- •Forty-one determinants to using procedural pain treatments in infants and children were identified.
- •Previously known common barriers/facilitators to pediatric pain management are confirmed.
- •Unique determinants related to parents, organizational structures, culture were identified.
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.
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.
Multiple barriers as well as facilitators to using evidence-based pain management strategies were identified.
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.
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- Paediatric pain management: Knowledge, attitudes, barriers and facilitators among nurses - integrative review.International Nursing Review. 2018; 65: 524-533
- Prevention and Management of Procedural Pain in the neonate: An update.Pediatrics. 2016; 137: e20154271
- Breast-feeding analgesia in infants: An update on the current state of evidence.Journal of Perinatal & Neonatal Nursing. 2017; 31: 145-159
- Hospitalized children continue to report undertreated and preventable pain.Pain Research and Management. 2014; 19: 198-204
- Nurses’ perceived barriers to and facilitators of research utilization in mainland China: A cross-sectional survey.Open Nursing Journal. 2013; 7: 96-106
- Consolidated framework for implementation research constructs.Vol. 2019. 2018
- Prevalence and source of pain in pediatric inpatients.Pain. 1996; 68: 25-31
- Barriers to pediatric pain management: A brief report of results from a multisite study.Pain Management Nursing. 2019; 20: 305-308
- Barriers to pediatric pain management: A nursing perspective.Pain Management Nursing. 2011; 12: 154-162
- Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science.Implementation Science. 2009; 4: 50
- The qualitative content analysis process.Journal of Advanced Nursing. 2008; 62: 107-115
- 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. 2017; 9: 15-23
- When east meets west: A qualitative study of barriers and facilitators to evidence-based practice in Hunan China.BMC Nursing. 2018; 17: 26
- Innovations in knowledge transfer and continuity of care.Canadian Journal of Nursing Research. 2004; 36: 89-103
- Lost in knowledge translation: Time for a map?.Journal of Continuing Education in the Health Professions. 2006; 26: 13-24
- Pain prevalence in a pediatric hospital: Raising awareness during pain awareness week.Pain Research and Management. 2014; 19: e24-e30
- Sweet solutions to reduce procedural pain in neonates: A meta-analysis.Pediatrics. 2017; 139
- Be sweet to babies during painful procedures: A pilot evaluation of a parent-targeted video.Advances in Neonatal Care. 2017; 17: 372-380
- Pain management during newborn screening: Using YouTube to disseminate effective pain management strategies.Journal of Perinatal & Neonatal Nursing. 2017; 31: 172-177
- Neuroprotective Core measure 5: Minimizing stress and pain—Neonatal pain management practices during heel lance and venipuncture in Ontario, Canada.Newborn and Infant Nursing Reviews. 2015; 15: 116-123
- PARIHS revisited: From heuristic to integrated framework for the successful implementation of knowledge into practice.Implementation Science. 2016; 11: 33
- A systematic review of the effects of repeated painful procedures in infants: Is there a potential to mitigate future pain responsivity?.Journal of Nursing Education and Practice. 2013; 3: 99-112
- Code saturation versus meaning saturation: How many interviews are enough?.Qualitative Health Research. 2016; 27: 591-608
- Leadership behaviours play a significant role in implementing evidence-based practice.Journal of Clinical Nursing. 2018; 27: e1684-e1685
- Using the consolidated framework for implementation research (CFIR) to produce actionable findings: A rapid-cycle evaluation approach to improving implementation.Implementation Science. 2017; 12: 15
- A systematic review of the use of the consolidated framework for implementation research.Implementation Science. 2016; 11: 72
- Pediatric clinical practice guidelines for acute procedural pain: a systematic review.Pediatrics. 2014; 133: 500-515
- Pediatric pain: Prevalence, assessment, and management in a teaching hospital.Brazilian Journal of Medical and Biological Research. 2012; 45: 1287-1294
- Children’s forgetting of pain-related memories.Journal of Pediatric Psychology. 2016; 41: 220-231
- Oxford textbook of paediatric pain.Oxford University Press, Oxford, UK2014
- Making sense of implementation theories, models and frameworks.Implementation Science. 2015; 10: 53
- A refined compilation of implementation strategies: Results from the expert recommendations for implementing change (ERIC) project.Implementation Science. 2015; 10: 21
- Whatever happened to qualitative description?.Research in Nursing & Health. 2000; 23: 334-340
- What's in a name? Qualitative description revisited.Research in Nursing & Health. 2010; 33: 77-84
- The state of readiness for evidence-based practice among nurses: An integrative review.International Journal of Nursing Studies. 2016; 56: 128-140
- ChildKind: A global initiative to reduce pain in children.Pediatric Pain Letter. 2010; 12: 26-30
- Pharmacological and combined interventions to reduce vaccine injection pain in children and adults: Systematic review and meta-analysis.Clinical Journal of Pain. 2015; 31: S38-S63
- Pain prevalence and treatment patterns in a US Children’s hospital.Hospital Pediatrics. 2015; 5: 363-370
- Qualitative research in nursing: Advancing the humanistic imperative.5th ed. Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia2011: 2011
- Epidemiology and management of painful procedures in children in Canadian hospitals.Canadian Medical Association Journal. 2011; 183: E403-E410
- Inadequate pain management during routine childhood immunizations: The nerve of it.Clinical Therapeutics. 2009; 31: S152-S167
- Managing pain in children: A cinical guide.Blackwell Publishing Ltd, 2009
- Pain as the neglected patient safety concern: Five years on.Journal of Child Health Care. 2016; 20: 537-541
- Neonatal pain and developmental outcomes in children born preterm: A systematic review.Clinical Journal of Pain. 2015; 31: 355-362
- The experiences of last-year student midwives with high-Fidelity perinatal simulation training: A qualitative descriptive study.Women and Birth. 2017; 30: 253-261
- Pain prevalence in hospitalized children: A prospective cross-sectional survey in four Danish university hospitals.Acta Anaesthesiologica Scandinavica. 2017; 61: 328-337
- Choosing implementation strategies to address contextual barriers: Diversity in recommendations and future directions.Implementation Science. 2019; 14: 42
- Barriers to and facilitators of research utilization: A survey of registered nurses in China.PLoS One. 2013; 8: e81908
- What caused seriously shortage of Chinese nurses?.Iranian Journal of Public Health. 2018; 47: 1065-1067
Published online: June 22, 2020
Accepted: June 9, 2020
Received in revised form: June 5, 2020
Received: February 18, 2020
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