Key study : Brudvik et al Flashcards
(18 cards)
What was the context of the study by Brudvik
Research showed that hospital doctors tend to underestimate childrens pain and pain relief medication is offered less often.
Research also suggests that parents are better judges of their childrens self-reported pain with fathers providing less accurate ratings than mothers. (Morrow et al)
What were the aims of the study of the study by Brudvik
Brudvick wanted to explore:
1) The relationship between children’s self-reported pain and ratings from intensity made by their parents and doctors
-2) How age, medical condition and severity of pain affect pain intensity estimates
3) Whether pain assessments affects the administration of pain relief
What is the sample
243 children aged 3-15 years old
- 53% boys, 47% girls
- attended the Norwegian emergency department over a 17-day period
- 51 different physicians
- 57% men, 43% women
- 51% had children of their own
- none specialised in paediatrics
What measures were used to measure pain (the ones filled by children
Children aged 3-8 filled out the Faces Pain Rating Scale-Revised (FPS-R) which had 6 faces showing increasing levels of pain.
Children aged 9-15 used the Visual Analogue Scale (VAS) and Coloured Analogue Scale (CAS) where they marked on a line where their pain was, from no pain (green) through to the worst thinkable pain (red)
What measures/psychometric did the parents complete
- Parents and physicians completed the Numeric Rating Scale (NRS) to estimate the child’s level of pain from 0-10. They completed their score before the child and both parents and children were told to not share scores with the physician
- As well as pain assessments, the parent’s questionnaires gathered demographic information. Physician’s questionnaires gathered information about their medical experience, speciality and if they had their own children
- The child’s diagnosis was classified as either: infections, fractures, wound injuries/soft tissue or ligament/muscle injuries. Most children had soft tissue, muscle or ligament injuries (51%) followed by fractures, infections and wound injuries.
What were the results
On average, physicians assessed pain level to be NRS=2.3, lower than the child’s assessment and NRS=1.6 lower than the parents’ assessment.
- The doctors mean assessment was NRS = 3.22. The parents’ mean evaluation was NRS = 4.83. The children’s own mean evaluation was NRS = 5.5
- The children, parents and physicians all estimated the highest mean pain intensifies score when the child had a fracture.
Physicians significantly underestimated the pain compared with both children and parents in all diagnostic groups, but less so in cases where fractures were involved.
What was the conclusion
The research showed that emergency department physicians significantly underestimate pain compared to parents and children. This is the case across all conditions and ages but is less likely to occur with fractures and less likely to occur with children aged 8 and over.
Evaluation
-Standardisation
-Idiographic vs nomothetic
-
useful application
There are real life implications because the findings can be used to educate doctors about this issue, and this could help doctors give a more accurate assessment of a child’s pain. This could then potentially increase the likelihood of a child being given painkillers which would both reduce their pain and make the child less scared or anxious of hospitals and doctors in the future
What are the weaknesses of the study
1)Generalisability
A weakness is that the findings may not be generalisable as the study only looked at one
emergency department in one Norwegian hospital. This makes the findings not generalisbale to the wider population specifically hospitals outside of Norway
2) Validity
A further weakness is that although the parents rated their children’s pain first, the parents
and children were not completely blinded to (unaware of) each other’s answers. This means the children’s answers may have been influenced by their parents’ reactions. For example, they might have said they felt less pain than they really did so that their answer matched their parents. This is important because it means the children’s ratings may not have been completely valid.
What are the strengths of the study
1) Standardisation
One strength of the study is standardisation. The study is highly standardised as the doctors were trained to use the numerical rating scale and parents were given a detailed
written description to ensure they each gave similar support to their children regarding
their interpretation of the faces on the pain scales. This is a strength as it makes the study easy to replicate making it high in reliability.
2) Natural setting
Another strength of the study is that it took place in the doctors natural setting. This is a strength as the doctors went about their usual
routines, with relatively limited time to conduct their consultations. This strengthens the
study’s ecological validity. Had the doctors been observed away from the usual hospital
setting, they may have spent more time thinking about their clinical assessment and the
researchers would have gained less understanding of everyday medical practices.
Ethics
Informed consent;
all parents gave written consent for themselves and their children to be involved in the study. This was critical as the families were especially
vulnerable due to their children’s injuries/illnesses, meaning they were at greater risk of psychological harm.
The researchers also made sure that one of the team was always
available to provide extra support or guidance about the study if the families needed it. As
the children’s medical condition could change very quickly, it was important that parents
knew that someone was available in case they wished to exercise their right to withdraw.
Idiographic vs nomothetic
Brudvik et al.’s research illustrates the nomothetic approach in psychology. This is
because they measure pain numerically using rating scales. This means researchers
can use statistical analysis to determine the significance of the findings. If Brudvik’s
team had asked open questions in their questionnaires, they could have collected
qualitative data. This would have allowed for a more idiographic approach and the
researchers could have learned more about how and why some children experience
greater pain than others, despite similar diagnoses.
Generalisability
A weakness is that the findings may not be generalisable as the study only looked at one
emergency department in one Norwegian hospital. This makes the findings not generalisbale to the wider population specifically hospitals outside of Norway
Explain two weaknesses with the rating scales used by the 3–8-year-old
children. [4]
children might be in too much pain (1) to want to complete a rating scale
such as the Wong-Baker faces scale (2)
children may not understand what they are required to do (1)
the measure is not valid (1) the ‘smiley face’ may not translate into actual
pain or the type of pain the child is experiencing (2)
the smiley face may not be reliable (1), but then again, the level of pain
can also change (2).
Suggest one way in which a child’s pain can be assessed, other than
using a rating scale. [2]
by using a clinical interview (1) the child can be asked questions (at a
young child’s level) such as ‘point to where it hurts’ (2)
by observing the child’s behaviour (1) such as whether they are crying,
limping, holding an area (2).
Outline one rating scale completed by the 9–15-year-old children. [2]
the Visual Analogue Scale (VAS) (1) often a line drawn on paper with a
severity scale. Like the ‘Coloured’ below, but without colours (2)
the Coloured Analogue Scale (CAS) (1) which has a line on a piece of
paper with pain severity ranging from 0 (green) to 100 (red) (2)
Outline one rating scale completed by the 3–8-year-old children. [2]
the Wong-Baker Faces Pain Rating Scale (1) which has 6 faces showing
0–10 increasing levels of pain (2)
the Faces Pain Scale (FPS-R) (1) which also has 6 faces with a 0–10
scale (0, 2, 4, 6, 8, 10) (2).
