Keywords
Procedural Pain
Pain Management
Nurses
Decision Making
How to Cite
Abstract
Introduction. Procedural pain is a common reason for pediatric emergency department visits and remains frequently undertreated despite the availability of evidence-based recommendations. Nurses play a key role in pain assessment and management; however, limited evidence is available regarding the factors influencing their clinical decision-making in everyday practice. This study aimed to describe nurses’ perceptions, self-reported practices, decision-making criteria, and perceived barriers related to procedural analgesia in a tertiary pediatric emergency department.
Methods. A cross-sectional observational study was conducted in February 2026 in the emergency department of a tertiary pediatric hospital in Italy. An anonymous online questionnaire was administered to nurses working in the department. The survey explored procedural pain perception, analgesia and sedation decision-making, pain assessment practices, organizational barriers, and self-perceived competence. Descriptive statistics were performed, while exploratory analyses included Fisher’s exact test, Mann–Whitney U test, and Spearman’s correlation coefficient.
Results. Twenty-five nurses completed the survey (response rate 75.8%). Most participants had received specific training on procedural pain management within the previous 24 months (68%) and reported the availability of local protocols (88%). Procedural pain management was considered a high priority by 68% of respondents, although 48% believed procedural pain was frequently underestimated in their workplace. Clinical judgment combined with team consultation represented the most common decision-making approach (80%). Procedural invasiveness was the main criterion guiding analgesic escalation (44%). Workload and crowding were identified as the principal barriers to effective analgesia (72%). Emergency department experience was positively associated with perceived competence (rho=0.428; p=0.037) and negatively associated with the perceived impact of crowding on clinical decisions (rho=-0.417; p=0.043).
Discussion. Organizational constraints and reliance on subjective clinical judgment continue to influence procedural analgesia practices. Decision-support tools, targeted training, and strategies to strengthen nursing autonomy may improve the consistency of pediatric procedural pain management.
References
Atefeh S. (2025). Barriers and facilitators of pain management in children: a scoping review. BMC anesthesiology, 25(1), 148. https://doi.org/10.1186/s12871-025-02941-2
Çelik, E. G., & Sönmez Düzkaya, D. (2024). The Impact of Cold Spray and Ice Application During Intravenous Access on Pain and Fear in Children Aged 7-15 Years in the Pediatric Emergency Unit: A Randomized Controlled Trial. Journal of emergency nursing, 50(2), 264–272. https://doi.org/10.1016/j.jen.2023.11.012
Czarnecki, M. L., Salamon, K. S., Thompson, J. J., & Hainsworth, K. R. (2014). Do barriers to pediatric pain management as perceived by nurses change over time?. Pain management nursing : official journal of the American Society of Pain Management Nurses, 15(1), 292–305. https://doi.org/10.1016/j.pmn.2012.12.003
de Souza, D. M., Harrison, D., Butrico, L. S., & Rossato, L. M. (2025). How frequently do hospitalized children undergo painful procedures? A longitudinal study on the number of procedures and associated factors. Journal of pediatric nursing, 82, e102–e110. https://doi.org/10.1016/j.pedn.2025.03.025
Eull, D., Looman, W., & O'Conner-Von, S. (2023). Transforming acute pain management in children: A concept analysis to develop a new model of nurse, child and parent partnership. Journal of clinical nursing, 32(15-16), 5230–5240. https://doi.org/10.1111/jocn.16625
Guillari, A., Giordano, V., Catone, M., Gallucci, M., & Rea, T. (2024). Non-pharmacological interventions to reduce procedural needle pain in children (6-12 years): A systematic review. Journal of pediatric nursing, 78, e102–e116. https://doi.org/10.1016/j.pedn.2024.06.025
Hasanah, I., Nursalam, N., Krisnana, I., Arief, Y. S., Qur'aniati, N., Haikal, Z., Sulistyawati, R. A., & Rohita, T. (2024). Non-Pharmacological Pain and Stress Management (N-PPSM) in Pediatric Wards: A Nurses' Perspective. Pain management nursing : official journal of the American Society of Pain Management Nurses, 25(5), 510–517. https://doi.org/10.1016/j.pmn.2024.07.005
