Pain in children with cancer: knowledge and attitudes of Dutch paediatric nurses

Abstract

Children with cancer frequently experience pain as a result of the disease or its treatment. The assessment of pain in children is a multifaceted process. Their response to pain is both behavioural and physiological. In addition, the changing developmental levels of children complicate the assessment process. Paediatric care providers must use their knowledge of a child's cognitive abilities, developmental level and the nature of childhood pain to accurately assess an individual child's pain. Paediatric oncology nurses play an important role in the assessment and management of pain. Literature suggests that pain in children is often poorly assessed and undertreated due to a lack of knowledge and misconceptions. The purpose of this study is to explore the current knowledge and attitudes of paediatric nurses regarding pain in children with cancer in The Netherlands. Questionnaires were sent to 252 nurses in 7 hospitals. The questionnaire included demographic questions, and questions or nurses' knowledge of pain, attitudes towards childrens' reports of pain, nurses' perception of the effectiveness of pharmacological and non-pharmacological pain-relief interventions and pain-relief interventions they use. A total of 174 (69%) nurses responded. Findings indicate that the majority of the nurses have a sufficient knowledge base regarding pain in children. However, a distressing factor is that their knowledge of the effectiveness of pain-relief interventions does not reflect the interventions they use. Although nurses may know that a specific intervention is effective, they fail to put it into practice. Demographic factors, like age, education or work experience had no influence on the nurses' knowledge or application of their interventions. Further studies need to examine the cause of the discrepancy between knowledge and practical application of pain-relief interventions. It is vital that paediatric oncology nurses should not only be educated in knowledge of pain and pain interventions, but should also be stimulated to use these interventions in daily practice. Only then will this ensure that adequate pain control in children with cancer is achieved.