The analgesic response is moderated by nurses' confidence in their pain assessment: Results from pediatric acute pain study.

BACKGROUND: Managing acute pain in children remains challenging, and clinical decisions often depend on nurses' interpretation of both reported and behavioral pain cues. Nurse confidence in their assessments may influence treatment decisions and outcomes, yet evidence from real-world clinical settings is limited. PURPOSE: This study examined whether nurses' confidence in assessing children's pain moderates the relationship between analgesic type (opioid versus non-opioid) and pain reduction in pediatric patients. METHODS: A dyadic observational study was conducted in two hospitals with 120 children aged 8-17 years and 46 nurses. Pain intensity, pain behavior, and nurse confidence in pain assessment were assessed. Children reported pain again one hour after receiving opioid or non-opioid analgesics. Analgesic response was calculated as the reduction in the child's self-reported pain. Hypotheses were tested using mixed-effects modeling to account for the nested structure of the data. RESULTS: Nurses' confidence in pain assessment significantly moderated the association between analgesic type and analgesic response (B = 0.51, SE = 0.18, p = 0.005). When nurses' confidence was low, non-opioids were associated with greater pain reduction than opioids, whereas when nurses' confidence was high, opioids were associated with greater pain reduction than non-opioids. Pain behavior, but not pain intensity, predicted nurses' confidence (p < 0.001), indicating that behavioral cues shaped clinicians' certainty. CONCLUSIONS: Nurse confidence in pediatric pain assessment appears to be an important contextual factor in children's analgesic response. IMPLICATIONS TO PRACTICE: Consider low nurse confidence during pediatric pain assessment as a cue for additional assessment and communication before treatment decisions.