Background & Aims
Pediatric nurses frequently encounter inconsistencies between a child’s verbal pain intensity reports and the child’s behavior. According to pain assessment theories, such inconsistencies represent a pain message of low clarity, which negatively affects the healthcare provider’s certainty regarding the symptom assessment. This, in turn, could result in less-than-ideal treatment and outcomes. These theoretical concepts have not yet been tested in real clinical scenarios. Herein we report the preliminary results of the first study aimed at assessing these constructs and their clinical relevance.
Methods
In this dyad study, children who were planned to undergo elective surgery and the clinical nurses at the pediatric department were recruited. Postoperatively, the nurses assessed pain before, and one hour after analgesic administration using the 0-10 Numerical Rating Scale (NRS). Nurses also assessed children’s pain behavior before analgesic administration by rating the child’s pain behavior on a 0-10 NRS. Pain-message-clarity was calculated as the absolute value of the difference between the 0-10 NRS pain score and the child’s pain behavior score. Nurse’s confidence in their pain assessment was collected immediately after the interaction, on a 0-10 scale. Data was processed and analyzed with SPSS for Windows version 23 (Chicago, IL). All measures were normally distributed (Shapiro-Wilk tests). Mix model analysis regression was used to assess all dependent and independent variables.
Results
To date, 115 child-nurse dyads have been completed. The mean pain intensity scores recorded by the nurses at baseline were 5.8 ± 2.0, and 0.9 ± 1.7 one hour after analgesic administration, with a mean pain reduction of 4.9 ± 2.5.
Pain behavior averaged 4.9 ± 2.6 and the calculated pain message clarity was 2.5 ± 2.5. A strong negative correlation was found between pain message clarity and the nurse’s confidence in their pain assessment (p=0.001), so the larger the pain message clarity is (i.e. lower values), the higher the nurse’s confidence in pain assessment was. Furthermore, nurse’s confidence in their pain assessment significantly (p=0.011) predicted the treatment response, so the larger the nurse’s confidence is, the larger the reduction in pain, and vice versa.
Conclusions
As hypothesized, pain message clarity predicts nurse’s confidence in their pain assessment, and the nurses’ confidence in their assessment predicts the treatment response. These results imply that attention should be given to nurse’s confidence in their pain assessment because low confidence might result in poorer treatment responses.
According to pain assessment theories, pain message of low clarity will negatively affect caregiver certainty in the assessment, and later on, will negatively affect treatment outcomes. Of greatest interest are cases in which nurses are uncertain regarding the children’s pain, due to low pain message clarity. Such scenarios might result in poorer treatment outcomes.
References
Drendel, Amy L., Kelly, B. T., & Ali, S. (2011). Pain assessment for children: Overcoming challenges and optimizing care. Pediatric Emergency Care, 27(8), 773–781.
Hadjistavropoulos, T., & Craig, K. D. (2002). A theoretical framework for understanding self-report and observational measures of pain: A communications model. Behavior Research and Therapy, 40(5), 551–570.
Tait, R. C., Chibnall, J. T., & Kalauokalani, D. (2009). Provider judgments of patients in pain: Seeking symptom certainty. Pain Medicine, 10(1), 11–34.