Nurses' Knowledge and Attitudes Regarding Pediatric Pain Management in Western Australia.

BACKGROUND AND AIM: Despite clinical guidelines, suboptimal pediatric pain management persists. A local audit found poor guideline compliance. Inadequate knowledge is a recognized barrier to the delivery of evidence-based care. The aim of the study was to investigate nurses' knowledge and attitudes regarding pain management at an Australian tertiary pediatric hospital. Design, Setting, Participants and Method: A cross-sectional, descriptive study using the Pediatric Pain Knowledge and Attitudes Questionnaire (Revised) was distributed to 590 nurses in an Australian pediatric hospital. RESULTS: The mean knowledge score (n = 201) was 77.56 out of 100 (range 49.82-94.16, standard deviation [SD] 8.55); mean attitude score (n = 229) was 72.46 out of 100 (range 33.33-93.33, SD 11.76). Significant differences in mean knowledge scores were found between nurses' designations (p = .018), with the greatest mean difference (MD) between clinical nurses and enrolled nurses (10.5; p = .002). Nurses with experience in critical care had significantly higher mean knowledge scores (MD 3.1; p = .012). Senior registered nurses had the most positive mean attitude score (82.4, SD 6.2), which was significantly higher than clinical nurses (73.77, SD 10.0), registered nurses (71.64, SD 12.6), and enrolled nurses (68.89, SD 8.8) (p < .05). Nurses with specialist pediatric qualifications had significantly more positive attitude scores (mean 75.65, SD 11.6) than those without (mean 70.86, SD 11.7; p = .005). However, 51% of respondents believed that children tolerate pain better than adults do. CONCLUSION: Although nurses' overall knowledge and attitude toward pediatric pain were among the highest reported, areas for targeted education using in-service education and workshops were identified alongside a need for exploration of the impediments to providing best care.

Instrument validation process: a case study using the Paediatric Pain Knowledge and Attitudes Questionnaire.

AIMS AND OBJECTIVES: To compare two methods of calculating interrater agreement while determining content validity of the Paediatric Pain Knowledge and Attitudes Questionnaire for use with Australian nurses. BACKGROUND: Paediatric pain assessment and management documentation was found to be suboptimal revealing a need to assess paediatric nurses' knowledge and attitude to pain. The Paediatric Pain Knowledge and Attitudes Questionnaire was selected as it had been reported as valid and reliable in the United Kingdom with student nurses. The questionnaire required content validity determination prior to use in the Australian context. DESIGN: A two phase process of expert review. METHODS: Ten paediatric nurses completed a relevancy rating of all 68 questionnaire items. In phase two, five pain experts reviewed the items of the questionnaire that scored an unacceptable item level content validity. Item and scale level content validity indices and intraclass correlation coefficients were calculated. RESULTS: In phase one, 31 items received an item level content validity index <0·78 and the scale level content validity index average was 0·80 which were below levels required for acceptable validity. The intraclass correlation coefficient was 0·47. In phase two, 10 items were amended and four items deleted. The revised questionnaire provided a scale level content validity index average >0·90 and an intraclass correlation coefficient of 0·94 demonstrating excellent agreement between raters therefore acceptable content validity. CONCLUSION: Equivalent outcomes were achieved using the content validity index and the intraclass correlation coefficient. RELEVANCE TO CLINICAL PRACTICE: To assess content validity the content validity index has the advantage of providing an item level score and is a simple calculation. The intraclass correlation coefficient requires statistical knowledge, or support, and has the advantage of accounting for the possibility of chance agreement.

Development of a population pharmacokinetic model for parecoxib and its active metabolite valdecoxib after parenteral parecoxib administration in children.

BACKGROUND: Parecoxib is a cyclooxygenase-2 selective inhibitor used in management of postoperative pain in adults. This study aimed to provide pediatric pharmacokinetic information for parecoxib and its active metabolite valdecoxib. METHODS: Thirty-eight children undergoing surgery received parecoxib (1 mg/kg IV to a maximum of 40 mg) at induction of anesthesia, and plasma samples were collected for drug measurement. Population pharmacokinetic parameters were estimated using nonlinear mixed effects modeling. Area under the valdecoxib concentration-time curve and time above cyclooxygenase-2 in vitro 50% inhibitory concentration for free valdecoxib were simulated. RESULTS: A three-compartment model best represented parecoxib disposition, whereas one compartment was adequate for valdecoxib. Age was linearly correlated with parecoxib clearance (5.0% increase/yr). There was a sigmoid relationship between age and both valdecoxib clearance and distribution volume. Time to 50% maturation was 87 weeks postmenstrual age for both. In simulations using allometric-based doses the 90% prediction interval of valdecoxib concentration-time curve in children 2-12.7 yr included the mean for adults given 40 mg parecoxib IV. Simulated free valdecoxib plasma concentration remained above the in vitro 50% inhibitory concentrations for more than 12 h. In children younger than 2 yr, a dose reduction is likely required due to ongoing metabolic maturation. CONCLUSIONS: The final pharmacokinetic model gave a robust representation of parecoxib and valdecoxib disposition. Area under the valdecoxib concentration-time curve was similar to that in adults (40 mg), and simulated free valdecoxib concentration was above the cyclooxygenase-2 in vitro 50% inhibitory concentration for free valdecoxib for at least 12 h.