Development and Validation of a Virtual Human Vignette to Compare Nurses’ Assessment and Intervention Choices for Pain in Critically Ill Children

Abstract

Introduction As virtual experiences are increasingly used in healthcare 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 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 employed. 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. VH 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. VH vignettes may be useful in studying the influence of facial actions on nurses’ choices for children’s pain assessment and treatment.

Nurses' Beliefs Regarding Pain in Critically Ill Children: A Mixed-Methods Study

“…Methods for this study have been reported in prior publications, and additional details regarding the instruments as well as data collection and analysis can also be obtained elsewhere (LaFond, Van Hulle Vincent, Corte, et al, 2015; LaFond, Van Hulle Vincent, Lee, et al, 2015). …”

“…Because the PBPQ was adapted for this study, content validity was assessed through expert review; four advanced practice nurses with an average of 10 years’ experience in pediatric critical care affirmed the accuracy and relevance of content for PICU nurses (LaFond, Van Hulle Vincent, Corte, et al, 2015; LaFond, Van Hulle Vincent, Lee, et al, 2015). Further, a PICU clinical pharmacist confirmed accuracy and relevance of opioid kinetics items.…”

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

“…Four advanced practice nurses with expertise in care of critically ill children reviewed the adapted PBPQ for accuracy of content and applicability to the PICU. Details regarding this process have been previously reported (LaFond et al, in press). …”

“…A description of the development and validation of the VH vignettes can be read elsewhere (LaFond et al, in press). Each VH vignette depicts a boy in the PICU; nurses visualize his current behavior, vital signs, and reported level of pain.…”

“…For each VH vignette, the nurses recorded their rating of the child's pain and any interventions they would provide (open-ended item). Additional details regarding the viewing of the VH vignettes can be found elsewhere (LaFond et al, in press). After viewing all of the VH vignettes, open-ended semi-structured interviews approximately 10 to 20 minutes in length were conducted and audio-recorded.…”