How nurses use reassurance to support the management of acute and chronic pain in children and young people: an exploratory, interpretative qualitative study

Reassurance in the context of paediatric pain is regarded to promote distress. Typically, spoken reassurance is reported as short, generic statements (“it’s ok”, “don’t worry”); little research has considered wider reassuring behaviours and actions undertaken by nurses. Most studies focus on uni-directional, dyadic relationships between reassurance and pain (parent-to-child, professional-to-child) failing to capture the inherent complexities. Adopting an exploratory interpretative qualitative approach, this paper reports on findings from the qualitative interview component of a mixed-methods study, concerning how nurses actively use reassurance when talking to children and their parents about pain. Eighteen nurses with experience of managing children’s pain were recruited on completion of an international online survey (distributed by pain and children’s nursing networks and via newsletter, email, social media). All 18 nurses completed a semi-structured interview concerning their experiences of managing children’s pain working in UK (n=14), Canada (n=3) and Australia (n=1) in primary, secondary and tertiary settings with nursing experience ranging from pre-qualification to >20 years. Thematic analysis generated three themes which reflect the main ways in which nurses focus their reassurance within encounters with children and their parent(s): (1) on child and parent(s), (2) on the child, and (3) on the parent. Nurses generated reassurance using language, gesture, relationship building, individualising approaches, education and preparation. The study highlights the diversity of reassurance provided by nurses in relation to children’s pain. Our study finds that when nurses reassure children about pain, they focus their reassurance in three distinct directions (child, parents, and children and parents in partnership); this has not been specifically acknowledged by previous research. We highlight the wide range of implicit and explicit reassurance actions undertaken by nurses and propose that reassurance that extends beyond limited vocalizations is part of a complex package of care that can support children’s current and future pain experiences.