Brudvik et al. (2016)

Question 1

Clinical assessment

Answer 1

Refers to collecting info and drawing conclusions through the use of observation, psychological tests, neurological tests and interviews, to determine what the person’s problem is and what symptoms they are presenting with.

Question 2

Emergency department management

Answer 2

A hospital facility that is staffed 24 hours per day, 7 days a week and provides unscheduled outpatient services to patients whose condition requires immediate care.

Question 3

Fractures vs dislocations

Answer 3

Dislocation = a bone is displaced from its normal position at a joint.

Fracture = bone has been broken.

Question 4

Paediatrics

Answer 4

Branch of medicine than involves the medical care of infants, children, adolescents and young adults (1-18 years-old).

These injuries have many different causes, severities and effects.

Question 5

FPS-R: Faces pain rating scale- revised

Answer 5

A pain rating scale suitable for children aged 3-8 years-old, showing 6 faces indication increasing levels of pain.

Question 6

CAS: Coloured analogue scale

Answer 6

A pain rating scale suitable for children aged 9-15 years-old, where respondents mark on a line where their pain was from ‘no pain’ (green) to ‘worst thinkable pain’ (red).

Question 7

NRS: Numerical rating scale

Answer 7

A scale from 0-10 where respondents give the numerical value that best represents their pain, 0 being no pain etc.

Question 8

Background

Answer 8

Research shows that doctors in hospitals often underestimate children’s pain, administering weaker pain relief less often.

Parents are better at estimating than nurses, but still underestimate their children’s pain (Rajasagaram et al., 2009).

Question 9

Aims

Answer 9

To investigate:

1. the relationship between children’s self reported pain and parents’ and doctors’ pain ratings.
2. how age, medical condition and severity of pain affect pain estimates.
3. whether pain assessment affects administration of pain relief.

Question 10

Participants

Answer 10

243 paediatric patients aged 3-15 years-old (mean age 10.6), their parents and 51 doctors.

Question 11

Sampling

Answer 11

Opportunity sample of patients being treated as Bergen Accident & Emergency Department (ED) in Norway, 2011.

Question 12

Method

Answer 12

Correlational field study.

Question 13

Dependent variables

Answer 13

• Numeric rating of child’s pain by doctors and parents.
• 3-8 year-olds responses on 2 visual analogue scales.
• 9-15 year-olds responses using a visual analogue rating scale, with a coloured green-red line.

Question 14

What did participants complete?

What about their parents?

Answer 14

Scales and questionnaires.

Their parents answered demographic questions.

Question 15

What were doctors asked to do?

Answer 15

Give details of experience, whether they were parents, pain relief given and match between child’s rating and their own.

Question 16

What were the childrens’ diagnosises classed as?

Answer 16

• Infection
• Fracture
• Wound/soft tissue injury
• Ligament/muscle injury

Question 17

What else was recorded?

Answer 17

Each family’s total waiting time.

Question 18

Was consent given? By who?

What other ethical measures were taken?

Answer 18

Written consent was provided by parents for themselves and their children.

Researchers ensured someone was always available to provide extra support/guidance.

The children’s medical condition could change rapidly, so it was important parents knew someone was avaiable if they wished to use their right to withdraw.

Question 19

Results

Answer 19

• Only 42% of children with severe pain (judged by doctors) were given pain relief medication.
• Only 14.3% of children self-rating pain as severe were given pain relief medication.

Question 20

Assessed the child’s mean pain to be on NRS…

Answer 20

• Physicians: NRS = 3.2
• Parents: NRS = 4.8
• Children: NRS = 5.5

Question 21

Conclusions

Answer 21

• Doctors significantly underestimate pain in 3-15 year-olds.
• Anxiety increases pain perception.
• Doctors should place higher value on parental reports of children’s pain.

Question 22

Strengths

Answer 22

• Standardised procedure = increases validity and reliability since it can easily be replicated.
• Ecologically valid = field experiment in a natural setting with real doctors, parents, patients etc. with real medical conditions.
• Sample = large sample of children allows a range of conditions and pain to be measured, increasing validity.
• RWA

Question 23

Criticisms

Answer 23

• Cultural bias = Norwegian emergency department, only with children, so low generalisability.
• Low validity = parents and children knew each other’s answers, therefore children could have been influenced by their parent’s reactions.

Question 24

How does Brudvik’s study show idiographic vs nomothetic?

Answer 24

Illustrates the nomothetic approach by measuring pain numerically and using statistical analysis to determine the significance.

Open questions and a more idiographic approach could have collected more data about how/why children experience pain differently.

Question 25

How does Brudvik’s study have application to everyday life?

Answer 25

Study can be used to support changes in Norwegian paediatric care.

Training should include listening to children/parents regarding pain levels and remembering people can experience the same pain differently.