Nursing insights into the management of procedural pain in pediatric patients: A qualitative study

Background Understanding how nurses perceive, assess, interpret, and manage procedure-related pain in pediatric patients is key to improving the quality of care. This study aimed to explore how pediatric nurses interpret pain-related cues during painful procedures and how these interpretations guide their clinical judgments and management decisions, within the real-world context of their everyday practice.Methods A qualitative case study was conducted using in-depth interviews with pediatric nurses at a hospital in northern Spain between January and June 2025. Data were analyzed using inductive thematic analysis.Results A total of 21 nurses were interviewed. Three themes emerged from the analysis: a) the interpretation of pain that is difficult to assess; b) from interpretation to action; and c) the conditions under which decisions are made. Six subthemes were identified: pain, fear, and anxiety intertwined; personal experience as a lens; language, environment, and distraction adapted to the child; family, between support and interference; growing awareness of children's pain, without shared criteria; and the emotional cost of caring.Conclusions Assessing pediatric pain is more an act of interpretation than measurement, and it rests on each professional's individual judgment. A humanized approach, specialized training, and systematic pain documentation are essential to enhance the quality and continuity of pediatric care.Practice implications the incorporation of structured protocols, including non-pharmacological strategies, family involvement, the integration of validated scales into the electronic record, and targeted training for nursing staff, can improve pain assessment and strengthen nursing competencies.