Roxie L. Foster

A review of factors predicting children's pain experiences.

Despite decades of research, hospitalized children continue to suffer from unrelieved pain. Failure to apply state-of-the-art knowledge to clinical practice has been termed one of the greatest paradoxes in modern medicine (Kenny, 2001). Clearly, effective pain management requires state-of-the-art knowledge about the pain experience. This article reviews research over the past two decades related to the predictors of age, gender, prior pain experiences, pain expectation, pain acceptance, and pain tolerance. The review underscores implications for clinical practice and indications for future research.

Measuring the quality of children's postoperative pain management: initial validation of the child/parent Total Quality Pain Management (TQPM) instruments.

Quality improvement measurement instruments for pediatric postoperative pain management are virtually nonexistent. Without standardized instruments to measure pediatric pain management outcomes, practitioners are hampered in their efforts to improve the quality of pain management for children. In this study, instruments for children (8--12 years) and parents were developed and tested to measure the quality of childrens postoperative pain management. The child (Child TQPM) and parent (Parent TQPM) Total Quality Pain Management instruments were tested with 50 parent/child dyads across two large treatment centers. The pain rating scale modified for these instruments demonstrated good criterion validity with the well established Varni/Thompson Pediatric Pain Questionnaire Visual Analogue Scale. Parent--child agreement was described for responses across instruments. Construct validity was examined through selected inter-item relationships. Psychometric analyses support the initial measurement properties of the pediatric TQPM instruments.

SYMPTOM MANAGEMENT OUTCOMES : DO THEY REFLECT VARIATIONS IN CARE DELIVERY SYSTEMS?

OBJECTIVES Symptom management is increasingly recognized as a critical element of patient care, particularly in managing chronic illness. However, research on outcomes related to symptom management is in its infancy, except for the symptom of pain. This symptom was therefore chosen as a prototype to review the state of the science regarding relations between organizational variables and symptom management outcomes and to illustrate the issues regardless of the symptom managed. This article discusses pain outcome measures appropriate for acute and cancer pain, proposes attributes of the care delivery system that may affect outcome measures, and identifies challenges associated with this type of research. METHODS Review of quality assurance studies raises issues concerning the adequacy of currently used outcomes for pain and satisfaction with pain management. Although considerable effort has been expended in developing pain measurement in adults and children, critical issues for examining pain management outcomes include deciding what perspectives should be used as the most valid indicator of the pain outcome and when the measures should be obtained. RESULTS Critical concerns are raised about the measure of satisfaction with pain management and its appropriateness as the end-result outcome. A key issue is whether respondents actually disentangle satisfaction with pain management from satisfaction with other aspects of care, including caring dispositions of health-care providers. Finally, the question is raised: Are pain outcomes affected by organizational context? CONCLUSIONS Although the answer to this question is unknown, a few research studies suggest that organizational context is likely to influence pain outcomes. It is clear, however, from ongoing work that until several conceptual, methodological, and analytic challenges are resolved, research is unlikely to capture the influence of variations in care delivery systems on symptom management outcomes.

Reporting guidelines: CONSORT, PRISMA, and SQUIRE

First published in 1996, the CONSORT guidelines were created to address inadequate reporting of clinical trials, especially individually randomized, two-group, parallel trials. The original guidelines were developed by a team of statisticians, epidemiologists, and biomedical editors and were revised in 2001 and again in 2010 (Moher, Schultz, & Altman, 2001; Schulz, Altman, & Moher, 2010). The intent of the CONSORT checklist and flow diagram was to provide a template for authors to fully and accurately describe research methodology. Moher and colleagues (2001) asserted that whereas inadequate reporting hinders interpretation, it also “borders on unethical practice when biased results receive false credibility” (p. 4). The latest CONSORT statement, checklist, flow diagram, and explanation and elaboration document are available on the website (http://www.consort-statement.org) or from one of several publications such as Schulz and colleagues (2010). The CONSORT guidelines can be useful whether or not the study was designed as a randomized controlled trial (RCT). Although most applicable to an RCT, the author of a quantitative study who chooses only the relevant checklist elements will still benefit from prompts to include the appropriate information in the introduction, methods, results, and discussion sections. Fuzzy reporting and omission of critical information comprise the majority of reviewers’ comments and queries back to authors of manuscripts submitted for peer review. For example, authors frequently omit adequate description of the “settings and locations where the data were collected” and have a tendency to gloss over limitations that should include “sources of potential bias, imprecision, and, if relevant, multiplicity of analyses” (Schulz et al., 2010, p. 2). PRISMA: PREFERRED REPORTING ITEMS FOR SYSTEMATIC REVIEWS AND META-ANALYSES

Multisite Clinical Research: A Challenge for Nursing Leaders

The need for the application of research-based data to diversified healthcare systems has led to more attempts by nurse researchers to investigate phenomena across clinical sites. Nurse executives increasingly are asked to justify resource allocation among organizations, and must compare patient-care practices within complex systems that are often geographically distant. This article describes the pitfalls encountered and the progress made by researchers during a 4-year multisite, multimethod clinical investigation collecting clinical outcome and organizational context data from seven hospitals.

