Children's Pain: PICU Nurses' Beliefs and Responses to Virtual Human Vignettes

Children's Pain: PICU Nurses' Beliefs and Responses to Virtual Human Vignettes Cynthia M. LaFond, Ph.D. Department of Nursing University of Illinois at Chicago Chicago, Illinois (2013) Dissertation Chairperson: Catherine Vincent, R.N., Ph.D. Purpose: The purpose of this cross-sectional, mixed-methods study was to describe and compare PICU nurses’ beliefs regarding children’s pain management and their assessment and intervention choices in response to virtual human (VH) vignettes. Additionally we sought to determine the effect of child behavior (smiling, grimacing), and pain type (post-operative, sickle cell) on PICU nurses’ pain ratings and morphine dose choices among vignettes (virtual human and written). Sample/Methods: Forty nurses working in a PICU responded to 4 virtual human (VH) vignettes (computer-generated patient scenarios). Vignette patients differed only in pain type and behavior. The nurses participated in semi-structured interviews about their pain assessment and pain intervention choices and completed the Pain Beliefs and Practices Questionnaire. Results: Nurses most often described the child’s diagnosis, behavior, verbal expression of pain, and vital signs as important components of their pain assessment and choices to intervene for pain. Faulty beliefs related to the risks of opioid analgesics and the pharmacodynamics of intravenous analgesics were prevalent. Nurses’ beliefs consistent with best practice included: ability to experience pain while receiving sedatives, ability to treat pain at multiple points along the pain pathway, and harmful effects of pain. Significant multivariate effects were identified for facial expression and vignette type. The children in the vignettes that were grimacing received higher pain ratings and morphine doses than the children that were smiling. Nurses also rated and provided more morphine to the children within the written vignettes. Conclusions: Results substantiated nurses’ reliance on children’s behavior to assess and intervene for pain over the child’s self- report, even when the child is able to articulate pain presence and intensity.