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Pediatric nurses' pain management practice: barriers to change.

A qualitative, descriptive design was used to examine factors that influence pediatric nurses' pain management practices. Staff nurses from one pediatric unit (N = 16) at a community-based hospital attended from one to six discussion groups. Detailed content analysis of transcripts from each discussion group was conducted. Several themes emerged in the analysis. Some themes are based on the nurses clinical practice of pain assessment and management, while others reflect the organizational issues and changes staff experienced. Themes identified included: barriers/solutions to clinical practice change, organizational barriers to practice change, and staff commitment toward pain management. Staff attendance and commitment to participation in this research was commendable considering the external pressures they felt and expressed about job insecurity and poor unit morale. It seemed that their commitment to attend and participate was, in part, based on the value they placed upon clinical skills and knowledge. The opportunity to talk about the effects of organizational change, both individually and collectively, on their work environment was also considered beneficial.