain in
children. A study was conducted with the objectives to develop and evaluate the effectiveness of pain
management guidelines in terms of knowledge, attitude and practices of nursing personnel working in
pediatric units, determine the relationship between knowledge and attitude and knowledge and practice
and seek association of knowledge and practices with selected variables
Methodology: A pre-experimental approach and one group pretest-posttest design was selected. The
tools were a structured knowledge questionnaire, attitude scale and an observation checklist. Pain
management guidelines were developed based on expert opinion and review of literature. Sixty nursing
personnel who met the sampling criteria were selected by purposive sampling. On day 1, pretest of
knowledge and attitude ware administered and the pain management practices were observed. On the
same day, pain management guidelines were given to them with small group discussion. Demonstration
of pain assessment and management during painful procedure was given in small groups. On seventh
day, posttest of knowledge and attitude was administered. Posttest practices were observed.
Results: Findings of the study revealed that the mean posttest knowledge score was significantly higher
than the mean pretest knowledge score with a mean difference of 5.18 (P<0.05). The mean posttest
attitude score was significantly higher than the mean pretest attitude score with a mean difference of
12.43 (P<0.05). The mean posttest practice score was significantly higher than the mean pretest practice
score with a mean difference of 3.1 (P<0.05). There was a significant positive relationship between
knowledge and attitude (P<0.05). There was also a significant positive relationship between knowledge
and practices (P<0.05). The knowledge and practices of nursing personnel regarding pain management were not associated with years of experience, professional qualification and In-service education on pain management.

Conclusion: Knowledge deficit, unfavorable attitude and poor practices existed regarding pain management in children. Pain management guidelines were found to be effective in enhancing the knowledge, changing the attitude and improving the practices of nursing personnel.


Pain management guidelines, Knowledge, Attitude, Practices, Nursing personnel, Pediatric units

Full Text:



Hockenberry JM. Wong’s Essentials of Pediatric Nursing.

(7th ed.). Missouri: Mosby Publications 2008.

American Academy of Pediatrics (AAP) & American

Pain Society (APS). The assessment and management

of acute pain in infants, children, and adolescents.

Pediatrics 2001; 108(3): 793-97.

International Association for the Study of Pain (IASP),

Special Interest Group on Pain in Childhood. Children’s

pain matters! Priority on Pain in Infants, Children, and

Adolescents. 2005.

Joint Commission on Accreditation of Healthcare

Organizations (JCAHO). Standards for pain assessment

and treatment: Comprehensive Accreditation Manual

for Ambulatory Care, Behavioral Care, Health Care

Networks, Home Care, Hospitals, and Long Term Care.

Polkki T. Laukkala H. Vehvilainen – Julluinen K. Pietila.

Factors influencing nurses’ use of non-pharmacological

pain alleviation methods in pediatric patients.

Scandinavian Journal of Caring Sciences 2003; 17(4):


Jacob E, Puntillo KA. A survey of nursing practice in

the assessment and management of pain in children.

Pediatric Nursing 1999; 25: 278-86.

Vincent CVH, Denyes MJ. Relieving children’s pain:

nurses’ abilities and analgesic administration practices.

Journal of Pediatric Nursing 2004; 19(1): 40-50.

Salantera S, Lauri S. Nursing students’ knowledge of

and views about children in pain. Nurse Education

Today 2000; 20(7): 537-47.

Twycross A. Managing pain in children: Where to

from here? Journal of Clinical Nursing 2010; 19(15-

: 2090-99.

Manworren R. C. B and Hayes J. S. Pediatric nurses’

knowledge and attitudes survey regarding pain.

Pediatric Nursing 2000; 26(6): 610.

Walco G, Cassidy R, Schechter N. Pain, hurt, and harm.

The ethics of pain control in infants and children. New

England Journal of Medicine 1994; 331(8): 541-44.

Twycross A, Powls L. How do children’s nurses make

clinical decisions? Two preliminary studies. Journal of

Clinical Nursing 2006; 15(10): 1324-35.

Rieman M, Gordon M. Pain Management competency

evidenced by a survey of pediatric nurses’ knowledge

and attitudes. Pediatric Nursing 2007; 33(4): 307-12.

McNamara MC et al. Effect of education on knowledge,

skills and attitudes around pain. British Journal of

Nursing 2012; 21(16): 958-64.

Twycross A. What is the impact of theoretical

knowledge on children’s nurses’ postoperative pain

management practices? An exploratory study. Nurse

Education Today 2007; 27(7): 697-707.

Owens Denise et al. Evaluating students’ knowledge

of child pain and its management after attending a

bespoke course. Nursing Children and Young People

; 26(2): 34-40.

Lawes C, Sawyer L, Amos S et al. Impact of an education

programme for staff working with children undergoing

painful procedures. Paediatric Nursing 2008; 20(2):



  • There are currently no refbacks.

Copyright (c) 2017 International Journal of Nursing & Midwifery Research

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.