Strategies to Improve Clinical Nurses' Performances and Competencies in Providing a Good Pain Management to Hospitalized Children in Indonesia
Mediani HS*
Faculty of Nursing, University of Padjadjaran, Indonesia
Submission: May 05, 2017; Published: June 07, 2017
*Corresponding author: Mediani HS, Faculty of Nursing, University of Padjadjaran, Indonesia, Tel: 6282217391965; Fax: +62227795596; Email: hennymediani@hotmail.com/ henny.mediani@unpad.ac.id
How to cite this article: Mediani H. Strategies to Improve Clinical Nurses' Performances and Competencies in Providing a Good Pain Management to Hospitalized Children in Indonesia. JOJ Nurse Health Care. 2017; 2(2): 555581. DOI: 10.19080/JOJNHC.2017.02.555581
Opinion
In this brief article I would like to point out that effective pain management for pediatric patients remains an elusive goal in Indonesia. Many of Indonesian children endure pain from surgery, illness, nursing interventions and other medical procedures during hospitalization. However, little attention has been given to Indonesian children's pain management and care. Children's pain is often not recognized, is ignored or even denied. The management of pain in children fails to be given appropriate priority and children's pain is not properly managed in a variety of clinical situations in Indonesia. Globally, pain in children is an issue in hospitalized children and a public health concern of major significance in most parts of the world [1,2]. This report describes contemporary thinking about pain in children and its management in order to identify those factors that must be considered in developing some strategies to improve clinical nurses' performances and competencies in providing good pain care to Indonesian pediatric patients.
Several factors have been identified in the literature that may contribute to barriers to providing adequate pain management to children. These barriers can be grouped into four themes: nurses-related barriers, patient-related barriers, physician-related barriers and system-related barriers [3-5]. A current study conducted by Mediani [1] found that Indonesian nurses practicing in today's pediatirc healthcare environment are confronted with increasingly complex moral and ethical dilemmas. Pediatric nurses encounter these dilemmas in situations where their ability to provide a good pain care is frequently hindered by conflicting values and beliefs of other healthcare providers. Mediani [1] identified that the organisational context of the hospitals impacted on nurses' pain assessment and pain management practices. This effect was juxtaposed with their need to provide effective pain care. Within the reality of the practice setting nurses experienced many professional role tensions when managing pain in hospitalized children, which influenced their perceptions of their role as professional nurses. The professional role tensions occurred as a result of the conflict between the nurses' perceptions of the barriers to pain management and their views on how the role of pain management should be carried out.
A significant finding of this evidence was the nurses' suggestions for improving pain management practice in the context of pediatirc settings in Indonesia. Several strategies have been proposed in literature as means of overcoming some barriers indentified in current evidence and are presented in this paper. One an important strategy is the need to empower nurses to provide good pain care.Other strategy is needed to develop a team approach to pain management that would include both nurses and the medical profession. Nurses' professional autonomy, control over nursing practice, and effective inter-professional collaboration are viewed as core elements of nursing practice, and correlate with improved patient outcomes. Another important aspect that identified from the current evidence was nurses' knowledge gaps appear to persist, in particular in relation to pain assessment skills for assessing children's pain, basic knowledge and principles of pharmacological pain management for children, pain medication including the dosage, action and side effects of analgesic drugs and their management. Therefore, it is suggested that the hospital organization should provide nurses with training courses or in-service education about pain management in children, and provide an opportunity for nurses who had graduated from the diploma of nursing program to undertake a Bachelor's degree in nursing. Professional competence is a prerequisite for providing morally responsible care. The elements of a profession, such as formal education based on theoretical knowledge, a code of ethics, professional organizations that guide practice and the provision of necessary service to society, all serve to develop professional competence. Standards for ethical conduct are also necessary in order to provide morally responsible care.
To sum up, the importance of providing effective pain care cannot be over emphasized. Nurses have obligations to patients, one another to assure optimal pain management, personal wellbeing, and quality of life for all paediatirc patients with whom they come in contact. There is a give and take to empowerment, so nursing must be prepared to reshape the health care environment and act as its full partner. Both the culture of the profession and the culture of the workplace must be transformed. Creating an environment that supports both formal and informal continuing educational opportunities and learning will provide for autonomous clinical nursing practice.
References
- Mediani HS (2014) Indonesian nurses management of pain in children: a grounded theory study. Curtin University, Australia.
- Twycross A, Finley A (2013) Nurses' aims when managing pediatric postoperative pain: is what they say the same as what they do? J Spec Pediatr Nurs 19(1): 17-27.
- Czarnecki ML, Turner HN, Collins MP, Doellman D, Wrona S, et al. (2011) Procedural pain management: a position statement with clinical practice recommendations. Pain Manag Nurs 12(2): 95-111.
- Gimbler-Berglund I, Ljusegren G, Enskar K (2008) Factors influencing pain management in children. Paediatr Nurs 20(10): 21-24.
- Twycross A, Collins S (2013) Nurses' views about the barriers and facilitators to effective management of paediatric pain. Pain Manag Nurs 14(4): 164-172.