Nurses' perceptions of children's pain: a pilot study of cognitive representations

Despite advances in pain assessment and management, hospitalized children continue to report high levels of pain intensity. Untreated pain can have deleterious effects on multiple body functions, resulting in delayed recovery, prolonged hospitalization, and worsening illness. Prior research demonstrates that nurses administered analgesia that was less than amounts recommended by standards and less than that available by physician order. This study was conducted to better understand how nurses think about and respond to children's pain by examining pediatric nurses' cognitive representations (CRs) and comparing the contents of CRs with standards of practice and with management decisions in case studies. Kaplan's theory of CR guided the research. Twenty registered nurses' CRs were measured by the Conceptual Content Cognitive Map open-ended technique. Descriptive and content analyses revealed that participants have rich and diverse CRs of children's pain. Cognitive map content items (294) were coded by investigators as belonging to an assessment (63%) or management (37%) domain. Items were further coded into multiple subgroups in each domain. For assessment, 65% of participants included the use of children's self-report of pain in their maps while 80% included behavioral manifestations; 50% included both. For management, 75% of participants identified pharmacological approaches, 60% identified nonpharmacological approaches, and 35% identified family involvement; 25% identified all three approaches. Indicators in participants' cognitive maps suggest there may be a relationship between nurses' CRs and choice of analgesic administration. Findings provide the direction for future education and research to improve children's pain relief.