What a pilot study is and what it is not

The literature is replete with pilot studies or research designated as pilot work. Whereas these small studies can play an important part in knowledge development, they are also “misused, mistreated, and misrepresented” (Lancaster, Dodd, & Williamson, 2004, p. 307). The purpose of this editorial is to review when it is appropriate to use the term pilot study in publishing research results and when it is not.

Language Used by Korean and Korean American Children to Describe Emotional Reactions to Illness and Hospitalization

Most children experience emotional distress during hospitalization. However, existing instruments for assessing emotional status in hospitalized children have limitations. To address this, the authors determine the language that Korean and Korean American children use to describe emotions that may relate to illness and hospitalization. Using a descriptive exploratory design, projective method, and card sort, the study is conducted in six Korean ethnic churches in the Midwest metropolitan area of United States and uses a convenience sample consisting of 94 children, ages 7 to 12 years. Fifteen English emotion words and 13 Korean emotion words are chosen by at least 50% of the Korean-American and Korean children, and childrens emotional responses are expressed differently in Korean and English. Health care providers should be cautious about direct translation, because cultural nuances can convey different meanings in another language. In preparation for the rapid growth of minority children in the United States, health care providers should understand cultural perspectives related to minority childrens experiences of health and illness and provide linguistically and culturally appropriate care.

Psychometric validation of Emotional Reaction Instrument-English to measure American children’s emotional responses to hospitalisation

AIMS AND OBJECTIVES The aim of this study was to test the initial psychometric properties of the Emotional Reactions Instrument-English with hospitalised American children, ages 7-12 years, in the USA. BACKGROUND Childrens negative emotional responses have been a subject of concern for paediatric clinicians and researchers, especially because negative emotional responses following or during hospitalisation are associated with adverse patient outcomes. Existing self-report paediatric instruments have a number of limitations including lack of clinical feasibility and psychometric evidence. DESIGN A survey and psychometric approach was used to test initial reliability and validity of the Emotional Reactions Instrument-ENGLISH. METHODS Two hundred hospitalised American children, 7-12 years of age, who were admitted to a Childrens Hospital in the USA were recruited for this study. The children were administered the Emotional Reactions Instrument-English, the Facial Affective Scale, and a demographic form. RESULTS Internal consistency was supported by a Cronbachs alpha of 0·83 for the total scale. Alpha coefficients for subscales ranged from 0·59-0·82. Construct validity was tested with exploratory factor analysis. Through principal component analysis, four factors were identified that explained 64% of the variance. Concurrent validity was supported by most items in the Emotional Reactions Instrument-English being significantly correlated with the Facial Affective Scale (r = 0·18-0·59). The instrument can be administered to hospitalised children in 5-10 minutes. CONCLUSIONS The results of this exploratory study provide initial support for the psychometric adequacy of the Emotional Reactions Instrument-English with hospitalised American children ages 7-12 years. Further testing of the Emotional Reactions Instrument-English is required to validate the subscales and evaluate the instruments use with children of different ages, race and ethnicity. RELEVANCE TO CLINICAL PRACTICE This study introduces a new, clinically feasible instrument to measure childrens diverse emotional responses to hospitalisation.

Psychometric assessment of the Emotional Reactions Instrument-Korean (ERI-K) to measure Korean children's emotional reaction to hospitalization.

The purpose of this study was to test psychometric properties of the Emotional Reactions Instrument—Korean (ERI-K). A convenience sample of 170 hospitalized Korean children was recruited. Each child was asked to describe how she or he felt during hospitalization, through the ERI-K and the Facial Affective Scale. Surprisingly, children reported lower levels of negative emotions and physical discomfort and a moderate level of positive emotion (Happy, Good). Internal consistency reliability of .88 for the 14-item scale provides strong support for reliability. Construct validity was supported by item-to-total correlations ranging between .42 and .65. Exploratory factor analysis identified two factors that explained 54% of the variance. Further testing of the ERI-K is recommended to provide additional evidence of psychometric adequacy across Korean populations.

Concept Analysis of Pain

The purpose of this paper is to expand the understanding of tile concept of pain. The authors intent to clarify the defining attributes of pain and identify antecedents that influence the perception of pain and the possible consequences of pain by using Walker and Avants (1995) concept analysis. A model case demonstrates how pain is tied to these critical attributes. A borderline case and a contrary case are presented to differentiate the concept of pain from other concepts. Empirical referents demonstrate the current perspective of the concept of pain.