Meta-synthesis of nurses' perspectives on pediatric pain management reveals key themes

BackgroundPain remains one of the most frequently misinterpreted, underdiagnosed, and inadequately managed clinical conditions in pediatric populations. An estimated 50%–70% of pediatric patients experience undertreated pain, which can have serious negative effects on their overall health and well-being. Our study aims to identify, appraise, and synthesize qualitative studies exploring nurses’ perspectives on pain management for pediatric patients to develop a conceptual understanding of facilitators and barriers from the nurses’ perspective.MethodsThis review was registered with PROSPERO (CRD420251034205). A comprehensive literature search was conducted across CINAHL, PubMed, and Nursing journals for English-language studies. The SPIDER framework was used to guide the selection of qualitative studies. Inclusion and exclusion criteria were applied following the PRISMA 2020 guidelines, resulting in the inclusion of nine studies in the final synthesis. Confidence in the synthesized findings was assessed using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach.ResultsAnalysis of nine qualitative studies identified five interconnected themes shaping nurses’ perceptions of pediatric pain management. Being Defeated by Pain reflected nurses’ emotional and professional struggles with persistent or poorly managed pain. Family Participation is a Necessity emphasized the vital role of caregivers in assessment and decision-making. Evidence-Based vs. Experience-Based Pain Assessment revealed tension between adherence to clinical guidelines and reliance on personal judgment. Pharmacological vs. Non-Pharmacological Interventions highlighted challenges in selecting appropriate treatment strategies within practical constraints. Culture-Related Pain Management illustrated how cultural beliefs influence both pain assessment and intervention. Collectively, these themes underscore the complex, multifaceted nature of pediatric pain care from the nursing perspective. The GRADE-CERQual assessment indicated high confidence in the findings for “Being Defeated by Pain” and “Pharmacological vs. Non-Pharmacological Interventions,” and moderate confidence for the remaining three themes.ConclusionsNurses face multifaceted challenges in pediatric pain management. Targeted, culturally sensitive strategies are needed to enhance nursing competence and quality of care.