PAIN: BRUDVICK ET AL.

Question 1

what was the context

Answer 1

• Research showed that hospital doctors tend to underestimate childrens pain and pain relief medication is offered less often.
• Research also suggests that parents are better judges of their childrens self-reported pain with fathers providing less accurate ratings than mothers. (Morrow et al)

Question 2

State the 3 aims

Answer 2

Brudvick wanted to explore:
- The relationship between childrens self-reported pain and ratings from intensity made by their parents and doctors
- How age, medical condition and severity of pain affect pain intensity estimates
- Whether pain assessments affects the administration of pain relief

Question 3

Describe the sample

Answer 3

• Opportunity sample
• 243 Paediatric patients
• ages 3-15 years
• 51 doctors were recruited

Question 4

What was the methodology

Answer 4

• Field study
• using questionnaires
• at the Bergen Accident and Emergency Department in Norway
• Correlations were used

Question 5

List the questionnaires used

Answer 5

• Numeric Rating scale
• Demographic questionnaire
• Faces Pain Scale-revised
• Wong Baker Faces Pain Rating Scale
• Visual Analogue Scale

Question 6

Describe the questionnaires done by the parents

Answer 6

• The NRS had to rate the intensity of the childs pain from 0-10
• demographic questions about their childs age, gender and nationality and were asked if they had given their child any pain relief before their consultation

Question 7

Describe what the doctors were asked

Answer 7

• Their own medical experience (in years)
• Medical specialisms
• Whether they were parents as well
• Whether they gave pain relief during their consultations - Whether the childs pain level seemed to match their diagnosis

Question 8

Describe the questionnaires 3-8 year olds completed

Answer 8

• Both the FPS-R and Wong questionnaire included pointing to the face that best matched their pain level.
• The researcher recorded the corresponding numerical score from 0-10

Question 9

Describe the questionnaire 9-15 year olds completed

Answer 9

• They indicated the intensity of their pain using the VAS with a coloured 100mm line.
• Green= No pain at all
• Red= The Worst thinkable pain

Question 10

How was the childs diagnosis classified

Answer 10

• An infection
• Fractures
• wound injury
• soft tissue injury

Question 11

State 3 results from the study

Answer 11

• Pain ratings were highest for children, followed by parental ratings and finally doctors ratings.
• Agreement between parents and doctors were low
• Doctors underestimate the pain of the younger children more than the older children.

Question 12

What did they conclude

Answer 12

• Brudvick concludes that doctors should place a higher value on parental reports of their childrens pain, especially when children are unable to communicate effectively for themselves

Question 13

State 3 methodological strengths

Answer 13

• The study was well standardised. For example doctors were trained to use the numerical rating scale and parents wre given a written description of how to explain the interpretation of the faces on the pain scales
• The natural setting where the doctors went about their usual routines. This strengthens the ecological validity. Had they been away from their usual hospital, they may have spent more time thinking about their clinical assessment.
• All parents consented for themselves and their children. They also made sure that each family was provided with extra support or guidance if needed. This was incase they wished to exercise their right to withdraw

Question 14

State 2 weaknesses

Answer 14

• Findings may not be generalisable as the study only looked at one emergency department in on Norwegian hospital. The doctors here have not specialised in paediatrics and they do not routinely assess pain, thus doctors in other countries may have assessed childrens pain more accurately.
• Parents and children were not completely blinded to each others answers. This means that the childrens answers may have been influenced by their parents reactions. For instance, may have made a lower score to match their parents score, lowering validity

Question 15

Application:

Answer 15

• Can be used to support changed in Norwegian paediatric care.
• For instance medical training should include the importance of listening to children regarding pain levels
• also VAS can be a helpful took in providing more useful info than asking them face-face as children may under-report their pain levels

Question 16

Idiographic v Nomothetic

Answer 16

• This study illustrated the nomothetic approach
• The use of pain scales meant researchers can use statistical analysis to determine the significance of the findings.
• If the study had asked open-questions in their questionnaires, they could have collected qualitative data, this would have allowed a more idiographic approach.