Introduction: It is a well known fact that children suffer from pain due to treatment and procedures in health care and historically, their procedural pain due to medical treatment has been undertreated and under-recognized. Children’s understanding of pain and their ability to express their feelings depend on their stage of development and the nature and diversity of their prior pain experiences. The goal of pain management is to reduce pain, distress and anxiety, and the nurse is the key person to help and support the child in pain. Nurses’ professional competence form the foundation for pain management procedures, and there is a need to investigate whether the care and procedures nurses perform for children in pain lead to desired outcomes.

Aim: The overall purpose was to describe nurses’ competence in pain management in children. The specific aims were to

- identify and describe knowledge about and attitudes to pain and pain management

- identify factors influencing pain management in children and

- describe nurses’ experiences of caring for children in pain.

Methods and material: Forty-two nurses participated in a survey on knowledge about and attitudes to pain management in children, and 21 nurses were interviewed about their experiences fromcaring for children in pain. All the data were analyzed using approved methods of analysis.

Results: The results showed that the nurses had good knowledge about and positive attitudes to pain management in children. Collaboration with physicians was considered important in providing children with sufficient pain relief. Parents were regarded as a resource, and the nurses described communication with parents as important. The nurses’ own experience led to a better understanding of the children’s situation.

The nurses stated that pain is a subjective experience and that if a child says he or she is in pain they should be believed. Pain was seen as a complex phenomenon, and the nurses had difficulty distinguishing between pain of different origins. In predictable situations, when the child had a clear medical diagnosis with physical pain and the child’s pain followed an expected pattern, the nurses trusted their knowledge and knew how to act. On the other hand, in unpredictable situations, when the child did not respond to the treatment despite all efforts, this created feelings of insufficiency, fear and abandonment, and even distrust.

Conclusions: The conclusions of this thesis are that pain management in children is a challenge for clinical nurses in unpredictable situations. Professional competence in nursing deals with both personal abilities and the organization. Reflective practices and dialogues with colleagues would improve nurses’ work satisfaction, and guidelines and better routines would improve nurses’ pain management when caring for children.