1. The authors would like to acknowledge the nursing staff that participated at all three locations. Without their support, many things would not be possible. Gustavo Medrano 1, Susan Heinze 1, Michelle Czarnecki 2, MSN, RN-C, CPNP; Katherine Simon 1, MS; Helen Turner 3, MSN, RN, PCNS-BC; Sharon Wrona 4, RN, MS, PNP-BC University of Wisconsin-Milwaukee 1,Children’s Hospital of Wisconsin 2, Milwaukee, WI; Doernbecher Children's Hospital 3, Portland, OR; and, Nationwide Children’s Hospital 4, Columbus, OH Gustavo Medrano 1, Susan Heinze 1, Michelle Czarnecki 2, MSN, RN-C, CPNP; Katherine Simon 1, MS; Helen Turner 3, MSN, RN, PCNS-BC; Sharon Wrona 4, RN, MS, PNP-BC University of Wisconsin-Milwaukee 1,Children’s Hospital of Wisconsin 2, Milwaukee, WI; Doernbecher Children's Hospital 3, Portland, OR; and, Nationwide Children’s Hospital 4, Columbus, OH Methods For the current study, 808 nurses from three pediatric hospitals (two Midwestern, one West Coast) completed an online survey on barriers to optimal pain management, adapted with permission from Vincent (2004). The Adapted Barriers to Optimal Pain Management Questionnaire is a 30-item measure that asks nurses to rank how much each barrier interferes with their ability to provide optimal pain management on a 10 point scale; with 0 meaning “not at all a barrier” and 10 meaning “a major barrier.” Response rates ranged from 11% (1 Midwestern) to 41% (West Coast). The top three departments reported were ambulatory (10.0%), PICU (8.7%), and day surgery/PACU/UR (7.9%). The demographics of the participants are presented in Tables I and II. As the demographics from the three sites were similar, data was compiled in subsequent analysis. Tables I and II: Demographics Results Per Czarnekci et al. (under editorial review), the items on The Barriers to Optimal Pain Management were divided into three factors: Institutional Barriers, Patient Barriers, and Beliefs and Biases. An ANOVA was conducted with the Pain Barrier factors as the dependent variable and Years of Pediatric Nursing Experience as the independent variable (Table III). Post-hoc analysis was conducted to determine which experience groups were significantly different from each other with regard to their responses to the three Pain Barrier factors. Selected References American Pain Society (APS). (2003). Principles of analgesic use in the treatment of acute pain and cancer pain. (5 th ed). Glenview, IL: Author. Czarnekci, M et. al.(under editorial review). Barriers to Pediatric Pain Management. Pain Management Nursing. Van Hulle, Vincent, C. (2005). Nurses’ knowledge, attitudes, and practices: Regarding children’s pain. MCN, 30(3), 177-183. For information, please contact Gustavo Medrano at gmedrano@uwm.edu Background Acute pain in children has been shown to have numerous negative effects, including longer postoperative recovery times, decreased activity and poorer sleep. Despite many advances, optimal management remains elusive (American Pain Society, 2003). There have been numerous studies that have examined the barriers to optimal pain management in the adult population, although few have looked into the pediatric population (Vincent, 2005). Vincent (2005) found that the six most common barriers in pediatric nursing population were: 1.Inadequate or insufficient physician medication orders. 2.Children’s reluctance to report pain. 3.Parents’ reluctance to have children receive medications. 4.Children’s reluctance to take pain medications. 5.Nurses’ own concern over medication side effects. 6.The low priority given to pain management by medical staff. Current Study Purpose: While it is helpful to know which barriers need to be addressed, the relationship between nurses’ years of experience and the barriers they perceive needs to be explored. Developing appropriate methods to decrease barriers may depend on the experience of the nurse. Hypothesis: There are significant differences in the nurses’ perception of barriers to optimal pain management, dependent on years of pediatric nursing experience. Children’s Hospital of Wisconsin N = 442 Doernbecher Children’s Hospital N = 123 Nationwide Children’s Hospital N = 243 Across all 3 hospitals N = 808 Gender (Female) 97.8%95.8%99.2%97.9% Ethnicity (Caucasian) 96.8%92.2%97.0%96.2% Highest Education Level (Baccalaureate) 75.7%60.7%41.7%62.9% Role (Staff Nurse) 88.4%95.9%63.0%81.8% Less than 2 N= 102 2 to 5 N=125 5 to10 N=165 10 to 15 N=78 15 to 20 N=91 Greater than 20 N=219 Years of Pediatric Nursing Experience α 13.1%16.0%21.2%10.0%11.7%28.1% α M=3.75, SD= 1.79 Table III Analysis of Variance for Years of Pediatric Nursing Experience __________________________________________________________________________________________________________________________________________________ Barrier Factor 20 yrsF __________________________________________________________________________________________________________________________________________________ Beliefs and Biases α 10.78 (5.26)10.62 (4.88)9.24 (4.50)8.5 (4.55)8.19 (4.27)8.25 (4.04)F(5)= 8.07 p<.01 Institutional Commitment b 34.74 (12.22)35.02 (12.35)35.86 (12.06)35.42 (14.02)35.82 (14.38)32.98 (13.22)F(5)=1.10 p=.36 Patient/Parent Barriers c 12.81 (5.61)12.08 (5.89)11.73 (5.78)11.40 (5.37)12.22 (6.32)10.57 (5.52)F(5)= 2.68 p=.02 __________________________________________________________________________________________________________________________________________________ α Examples of Beliefs and Biases include nurses’ concerns over drug addiction and side effects. b Examples of Institutional Commitment include low priority given to pain management by medical staff and insufficient resources. c Examples of Patient Barriers include patients’ reluctance to take medication and report pain. Discussion As hypothesized, significant differences were found between nurses’ perceptions of barriers to optimal pain management according to years of pediatric nursing experience. Specifically, barriers having to do with nurses’ beliefs and biases were found to be ranked higher by nurses with less pediatric nursing experience (p<.01). Also, barriers having to do with the patient or his/her parent were found to be ranked higher by nurses with less pediatric nursing experience (p<.05). Post-hoc analysis showed that a majority of the significant differences between experience groups were between the least experienced (less than 2 years and 2-5 years) and the rest of the sample (5 to10 years, 10 to 15 years, 15 to 20 years and greater than 20 years). All significant differences were of the lesser experienced nurses ranking barriers higher than more experienced nurses. In developing protocols to optimize pain management, nurses’ experience needs to be considered since lesser experienced nurses were shown to significantly rank certain barriers higher than more experienced nurses. Future research is needed addressing why less experienced nurses differ from the rest of the population when it comes to their perceptions of barriers having to do with the patient /their parent and of their own beliefs and biases. This difference could be due to differences in content knowledge and experience or generational. Elucidation on this matter could lead to more effective training designed to optimize pediatric pain management.