Background and aims Despite the various pain assessment tools available to date, pain assessment in critically ill children remains challenging for nurses. Clinical judgement of pain depends on different factors that have yet to be described in real-life settings. The aim of this observational study was to describe expert nurses’ clinical judgment when assessing pain in critically ill children.
Methods Following ethics approval and participants’ consent, a convenience sample of expert nurses working in a tertiary referral paediatric intensive care unit (PICU) in Western Switzerland participated in the study. Data were collected using the think-aloud method, combined with non-participant observation and semi-structured interviews. Data were analysed using deductive content analyses based on the O’Neil’s decision-making model. Categories
Results The ten nurse participants had an average of 12.9 years of nursing experience. Seven intubated and ventilated patients were observed. Four had cardiac surgery, one diaphragmatic hernia, one tracheal reconstruction, and one respiratory syndrome. Results show that pre-encountered data and knowing the patient are important factors. Expert nurses mobilise their knowledge to discriminate between pain-related agitation and agitation caused by other factors by generating hypothesis. They perform analgesic tests to confirm or refute pain. Counter-balancing the benefits and adverse effects of analgesia and sedation is also part of their clinical judgement when making decision about pain management.
Conclusions The clinical context of the patient plays an important part in nurses’ judgment about pain. To facilitate this difficult task, pain assessment should be combined with sedation assessment in critically ill children.