Evaluation of the Pain Resource Nurse Role
Pain resource nurses (PRNs), who act as pain management coaches or mentors for their colleagues, can contribute to effective pain management. The PRN's role has not been well evaluated in the context of pediatric nursing. Therefore, the objective of this study was to examine the PRN's role in a pediatric setting and, more specifically, to describe the role in terms of the activities PRNs engage in, the challenges they face, and the supports that help them fulfill their role. This research was part of an evaluation of the implementation of a comprehensive pain management program in a pediatric hospital. Focus groups were conducted with 18 PRNs six months after implementation of the PRN role. The essence of the role is to provide support for best-practice pain management to nurses and the multidisciplinary team. The PRNs described seven components of their role and specific strategies to operationalize their role. In addition, the PRNs faced challenges, including feeling disappointed when their expectations for better pain management were not met, experiencing difficulty fitting the activities into their busy workdays, facilitating their colleagues' improved pain management without also alienating them, and maintaining their enthusiasm and energy for the role. Pediatric nursing staff can effectively fill the role of the PRN. The role is multifaceted, and maintaining the role required commitment and enthusiasm on the part of the nurses, as well as commitment by their related institutions.

Pain management for hospitalized children is improving. Progress has been made in developing and implementing new strategies. For example, patient- controlled analgesia and intravenous (IV) sedation have been adopted with good effect (Ellis, Blouin, & Lockett, 1999; Ellis, McCarthy, Gosselin, & Splinter, 2000). However, despite recognition that pain management is an essential element of quality pediatric care (Joint Commission on Accreditation of Healthcare Organizations, 1999), too many children continue to experience unacceptable levels of pain (Cummings, Reid, Finley, McGrath, & Ritchie, 1996; Ellis et al., 2002; Johnston, Abbott, Gray-Donald, & Jeans, 1992).

Translating research into practice is difficult (Kitson, 1999), and challenges to adopting best practices are not unique to pain management. Evidence from evaluations of the implementation of clinical practice guidelines indicates that multifaceted interventions that target barriers to practice change are more likely than single interventions to be effective (Grimshaw et al., 2001), and multifaceted, institution-wide programs are recommended to achieve sustained improvements in pain management (Collins, 1999; Ferrell, Dean, Grant, & Coluzzi, 1995; Stratton, 1999; Weissman, Griffie, Gordon, & Dahl, 1997). One strategy to target barriers to practice change is to provide peer facilitators and champions (DiCenso et al., 2002).

Ferrell, Grant, and colleagues (1995), at the City of Hope National Medical Center in Duarte, California, developed the Pain Resource Nurse (PRN) Program to train clinical nurses to function as pain management experts for other staff nurses. In the City of Hope model, staff nurses received education about pain management and were trained to initiate unit activities related to pain management. Training was effective in improving nurses' knowledge (Ferrell, Grant, et al., 1995). The PRN model has been adopted in other centers (Howell, Foster, Hester, Vojir, & Miller, 1996; Krystal, Carr, Gavaghan, Porterfield, & Turner, 1997), but evaluative data and detailed descriptions of the role are lacking. The resource nurse model has been successfully implemented to address other clinical problems, including geriatric assessment (Lopez et al., 2002) and the assessment of acute confusion (Rapp et al., 1998). The PRN role has not been well described or evaluated in the context of pediatric nursing.