In spite of advances over the past decade in pain assessment and pharmacological management, hospitalized children continue to report significant unrelieved pain. Untreated pain may delay recovery, exacerbate injury, prevent healing, prolong hospitalization, and even lead to death. The long-range goal of this study is to improve children's pain relief by changing nurses' behaviors in regard to pain assessment and management. As a step toward this long-range goal, the primary purpose of the proposed study is to examine pediatric nurses' cognitive representations of assessment and management of children's pain to identify and better understand influences on their assessment and management behaviors.
The specific aims for this study are to: (1) determine pediatric nurses' cognitive representations of assessment of children's pain, (2) determine pediatric nurses' cognitive representations of management of children's pain, and (3) examine the degree of congruence between their cognitive representations and their decisions about pain assessment and analgesic administration. Research has shown that nurses consistently administer less analgesia than available and recommended, and that pediatric nurses believe that children over-report their pain. Survey data of nurses' knowledge and attitudes have failed to predict pain assessment and management behaviors. Pilot data suggest that measurement of nurses' cognitive representations may be more sensitive than survey instruments to capture data that may explain and predict nurses' assessment and management behaviors. A descriptive exploratory design will be used to address the study aims. Data will be collected from 100 registered nurses employed at two children's hospitals. Nurses' cognitive representations of children's pain assessment and pain management will be measured with the Conceptual Content Cognitive Map (3CM) open-ended technique. This mapping method permits identification of the assumptions, beliefs, facts, and misconceptions most likely to influence behavior. Nurses also will be asked to provide their responses to case studies about assessment and analgesia administration. Data analysis will include use of descriptive and content analyses and exploratory regression analysis to address the study aims. Once nurses' assumptions, beliefs, facts, and misconceptions about children's pain are better understood, researchers will be able to develop interventions to improve nurses' practice and children's pain relief. This will result in less suffering by children and improvement of their health and healing. ? ? ? ?

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Small Research Grants (R03)
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Nursing Science: Children and Families Study Section (NSCF)
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Bryan, Yvonne E
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University of Illinois at Chicago
Other Health Professions
Schools of Nursing
United States
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Vincent, Catherine Van Hulle; Wilkie, Diana J; Szalacha, Laura (2010) Pediatric nurses' cognitive representations of children's pain. J Pain 11:854-63