Barriers and Facilitators to Effective Procedural Pain Treatments for Pediatric Patients in the Chinese Context: A Qualitative Descriptive Study

doi:10.1016/j.pedn.2020.06.004

Journal of Pediatric Nursing

Volume 54, September–October 2020, Pages 78-85

https://doi.org/10.1016/j.pedn.2020.06.004 Get rights and content

Highlights

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Forty-one determinants to using procedural pain treatments in infants and children were identified.
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Previously known common barriers/facilitators to pediatric pain management are confirmed.
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Unique determinants related to parents, organizational structures, culture were identified.

Abstract

Purpose

To explore nurse and physician leaders' perceptions of barriers and facilitators to using evidence-based procedural pain treatments (i.e., sweet solutions, breastfeeding, and topical anesthetics) for hospitalized infants and children in the Chinese context.

Design and methods

A descriptive qualitative study was conducted at three pediatric inpatient surgical units in one hospital in China. Purposive sampling was used to recruit nurse/physician leaders who were engaged in the clinical management of the 3 units. Data collection included a focus group and individual interviews. The Consolidated Framework for Implementation Research (CFIR) was used to guide the analysis of the data.

Results

Ten participants attended the focus group and 13 took part in individual interviews. The findings highlight 41 implementation determinants, including two neutral influencing factors, 22 barriers, and 17 facilitators. These influencing factors aligned with the four CFIR domains and 25 of the 29 CFIR constructs. Common barriers to using evidence-based pain treatments across different contexts were identified, such as health care professionals' limited knowledge and misconceptions on pediatric pain management, no specific policies, low priority, heavy workload, staff shortage, and limited time. Unique determinants in the Chinese context were also identified, including parents' concerns of these new interventions, parent wrath, hierarchical managerial system, and lower authority of nurses.

Conclusions

Multiple barriers as well as facilitators to using evidence-based pain management strategies were identified.

Practice implications

The findings inform further development of implementation strategies and could be used as baseline data for comparing the barriers and facilitators evaluated during and after implementation.

Section snippets

Background

Hospitalized children experience multiple painful procedures and events as part of their illness and nursing and medical care (Stevens et al., 2011). A chart review undertaken in 32 inpatient units within eight Canadian children's hospitals in 2011 indicated that 78% of hospitalized children had undergone at least one painful procedure in a 24 h data collection period, with an average of six painful procedures per child (Stevens et al., 2011). Studies conducted over the past twenty years

Research design

This study is part of a larger international collaborative research project, guided by the Ottawa Model of Implementation Leadership (Gifford, Graham, Ehrhart, Davies, & Aarons, 2017), that aims to develop and field test leadership interventions for facilitating the implementation of evidence-based pediatric pain management in the Chinese context. A qualitative descriptive research design (Sandelowski, 2000, Sandelowski, 2010) was used in this study to explore nurse/physician leaders'

Results

Ten participants attended the focus group (90 min approximately) and 13 participants took part in individual interviews. Individual interviews ranged from 15 min to 55 min. Participant demographic characteristics are summarized in Table 1. Six of the participants participated in both the focus group and individual interviews. The findings highlight 41 implementation determinants to evidence-based procedural pain reduction strategies for hospitalized pediatric patients in the Chinese context,

Discussion

To our knowledge, this is the first study in China to explore barriers and facilitators to implementing evidence-based procedural pain management strategies for hospitalized infants and children during painful procedures. In total, based on the CFIR, 41 implementation determinants including two neutral influencing factors, 22 barriers and 17 facilitators, were identified in the study. Most findings were consistent with previous studies (Alotaibi et al., 2018; Czarnecki et al., 2019; Harrison et

Conclusion

Despite over two decades of research attention aimed at improving pain management for infants and children during painful procedures in the inpatient and ambulatory health care setting, studies around the world continue to report sub-optimal management of pediatric procedural pain. This study illustrated common barriers to using evidence-based procedural pain treatments in children across different contexts but also identified unique determinants in the Chinese context. The CFIR provided a

Funding sources

This study was funded by the University of Ottawa International Research Acceleration Program (2016–2018) and Gaoyuan Nursing Grant Support of Shanghai Municipal Education (Hlgy1801gj). None of these funders had a role in study design, data collection and analysis, publication decisions, or preparation of the manuscripts.

CRediT authorship contribution statement

Jiale Hu: Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Writing - original draft, Writing - review & editing. Hong Ruan: Conceptualization, Formal analysis, Investigation, Writing - review & editing. Qingge Li: Formal analysis, Investigation, Writing - review & editing. Wendy Gifford: Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Writing - review & editing. Yiyan Zhou: Formal analysis,

Declaration of competing interest

The authors disclose no conflict of interest.

Acknowledgments

Thanks are due to all the participants in the interview for their time, support and suggestions throughout this study. Also, the authors appreciate Brianna Hammond, Sarah Running and Christopher White for their efforts and research assistance.

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¹: Contribute to the manuscript equally, and both are the corresponding authors.

View full text

Barriers and Facilitators to Effective Procedural Pain Treatments for Pediatric Patients in the Chinese Context: A Qualitative Descriptive Study

Highlights

Abstract

Purpose

Design and methods

Results

Conclusions

Practice implications

Section snippets

Background

Research design

Results

Discussion

Conclusion

Funding sources

CRediT authorship contribution statement

Declaration of competing interest

Acknowledgments

Pain

Pain Management Nursing

Pain Management Nursing

Newborn and Infant Nursing Reviews

International Journal of Nursing Studies

Clinical Therapeutics

Women and Birth

Paediatric pain management: Knowledge, attitudes, barriers and facilitators among nurses - integrative review

International Nursing Review

Prevention and Management of Procedural Pain in the neonate: An update

Pediatrics

Breast-feeding analgesia in infants: An update on the current state of evidence

Journal of Perinatal & Neonatal Nursing

Hospitalized children continue to report undertreated and preventable pain

Pain Research and Management

Nurses’ perceived barriers to and facilitators of research utilization in mainland China: A cross-sectional survey

Open Nursing Journal

Consolidated framework for implementation research constructs

Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science

Implementation Science

The qualitative content analysis process

Journal of Advanced Nursing

Ottawa model of implementation leadership (O-MILe) and implementation leadership scale (ILS): Mapping concepts for developing and evaluating theory-based leadership interventions

Journal of Healthcare Leadership

When east meets west: A qualitative study of barriers and facilitators to evidence-based practice in Hunan China

BMC Nursing

Innovations in knowledge transfer and continuity of care

Canadian Journal of Nursing Research

Lost in knowledge translation: Time for a map?

Journal of Continuing Education in the Health Professions

Pain prevalence in a pediatric hospital: Raising awareness during pain awareness week

Pain Research and Management

Sweet solutions to reduce procedural pain in neonates: A meta-analysis

Pediatrics

Be sweet to babies during painful procedures: A pilot evaluation of a parent-targeted video

Advances in Neonatal Care

Pain management during newborn screening: Using YouTube to disseminate effective pain management strategies

Journal of Perinatal & Neonatal Nursing

PARIHS revisited: From heuristic to integrated framework for the successful implementation of knowledge into practice

Implementation Science