Barbara F. Fuller

Relationship of cues to assessed infant pain level.

Cues that 46 pediatric nurses with a BS in Nursing reported as key to their pain assessments of 88 videotaped infants, ages 0 to 12 months, are identified. Frequencies with which these cues were used for infants of different ages and the relationships between key cues and assessed levels of pain are described. Greater pain was strongly associated with tears, stiff posture, guarding, and fisting. Greater pain was moderately associated with inadequate type or dosage of analgesia, more recent surgery, Inconsolability, difficult to distract, does not focus on surroundings, frown, grimace, wrinkled face, flushed face, pain cry, and increased arousal in response to touch of sore area. Internurse variability in cue use was sizable. Most of the often-used cues had weak or no association with assessed pain level Only consolability, pain cry, grimace, and stiff posture were frequently used and correlated> .51 with assessed level of pain.

Acoustic Analysis of Cries from "Normal" and "Irritable" Infants

Infant irritability or colic is characterized by recurrent episodes of persistent, unexplained crying. The lack of a precise definition of the type and amount of cry that distinguishes an infant as colicky has hampered research and intervention efforts. The primary aims of this study are to describe the acoustic characteristics of cries of irritable infants and compare these to those ofnormal infants. Tape recorded cries of 11 irritable and 11 non-irritable infants were compared. The average agefor infants of both groups was 8 weeks. The cries of irritable infants were higher in jitter shimmer, proportion of noise, and tenseness than were the cries of control infants. Findings suggest that colic or infant irritability is more than just excessive crying. Acoustic characteristics of the cries of irritable infants reveal an increase in stress-arousal that supports the thesis of a state regulation disorder Characterizing the nature and origin of the cries of irritable infants is essential to an understanding that will eventually guide appropriate diagnosis and management of these infants.

The Influence of Background Clinical Data on Infant Pain Assessments

The purpose of this study was to determine the importance of knowledge of clinical background data on nursing assessments of infant pain. In a quasiexperimental design, the infant pain assessments of two groups of pediatric nurses were compared. Both groups assessed the levels of pain of the same videotaped infants. One group also read clinical background data about each infant; the other group did not. The group who read clinical background data evidenced higher mean levels of assessed pain per videotaped infant than did the group who only viewed the videotapes. Findings underscore the importance of clinical data and clinical context in the process of assessing infant pain and the risk of underestimating pain when all factors are not considered.

Validity and Reliability of a Practice-Based Infant Pain Assessment Instrument

The purpose of this study was to determine the validity and reliability of an infant pain assessment instrument. This instrument is an algorithm derived from a model of infant pain assessment that emerged from interviews with pediatric nurses and includes methods for evaluating clinical data that suggest the likelihood of pain. Unlike other instruments, this instrument is not restricted to use in clinical situations where the likelihood of pain is evident. This instrument determines the three levels of pain that guide subsequent nursing interventions: no pain, mild pain (discomfort), and severe pain. Content validity was determined by obtaining and incorporating feedback from a focus group of practicing pediatric nurses on various developmental stages of the instrument. Criterion-like validity was excellent: Mean Pearson correlations between the pain ratings of 18 videotaped infants by 24 nursing students using the instrument with ratings performed by a panel of 5 expert nurses not using any instrument was 0.96. Test-retest reliability, as measured by Pearson correlations between pain ratings 3 months apart, was also excellent (r = 0.91).

Testing a Model of the Nursing Assessment of Infant Pain

The purpose of this study was to test whether elements of an infant pain assessment model interacted as postulated by the model. The elements are the infant’s response to comfort measures and the principle of consolability. Four different scenarios for each of 16 videotaped infants were prepared. Each scenario represented one of four different combinations of likelihood of pain and consolability and consisted of a videotape plus written clinical information. Forty-eight volunteer pediatric nurses assessed infant pain of 16 scenarios, each depicting one of the 16 infants. Mean level of assessed pain was highest for the “high likelihood of pain and difficult to console” group, second highest for the “high likelihood of pain and easily consoled” group, third highest for the “low likelihood of pain and difficult to console” group and least for the “low likelihood of pain and easily consoled” group. Findings supported the infant pain assessment model.

SELECTION OF VIGILANT AND AVOIDANT COPING STRATEGIES AMONG REPRESSORS, HIGHLY ANXIOUS AND TRULY LOW ANXIOUS SUBJECTS

70 female graduate students from a western university were classified as to personality type: Highly Anxious, Truly Low Anxious, and Repressing, using a combination of scores from the Taylor Manifest Anxiety Scale and the Marlowe-Crowne Social Desirability Scales. Each subjects preference for monitor or blunter coping strategy was assessed via the Miller Behavioral Style Scale. Highly Anxious subjects chose significantly more monitor strategies than did Truly Low Anxious subjects or Repressors. The number of blunter strategies chosen did not differ across personality types. Chi-squared indicated that Highly Anxious subjects were more often classified as monitors than blunters whereas the proportions of monitors and blunters did not significantly differ between Truly Low Anxious subjects and Repressors. Results suggest that the repressor trait is distinct from avoidant and vigilant coping strategies.

Generalizability and Clinical Utility of a Practice-Based Infant Pain Assessment Instrument

The purpose of this study was to determine the clinical usefulness and generalizability of an infant pain assessment instrument. Earlier work showed that this instrument--an algorithm derived from a model of infant pain assessment-possessed excellent content validity, criterion-like validity, and 3-month stability (test-retest reliability). In this study, generalizability was determined by comparing the percentage agreement between inexperienced pediatric nurses and one author, both using the tool to assess pain of infants in various clinical settings, and by comparing the percentage agreement between one author who used the tool to assess pain and the infants pediatric nurse caretaker who used his or her clinical expertise, not the tool, to assess pain across various clinical settings. The results show excellent generalizability.