Abstract
The study examined the impact of disease diagnosis and prognosis on the assessment of pain and the ensuing analgesic medication decisions by pediatric nurses and residents. Knowledge, beliefs, and attitudes regarding pediatric pain and analgesia were explored as potential moderating factors in medication decision-making, as was coping style while under stress. Subjects, consisting of 51 pediatric nurses and 49 pediatric residents working at an ethnically diverse urban hospital, viewed two brief videotaped portrayals of two different boys (both 10-year-old black males) experiencing acute pain episodes, accompanied by vignettes describing each child's diagnosis (sickle cell disease or bone cancer) and history. The children were depicted as having been given an intravenous injection of 3.2 mg morphine (0.1 mg/kg) in the ER an hour before, which had infiltrated. For each videotape, subjects were asked to rate the child's global pain, select a dosage level of morphine to administer, estimate how frequently the child had presented with a pain crisis over the past year, and estimate the percentage chance that the child will be alive at various points of time in the future. Subjects also completed a demographic information form, a pediatric pain attitudes questionnaire (PPABQ) and a coping strategies inventory (COPE). The results indicated that disease diagnosis did not affect pain assessment and medication decision-making; however, there was an unexpected significant order effect. Subjects believed that children with sickle cell anemia were significantly more likely to exaggerate their pain behavior beyond the physiological experience than were children with seven other illnesses (including cancer). Attitudes, beliefs, and knowledge regarding pediatric pain management and assessment were demonstrated to affect treatment decisions and pain assessment. Medical staff who held more outdated beliefs or had inaccurate knowledge about pediatric analgesia rated the children's pain significantly lower and gave them significantly less analgesic medication than did those with better pediatric pain education. These results suggest that factors other than observed pain behaviors were influencing medication decisions.