Differences in pain assessment and decisions regarding the administration of analgesics between novices, intermediates and experts in pediatric nursing

doi:10.1016/S0020-7489(97)00024-2

International Journal of Nursing Studies

Volume 34, Issue 5, October 1997, Pages 325-334

https://doi.org/10.1016/S0020-7489(97)00024-2 Get rights and content

Abstract

This article describes a study examining the influence of expertise on nurses' pain assessments and decisions regarding pharmacological interventions in children. In an experimental design, novices (n = 271), intermediates (n = 222), and experts (n = 202) in pediatric nursing, various cases were presented. Each case consisted of a combination of a vignette and a video. Subjects were asked (1) to assess the child's pain intensity, (2) to specify their confidence in the assessment, and (3) to state whether or not they would administer a non-narcotic analgesic. The results indicated that expertise did not influence assessments of pain intensity. However, expertise did have a distinct impact on both the subjects' confidence in their decisions, and the decision to administer analgesics. Experienced nurses were most confident and were most inclined to administer analgesics.

The findings of this study are placed in the context of a general theory on the development of expertise, which assumes that experts' decision-making is based on cognitive structures that describe features of prototypical or even actual patients, so called “illness scripts”. From this theory it can be deduced that mainly practical experience is responsible for the (lack of) differences in decision-making between novices, intermediates and experts.

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From the initial 248 citations, 27 studies were included. Most studies were descriptive and examined relationships between personal factors and nurses’ pain management practices. Observational data from four papers added insights beyond that provided in self-report studies. Two articles used experimental designs with vignettes. Data were categorised into four topics: pain assessment; pharmacological practices; non-pharmacological practices; and factors affecting practices. Despite improvements in analgesic administration over the past 20 years, practices remain suboptimal. Children's behaviour appears to influence nurses’ pain assessment more than validated measures. A significant proportion of children did not have pain scores recorded in the first 24-h postoperatively. Children receive more analgesia when ordered around the clock compared to as required. However, around the clock analgesia prescription did not guarantee administration. Nurses reported using several non-pharmacological strategies routinely but some are not evidence based.
The results of this review indicate nurses’ assessment and management of children's pain is not consistent with published guidelines. Results of studies exploring nurse and child related factors are inconclusive. Research needs to examine the impact of organisational factors on nurses’ pain care practices. Intervention studies are needed to determine the most effective strategies to support and improve nurses’ pain care for children.
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Differences in pain assessment and decisions regarding the administration of analgesics between novices, intermediates and experts in pediatric nursing

Abstract

Pain

Pain

Int. J. Nurs. Stud.

J. Prof. Nurs.

Pain

Int. J. Nurs. Stud.

J. Obstet. Gynec. Neonatal Nurs.

From novice to expert: excellence and power in clinical nursing practice

Pijnbeoordeling bij kinderen, een onderzoek bij kinderen met pijn ten gevolge van medisch onderzoek en ten gevolge van ziekte

Verpleegkunde

Factors affecting nurses' decisions to medicate pediatric patients after surgery

Heart Lung

Nurses' perceptions of their problem-solving ability

J. Adv. Nurs.

Task complexity and nursing expertise as factors in decision making

Nurs. Res.

Nurses' responses to patients' suffering

A comparative study of intensive therapy unit and hospice nurses' knowledge on pain management

J. Adv. Nurs.