What factors influence nurses
adherence to paediatric pain
management guidelines in
New Zealand hospitals?
An exploratory study of
METHODS OF RESEARCH AND ENQUIRY 556301
RDP GROUP PRESENTATION NURSING 64-1
R AQUE L MUR PHY ( 1 3 0 2 6 5 5 ) , K E E LY Mc COWAT T ( 1 3 9 3 2 1 2 ) , MADDI POL E
( 1 3 8 6 9 5 5 ) , SA RAH ROB INSON ( 1 3 9 6 4 8 6 ) , E V E LYN WA RDEN ( 1 1 1 9 2 3 5 )
5 September 2014
Research issue and rationale
for research question
•The prevalence of pain in the hospitalised paediatric population is high,
and the pain intensity is often rated moderate to severe (Kozlowski et
•Nurses rely on techniques such as subjective observations of body
language and other non-verbal cues to manage pain (Twycross and
•Habich et al. (2012) and Twycross and Collins (2011) found that there is
insufficient adherence to hospital-developed pain management
•Use of guidelines can assist nurses to deliver effective pain
management (Bernhofer, 2011).
What factors influence nurses adherence to
paediatric pain management guidelines
in New Zealand hospitals?
An exploratory study of nurses experiences.
•To identify factors that have an influence on nurses adherence to
paediatric pain management guidelines.
◦ ‘Factors’ could either encourage or discourage adherence to guidelines.
◦ ‘Willingness’ and ‘ability’ to adhere to guidelines will be explored.
•To develop new insight into this important issue which has not been
explored in earlier research.
•To help inform improvements to paediatric pain management practice.
Research approach and
rationale for approach
•Qualitative research approach: An exploratory design.
• Generates new insight for a problem that has not clearly been defined
•Hermeneutic phenomenology design
• Provides insight into the experience of others
• Becomes Hermeneutic when method becomes interpretative (rather than
purely descriptive) (Kafle, 2011).
• Semi-structured focus groups with open-ended questions
• Participants to be given transcripts from focus group to allow for
•Why is this an appropriate choice?
•AUT Ethics Committee
• Requirements, guidelines and procedures
•ADHB approval process for Low Risk study:
• Submitting application form for research approval to the ADHB
• Obtaining approval at the department/service level
• Register the project at the research office
•How is this research project ethical?
• The aim of improving paediatric pain management practice
• Integration of Te Tiriti o Waitangi principles
•A combination of registered nurses, enrolled nurses, and nurse
•Currently working in paediatric ward at Auckland DHB
• At least 30 hours per week
•With at least one years experience in paediatrics
•Data collection technique:
• Focus group sessions of 5-6 nurses.
• 5-10 one hour sessions.
• Dependant on response to recruitment efforts.
• Guided questions open conversation among the participants.
• Sessions will be recorded and transcribed.
• Privacy and confidentiality in storage of data.
• AM / PM shift overlap.
• 6 months.
1. Researchers will read the focus group transcripts and become familiar
with the ‘essence’ of the nurses experiences.
2. Researchers will allow participants to review their transcripts with the
opportunity to make amendments.
3. After integrating participant feedback, researchers will codify the
transcripts, organising text into individually identifiable units of meaning.
4. Text will then be organised into categories containing multiple units of
meaning that are similar.
5. These categories will elucidate the major themes of the data, the major
themes of nurses experiences around adhering to paediatric pain
Thematic analysis data will be presented in table form and in rich
descriptive text, especially quotes, to illustrate the views of participants.
Encourages adherence Discourages adherence
“Children and parents were
more relaxed when we
followed the guidelines”
“We don’t have time to fill out 30
different forms for every patient on
Bernhofer, E. (2011). Ethics: ethics in pain management and assessment in hospitalized patients. The online journal of
issues in Nursing, 17(1). doi: 10.3912/OJIN.Vol17No01EthCol01
Habich, M., Wilson, D., Theilk, D., Melles, G., Crumlett, H., Masterton, J., & McGuire, J. (2012). Evaluating the
effectiveness of pediatric pain management guidelines. Journal of Pediatric Nursing, 27(4), 336-345.
Kafle, N. P. (2011). Hermeneutic phenomenological research method simplified. Bodhi: An interdisciplinary journal, 5,
181-200. Retrieved from
Kozlowski, L. J., Kost-Byerly, S., Colantuoni, E., Thompson, C. B., Vasquenza, K. J., Rothman, S. K., Billett, C., White, E.
D., Yaster, M., & Monitto, C. L. (2014). Pain prevalence, intensity, assessment and management in a
hospitalized pediatric population. Pain Management Nursing, 15(1), 22–35. doi: 10.1016/j.pmn.2012.04.003
Twycross, A & Collins, S. (2011). Nurses views about the barriers and facilitators to effective management of pediatric
pain. American Society for Pain Management Nursing, 14(4), 164-172. doi:10.1016/j.pmn.2011.10.007
Werner, G. (2007). Exploratory designs. In Werner, G. Collecting spatial data (3rd ed.). (pp. 77-99). NY: Springer.