PICU Nurses' Pain Assessments and Intervention Choices for Virtual Human and Written Vignettes

•Child factors considered were diagnosis, behavior, self-report, and vital signs•Nurses considered similar factors but their intervention choices varied widely•Many children were rated under their self-report and given a lesser intervention•Significant effects were identified for behavior and vignette type, not diagnosis•Nurses rated pain lower and chose less morphine when children smiled

The purpose of this concurrent mixed-methods study was to 1) examine the factors pediatric intensive care unit nurses consider when assessing and intervening for children who report severe pain and to 2) determine the effect of child behavior and diagnosis on the nurses' pain ratings and intervention choices for written and virtual human vignettes. Quantitative and qualitative results substantiated that despite recommendations to use self-report, many PICU nurses use behavior as the primary indicator to assess and treat pain, even when a child is old enough to articulate pain intensity and there is sufficient cause for pain to be present.