Clinical judgement of pain in the non-verbal child at the Paediatric Intensive Care Unit

Background: The aim of this study was to explore PICU nurses’ experiences of clinical judgment of pain in critically ill non-verbal children. The alleviation of children’s pain has been investigated from various perspectives but undertreated pain remains a problem in the Paediatric Intensive Care Unit with empirical evidence pointing towards the role of nurses and their pain judgment process. Summary of work: A phenomenographic method containing interviews was of seventeen experienced PICU nurses. Three categories emerged, describing nurses’ experiences of clinical judgment of pain from diverse perspective and levels of understanding. Summary of results: The findings are hierarchically ordered A, B, C, with A as the most elaborate level of understanding. (A), named Knowledge orientation, takes various aspects of pain in consideration and relates it to theoretical as well as experiential knowledge. (B), called Investigating orientation is focused on the specific child and this child’s specific pain cues, requiring the parent’s engagement. In (C) Practical orientation the judgment process is unsystematic, building on experiential knowledge. Conclusions: This study puts forward that the clinical judgment process has direct implications for how nurses take contextual factors, the child’s condition and the parents’ perceptions into consideration when judging the severity and intensity of the child’s pain, and by extension the child’s pain alleviation. Take-home messages: Increased awareness on nurses’ judgment processes benefits nursing care and nurses becomes more aware of how their judgment process directly affects the alleviation of pain. Finding ways of applying theoretical and experiential knowledge ineveryday care is proposed to systematically facilitate this