A qualitative national study of nurses’ clinical knowledge development of pain in pediatric intensive care

Abstract

Background: Vulnerable children undergoing intensive care might still experience pain when they should not, due tonurses and pediatricians insufficient knowledge about how critical illness affects childrens’ signs of pain. How signs ofpain are learned in clinical practice might be one of the remaining aspects in nurses insufficient pain alleviation. In theworkplace learning is directed by what the units shared meaning finds as significant and meaningful to learn. However,what it is viewed as meaningful to learn about pain from the nurses’ perspective might not be meaningful from the child’sperspective. When working together in the PICU, nurses rely on each other and interact in many ways, and theirunderstanding is related to situated knowledge and facilitated by a personal reference group of colleagues. Professionalconcern, depending on culture, traditions, habits, and workplace structures forms the clinical learning patterns in thePICU. However little is known about nurses’ clinical learning patterns or collegial facilitation within the PICU. Theseassumptions lead to the aim of the study: to elucidate patterns in clinical knowledge development and unfold the role offacilitator nurses in relation to pain management in the PICU.

Method: The study had a qualitative interpretive design approach using semi-structured interviews, analyzed withqualitative content analysis to elucidate both manifest and latent content.

Results: The findings elucidates that the workplace culture supports or hinders learning and collaboration. Knowledgedevelopment within practice is closely connected to the workplace culture and to nurses’ significant networks. Thefindings also clarify that nurses needs to feel safe in the workplace and on an individual level to build and rely onsignificant networks that facilitates their own personal knowledge development. There is an ongoing interaction betweenthe learning patterns and the facilitation the significant networks offer.

Conclusions: Nurses need to embrace effective learning about children’s pain from day one. Lack of a facilitatingstructure for learning, lack of assessment within clinical practice, and the focus on the individual nurses’ learning areremaining considerable problems when it comes to alleviating the vulnerable child’s pain. To increase the possibility ofpain alleviation in the clinical setting, it is of importance to attend to the caring culture and build a safe collaborative culture that is patient centered. This requires an environment that allows for open discussion, where questioning andreflecting is a natural part of the culture within the group. These factors need highlighting and thorough examination fromthe organization. Nurses focus on learning, and interact in a learning community of practice that is furthered when theyexperience a safe environment and find that their questions are taken seriously. Approaches to promote a scholarship ofnursing care are needed to develop clinical learning and, consequently, raise the quality of pain care.