Nursing Judgement: The Key to Pain Assessment in Children with Cerebral Palsy after Orthopedic Surgery

2.50
Hdl Handle:
http://hdl.handle.net/10755/154734
Type:
Presentation
Title:
Nursing Judgement: The Key to Pain Assessment in Children with Cerebral Palsy after Orthopedic Surgery
Abstract:
Nursing Judgement: The Key to Pain Assessment in Children with Cerebral Palsy after Orthopedic Surgery
Conference Sponsor:Sigma Theta Tau International
Conference Year:2002
Conference Date:July, 2002
Author:Ferraro, Mary
P.I. Institution Name:Shriner's Hospital for Children
Title:Nurse Manager
Objectives: Nursing judgment is always a critical component of pain assessment, but when verbal and behavioral cues are limited as with children who have neurologic impairment, expert judgment becomes the key component (Foster, 2001). The purpose of the study was to determine the degree of concordance between children with cerebral palsy and nurses' pain ratings. As secondary purpose was to validate evidenced-based nursing judgement. Design: A previously done retrospective chart review was the source of this secondary analysis. Eighty-seven charts were evaluated to compare three different regimens of morphine infusion and epidural analgesia in the first 24 hours of post orthopedic surgery. Children ranged in age from 2.6 years to 20.6 years and all had diagnoses of cerebral palsy requiring orthopedic procedures. Huth and Moore's 1998 middle range theory of acute pain management was the theoretical framework for this study. Sample: Nurses caring for patients in a specialty pediatric hospital offering orthopedic surgery were the focus of this analysis. All patients who had both nurse and patient pain ratings were included in this analysis. Out of a possible 24 nurses, 22 nurses and 20 patients' pain ratings were analyzed. The nurses were highly experienced in post operative management of children with cerebral palsy with an average length of employment in the facility of 10 plus years, were all female, and their ages ranged from their mid 20's to mid 50's. They had both formal and informal education on pain assessment and all were oriented to the pain assessment flow sheet that was developed by a hospital committee. In addition there were both objective and subjective assessment tools. Outcome Variables: The subjective tool used was the FACES scale, a cartoon visual analogue scale. Demonstrated reliability and validity for this tool is well established in the literature. The objective tool was adapted from examples found in the literature. Observations and physiologic parameters were included. Children were given a numeric rating in five separate categories and their total point score then reflected their overall assigned pain score. The five categories were blood pressure, crying/consolability, movement, agitation, and verbal/facial expression. Methods: Nurse's and patient ratings were available for the first 24-hour postoperative interval. Both Spearman's correlation coefficients and Kappa coefficients were tabulated. Findings: The tabulated Spearman's correlation coefficients suggest an overall high level of concordance with an overall correlation coefficient of .731, equivalent to moderate to good concordance. For Kappa, the grand mean was .704 reflecting "substantial" agreement. Possible reasons for these findings will be discussed. Conclusions/Implications: Results of this secondary analysis support the statement that "clinical expertise is a legitimate component of evidence-based practice" (Foster, 2001). Nurses caring for children with neurologic impairment experiencing post-operative pain are passionate about pain assessment and management. When passion is empowered by evidence-based nursing judgment, children receive the best possible care.

Repository Posting Date:
26-Oct-2011
Date of Publication:
Jul-2002
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleNursing Judgement: The Key to Pain Assessment in Children with Cerebral Palsy after Orthopedic Surgeryen_GB
dc.identifier.urihttp://hdl.handle.net/10755/154734-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Nursing Judgement: The Key to Pain Assessment in Children with Cerebral Palsy after Orthopedic Surgery</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2002</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">July, 2002</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Ferraro, Mary</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Shriner's Hospital for Children</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Nurse Manager</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">mferraro@shrinenet.org</td></tr><tr><td colspan="2" class="item-abstract">Objectives: Nursing judgment is always a critical component of pain assessment, but when verbal and behavioral cues are limited as with children who have neurologic impairment, expert judgment becomes the key component (Foster, 2001). The purpose of the study was to determine the degree of concordance between children with cerebral palsy and nurses' pain ratings. As secondary purpose was to validate evidenced-based nursing judgement. Design: A previously done retrospective chart review was the source of this secondary analysis. Eighty-seven charts were evaluated to compare three different regimens of morphine infusion and epidural analgesia in the first 24 hours of post orthopedic surgery. Children ranged in age from 2.6 years to 20.6 years and all had diagnoses of cerebral palsy requiring orthopedic procedures. Huth and Moore's 1998 middle range theory of acute pain management was the theoretical framework for this study. Sample: Nurses caring for patients in a specialty pediatric hospital offering orthopedic surgery were the focus of this analysis. All patients who had both nurse and patient pain ratings were included in this analysis. Out of a possible 24 nurses, 22 nurses and 20 patients' pain ratings were analyzed. The nurses were highly experienced in post operative management of children with cerebral palsy with an average length of employment in the facility of 10 plus years, were all female, and their ages ranged from their mid 20's to mid 50's. They had both formal and informal education on pain assessment and all were oriented to the pain assessment flow sheet that was developed by a hospital committee. In addition there were both objective and subjective assessment tools. Outcome Variables: The subjective tool used was the FACES scale, a cartoon visual analogue scale. Demonstrated reliability and validity for this tool is well established in the literature. The objective tool was adapted from examples found in the literature. Observations and physiologic parameters were included. Children were given a numeric rating in five separate categories and their total point score then reflected their overall assigned pain score. The five categories were blood pressure, crying/consolability, movement, agitation, and verbal/facial expression. Methods: Nurse's and patient ratings were available for the first 24-hour postoperative interval. Both Spearman's correlation coefficients and Kappa coefficients were tabulated. Findings: The tabulated Spearman's correlation coefficients suggest an overall high level of concordance with an overall correlation coefficient of .731, equivalent to moderate to good concordance. For Kappa, the grand mean was .704 reflecting &quot;substantial&quot; agreement. Possible reasons for these findings will be discussed. Conclusions/Implications: Results of this secondary analysis support the statement that &quot;clinical expertise is a legitimate component of evidence-based practice&quot; (Foster, 2001). Nurses caring for children with neurologic impairment experiencing post-operative pain are passionate about pain assessment and management. When passion is empowered by evidence-based nursing judgment, children receive the best possible care.<br/><br/></td></tr></table>en_GB
dc.date.available2011-10-26T13:14:06Z-
dc.date.issued2002-07en_GB
dc.date.accessioned2011-10-26T13:14:06Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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