# 3.1 Overcoming busyness

For parents/carers of children in hospital, the busyness of a nurse often acts as a deterrent to approaching them, even when their child is in pain (Simons et al., 2024):

> ‘You see how busy nurses are and you think of all the other children that they’re trying to look after’.

One parent summed up the busy nurse with the following:

> ‘You can tell when a nurse is overstretched. She doesn’t smile, she becomes unapproachable. She just wants to come in, give the medication and be out again. She doesn’t want to have chit-chat, she doesn’t want to do that because she’s almost constantly chasing her tail or trying to catch up. And if I notice that this is what’s happening it makes me a little bit reluctant to ask for what my young person may need.’

(Simons et al., 2024)

Kammerer et al. (2022) found that families feel that they must advocate for better pain care for children in hospital, but often feel too intimidated to do so, or worry that their concerns will be dismissed by healthcare professionals.

Families want healthcare professionals to proactively manage their children’s pain. However, Choueiry et al. (2024), who interviewed 11 nurses on parent–nurse relationships, found that when nurses have heavy workloads they tend to rely on parents for pain care of their children. Simons et al. (2024) also found that nurses reported similar frustrations, acknowledging that while they recognise that it is not always easy to approach a nurse, when the ward gets busy they rely on parents/carers coming to tell them if their child is in pain:

> ‘I always find if quite frustrating because I think we are busy, but that’s because we expect the parents to tell us if there’s any issues….., it’s not their problem if we’re busy, there’ll always be time made for stuff, or there’ll be delegation that we can do in order to make time if we’re not able to provide, to feel like we’re there… I feel bad for them that they feel like we’re too busy to spend time with them, whereas that’s often not the case’.

This reliance on parents/carers, compounded by a reluctance on the part of parents/carers to approach a nurse, may explain why some children’s pain is not effectively managed. Nurses agree that when a parent/carer isn’t confident in approaching a nurse they can hesitate or delay getting help when their child is in pain. This can lead to the parent/carer becoming anxious, which can then lead to a tense encounter with a nurse.

Figure 4 When nurses are busy they can seem unapproachable to parents/carers

There appears to be a lack of connection or relationship between parents/carers and nurses. The importance of building relationships with parents/carers is highlighted in a study by Andersson et al. (2022) who carried out a quantitative cross-sectional study of 69 hospitalised children aged 6–18 years, and found that half of the children/adolescents experienced moderate to severe pain. Of those children who experienced pain, six did not tell staff about their pain and five told their parents instead, meaning their likelihood of receiving pain relief was considerably reduced.

## Activity 3 The busy nurse

This activity should take approximately 10 minutes

With current staffing levels of children’s wards as they are, nurses are busy for most of their shift. This puts parents/carers off approaching them for help when their child is in pain. In spite of their busyness, nurses report wanting parents/carers to approach them.

This situation contributes to children experiencing unnecessary pain.

- What change in ward practice would make a difference for the nurse?
- What in your view would make a difference on the part of the parent/carer?

(A text entry box would appear here, but your browser does not support it.)

### Discussion

Nurses have reported that because recording pain scores is not part of auditing like recording fluid balance, it is sometimes not given the same priority. If pain score records were given a higher priority and visibility it is likely that, despite being busy, nurses would make pain assessment a higher priority.

Providing parents/carers with information such as how hospitals work, how pain is managed in hospital and when their child’s analgesia is due, can give parents the confidence to approach a busy nurse.

OpenLearn - Promoting the effective management of children’s pain – part 2
Except for third party materials and otherwise, this content is made available under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Licence, full copyright detail can be found in the acknowledgements section. Please see full copyright statement for details.