Exploration of nurses' pediatric pain management experiences in rural hospitals: A qualitative descriptive study.

Background: Hospitalized children continue to experience inadequate pain management. Children in the rural hospital setting may be at risk due to unique challenges experienced by Registered Nurses (RNs) in this context.

Objectives: To understand the experience of pain care from RNs who work in rural hospitals with inpatient pediatric patients.

Design: Qualitative description that used semi-structured interviews to explore RNs' inpatient pediatric pain care experiences.

Participants: RNs who: 1) worked directly with pediatric in-patients; 2) spoke English; 3) and who worked in rural Northern Ontario. Hospital sites were selected based on population density, from one province in Canada. To reduce heterogeneity, only sites with dedicated pediatric beds were eligible (n = 9).

Methods: This qualitative descriptive study used semi-structured interviews over Skype and telephone. Data were analyzed using inductive content analysis.

Results: Ten participants were recruited from seven sites. Five main categories were identified, with one category that influenced all other categories. Rural RNs needed to practice as generalists as they care for many types of patients. Resource challenges included a lack of specialist expertise and educational opportunities. Pediatric pain was not perceived as a priority within their organizations. Most participants perceived there were no explicit standards for pain care. Moving forward the adoption of built in assessments in electronic documentation was suggested as a solution to standard pain care.

Conclusions: Opportunity exists to improve pediatric pain management, however, without a systematic approach that considers the rural context, pain care for children will continue to be based on individual's beliefs and knowledge.