Langeli, M., Predieri, F., Di Toma, M., Campanozzi, A., Rugolotto, S., Torcetta, F., Mazza, A., Zangardi, T., Bazo, M., Pizzini, C., & Bressan, S. (2025). Pediatric procedural sedation and analgesia in the emergency setting in community hospitals in Italy: current status and challenges. Italian journal of pediatrics, 52(1), 13. https://doi.org/10.1186/s13052-025-02173-7
Lorente, S., Romero, A., Martínez, M., & Martínez-Mejías, A. (2023). Effectiveness of Procedural Sedation and Analgesia in Pediatric Emergencies. A Cross-Sectional Study. Journal of emergency nursing, 49(1), 75–85. https://doi.org/10.1016/j.jen.2022.10.004
Mahon, P., Aitken, C., Veiga, M., & Poitras, S. (2023). Time for Action: Understanding Health Care Professionals Views on Pain and Pain Management in a Pediatric Hospital. Pain management nursing : official journal of the American Society of Pain Management Nurses, 24(2), 171–179. https://doi.org/10.1016/j.pmn.2022.10.002
Moll-Bertó, A., López-Rodrigo, N., Montoro-Pérez, N., Mármol-López, M. I., & Montejano-Lozoya, R. (2024). A Systematic Review of the Effectiveness of Non-Pharmacological Therapies Used by Nurses in Children Undergoing Surgery. Pain management nursing : official journal of the American Society of Pain Management Nurses, 25(2), 195–203. https://doi.org/10.1016/j.pmn.2023.12.006
Neshat, H., & Ghorbani, F. (2023). Differences in the child, mother, and nurses' pain score measurements during pediatric venipuncture. Journal of pediatric nursing, 73, 102–105. https://doi.org/10.1016/j.pedn.2023.08.025
Sabetsarvestani, R., Geçkil, E., & Köse, S. (2024). A meta-synthesis of the language of pediatric pain. Journal of pediatric nursing, 79, 32–41. https://doi.org/10.1016/j.pedn.2024.08.020
Sahyoun, C., Cantais, A., Gervaix, A., Bressan, S., Löllgen, R., Krauss, B., & Pediatric Emergency Medicine Comfort and Analgesia Research in Europe (PemCARE) group of the Research in European Pediatric Emergency Medicine (2021). Pediatric procedural sedation and analgesia in the emergency department: surveying the current European practice. European journal of pediatrics, 180(6), 1799–1813. https://doi.org/10.1007/s00431-021-03930-6
Seipajærvi, A. L., Simonsen, G. R., Börner, F., & Smeland, A. H. (2025). Nurses' Knowledge and Attitudes About Pain Management in Pediatric Surgical Wards: An Educational Intervention Study. Pain management nursing : official journal of the American Society of Pain Management Nurses, 26(1), e42–e49. https://doi.org/10.1016/j.pmn.2024.08.013
Skog, N., Mesic Mårtensson, M., Dykes, A. K., & Vejzovic, V. (2021). Pain assessment from Swedish nurses' perspective. Journal for specialists in pediatric nursing : JSPN, 26(3), e12317. https://doi.org/10.1111/jspn.12317
Souza, D. M., Lestinge, G. S., Carvalho, J. A., & Rossato, L. M. (2024). Pain management in hospitalized children: unveiling barriers from the nursing perspective. Revista gaucha de enfermagem, 45, e20230151. https://doi.org/10.1590/1983-1447.2024.20230151.en
Stavleu, D. C., Mulder, R. L., Kruimer, D. M., Mensink, M. O., Kremer, L. C., Tissing, W. J., Loeffen, E. A., Procedural Local Anesthetics Guideline Panel, & procedural local anesthetics guideline panel (2025). Topical analgesia during needle-related procedures in children: a clinical practice guideline. Archives of disease in childhood, 110(8), 657–661. https://doi.org/10.1136/archdischild-2024-326917
Yan, C., Hu, J., Kang, J., Xing, X., Tu, S., & Zhou, F. (2024). Barriers and facilitators to using procedural pain treatments in pediatric patients (under 1 year old): protocol for a mixed studies systematic review with a narrative synthesis. Systematic reviews, 13(1), 287. https://doi.org/10.1186/s13643-024-02713-y
Yuan L. (2024). Effect of Educational Interventions for Improving the Nurses' Knowledge, Attitude, and Practice of Pediatric Pain Management: A Aystematic Review and Meta-Analysis. Pain management nursing : official journal of the American Society of Pain Management Nurses, 25(4), e271–e278. https://doi.org/10.1016/j.pmn.2024.04.005
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Aurora Sernesi, Chiara Romano, Biagio Nicolosi