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Purpose: To describe nurses’ knowledge and attitudes about relieving children’s pain, perceived barriers to optimal pain management, and analgesics administered by nurses in relation to levels of children’s pain. Study Design and Methods: Data were collected from 67 nurses and 132 children in their care. Outcomes were measured with The Nurses’ Knowledge and Attitudes Survey Regarding Pain, the Nurses’ Perceived Barriers to Optimal Pain Management for Children Survey, calculations of the ordered analgesia administered by the nurse, and the Oucher scale for intensity of children’s pain. Results: Most nurses demonstrated knowledge and positive attitudes about relieving children’s pain but lacked knowledge about the incidence of respiratory depression and thought that children overreport their pain. Inadequate or insufficient physician medication orders for pain were identified by 99% of nurses as the greatest barrier to optimal pain management. The children’s mean pain level was 1.63 (scale of 0 to 5). Of the 117 children who reported pain, 74% received analgesia. Nurses administered means of 37.9% of available morphine and 22.8% of available total analgesia. Clinical Implications: Nurses in practice need to become more aware of the adequacy of their analgesic administration, the value of children’s self-report of pain, and the limitation of relying on children’s behavioral manifestations to judge pain intensity. This study also demonstrates the importance of examining attitudes about children’s pain relief and learning more about respiratory depression in children receiving opioids. [ABSTRACT FROM AUTHOR]

Introduction: As virtual experiences are increasingly used in health care training and research, it is important that adequate processes are applied for developing valid scenarios. We describe the development and validation of virtual human (VH) vignettes, computer-generated scenarios with animated patients and clinical information, for a mixed-methods study regarding nurses' assessment and intervention choices for critically ill children's pain., Methods: We followed the case development and review process for high-fidelity simulation case scenarios, including the use of validated written vignettes and content experts. Forty nurses described their pain assessment and intervention choices for the newly derived VH vignettes and completed a pain questionnaire. Nurses' reports of VH vignette consistency with their professional experience and recognition of VH facial expressions were evaluated to establish face validity. Their pain ratings for the VH and written (questionnaire) vignettes were evaluated for convergent validity. Qualitative content analysis, descriptive statistics, correlations, and paired t tests were used., Results: Most nurses (68.4%) supported vignette consistency with their professional experience. Facial expression recognition was 98.4%. Smiling children's pain was rated significantly lower than grimacing children in both VH and written vignettes. Pain was rated significantly lower for grimacing children in the VH vignettes than the written vignettes. Virtual human vignette pain ratings were strongly correlated with their written counterparts., Conclusions: This process was effective for developing VH vignettes that demonstrated good face validity with participants and convergent validity with written vignettes. Virtual human vignettes may be useful in studying the influence of facial actions on nurses' choices for children's pain assessment and treatment.