Objective. The objective of this project was to develop core competencies in pain assessment and ... more Objective. The objective of this project was to develop core competencies in pain assessment and management for prelicensure health professional education. Such core pain competencies common to all prelicensure health professionals have not been previously reported.
The aim of this systematic review was to evaluate the effectiveness of toolkits as a knowledge tr... more The aim of this systematic review was to evaluate the effectiveness of toolkits as a knowledge translation (KT) strategy for facilitating the implementation of evidence into clinical care. Toolkits include multiple resources for educating and/or facilitating behaviour change. Systematic review of the literature on toolkits. A search was conducted on MEDLINE, EMBASE, PsycINFO and CINAHL. Studies were included if they evaluated the effectiveness of a toolkit to support the integration of evidence into clinical care, and if the KT goal(s) of the study were to inform, share knowledge, build awareness, change practice, change behaviour, and/or clinical outcomes in healthcare settings, inform policy, or to commercialise an innovation. Screening of studies, assessment of methodological quality and data extraction for the included studies were conducted by at least two reviewers. 39 relevant studies were included for full review; 8 were rated as moderate to strong methodologically with clin...
Extremely low gestational age infants (<28 weeks at birth) experience significant pain from re... more Extremely low gestational age infants (<28 weeks at birth) experience significant pain from repeated therapeutic procedures while hospitalized in the neonatal intensive care unit. As part of a program of research examining pain in preterm infants, we conducted a qualitatively driven mixed-methods design, supplemented with a qualitative and quantitative component, to understand how health care professionals (HCPs) assess and manage procedural pain for tiny and underdeveloped preterm infants. Fifty-nine HCPs from different disciplines across four tertiary-level neonatal units in Canada participated in individual or focus group interviews and completed a brief questionnaire. Four themes from the content analysis were (a) subtlety and unpredictability of pain indicators, (b) infant and caregiver attributes and contextual factors that influence pain response and practices, (c) the complex nature of pain assessment, and (d) uncertainty in the management of pain. The information gleaned...
Archives of disease in childhood. Fetal and neonatal edition, 2014
To determine the nature and frequency of painful procedures and procedural pain management practi... more To determine the nature and frequency of painful procedures and procedural pain management practices in neonatal units in Kenya. Cross-sectional survey. Level I and level II neonatal units in Kenya. Ninety-five term and preterm neonates from seven neonatal units. Medical records of neonates admitted for at least 24 h were reviewed to determine the nature and frequency of painful procedures performed in the 24 h period preceding data collection (6:00 to 6:00) as well as the pain management interventions (eg, morphine, breastfeeding, skin-to-skin contact, containment, non-nutritive sucking) that accompanied each procedure. Neonates experienced a total of 404 painful procedures over a 24 h period (mean=4.3, SD 2.0; range 1-12); 270 tissue-damaging (mean=2.85, SD 1.1; range 1-6) and 134 non-tissue-damaging procedures (mean=1.41, SD 1.2; range 0-6). Peripheral cannula insertion (27%) and intramuscular injections (22%) were the most common painful procedures. Ventilated neonates and neona...
Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur
Chronic pain negatively affects an adolescent's life; however, little is known about the soci... more Chronic pain negatively affects an adolescent's life; however, little is known about the social impact of chronic pain for adolescents. More is known about the general peer relationships of adolescents with chronic pain than their close friendships. Close friendships begin to take on more importance during adolescence as these relationships facilitate the development of an adolescent's sense of personal identity and increasing independence from family influences. Thus, chronic pain may create friendship challenges for adolescents beyond those typically experienced during this developmental trajectory, which may negatively impact their abilities to secure social support. To better understand the challenges adolescents with chronic pain face with regard to their friendships. An interpretative phenomenological study using individual interviews was conducted. Two themes emerged. 'Rethinking the self with pain' describes the intrusive nature of chronic pain, challenging t...
Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur
Although documentation of children's pain by health care professionals is frequently undertak... more Although documentation of children's pain by health care professionals is frequently undertaken, few studies have explored the nature of the language used to describe pain in the medical records of hospitalized children. To describe health care professionals' use of written language related to the quality and quantity of pain experienced by hospitalized children. Free-text pain narratives documented during a 24 h period were collected from the medical records of 3822 children (0 to 18 years of age) hospitalized on 32 inpatient units in eight Canadian pediatric hospitals. A qualitative descriptive exploration using a content analysis approach was used. Pain narratives were documented a total of 5390 times in 1518 of the 3822 children's medical records (40%). Overall, word choices represented objective and subjective descriptors. Two major categories were identified, with their respective subcategories of word indicators and associated cues: indicators of pain, includ...
Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur
Current approaches to evaluating pain in children with chronic arthritis suffer from methodologic... more Current approaches to evaluating pain in children with chronic arthritis suffer from methodological problems. A real-time data capture approach using electronic diaries has been proposed as a new standard for pain measurement. However, there is limited information available regarding the development and feasibility of this approach in children. The aim of the present study was to pilot test the e-Ouch electronic pain diary in terms of compliance and acceptability in adolescents with arthritis to further refine the prototype. A descriptive study design -- with two iterative phases of testing, modifying the prototype and retesting -- was used. A purposive sample of 13 adolescents with mild to severe pain and disability was drawn from a large rheumatology clinic in a university-affiliated pediatric tertiary care centre in Canada over a four-week period in December 2004. Participants were signalled with an alarm to use the diary three times per day for a two-week period. Adolescents com...
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2008
Despite a solid evidence base for pain management, pain is not always well managed in practice. I... more Despite a solid evidence base for pain management, pain is not always well managed in practice. Interventions to implement pain management evidence need to be shifted from a focus on individual characteristics to knowledge translation strategies that are grounded in theory and attend to the organizational context and social dimension of translating evidence into practice. The authors examine Appreciative Inquiry (AI) as an innovative knowledge translation intervention in the area of pain management in nursing. Their aims are to advance the current state of knowledge translation interventions in pain management and to examine the usefulness of potential interventions based on their congruence with theory. The theory and practice of AI are compared to the concept of knowledge translation and the elements of the Promoting Action on Research Implementation in Health Services framework. Discussion is grounded in pain management in nursing.
Canadian family physician Médecin de famille canadien, 2007
I have heard that thousands of Canadian kids are affected by fetal alcohol spectrum disorders. Ha... more I have heard that thousands of Canadian kids are affected by fetal alcohol spectrum disorders. Has there been any attempt to estimate what it costs our society? In a recent Canadian study, the lifetime cost of fetal alcohol spectrum disorders was estimated at $1 million per case. With an estimated 4000 new cases yearly, this translates to $4 billion annually.
Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur, 2001
The administration of sucrose with and without non-nutritive sucking (NNS) has been examined for ... more The administration of sucrose with and without non-nutritive sucking (NNS) has been examined for relieving procedural pain in newborn infants. The calming and pain-relieving effects of sucrose are thought to be mediated by endogenous opioid pathways activated by sweet taste. The orogustatory effects of sucrose have been demonstrated in animal newborns, and in preterm and full term human infants during painful procedures. In contrast to sucrose, the analgesic effects of NNS are hypothesized to be activated through nonopioid pathways by stimulation of orotactile and mechanoreceptor mechanisms. Although there is uncertainty as to whether the effects of sucrose and NNS are synergistic or additive, there is sufficient evidence to support the efficacy of combining the two interventions for procedural pain relief in infants. In this review article, the underlying mechanisms of sucrose and NNS, separately and in combination for relieving procedural pain in preterm and full term infants, are...
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2000
Patients have been found to receive inadequate analgesia despite moderate to severe pain after co... more Patients have been found to receive inadequate analgesia despite moderate to severe pain after coronary artery bypass graft (CABG) surgery. The purpose of this pilot study was to evaluate a preadmission educational booklet for patients undergoing their first uncomplicated CABG. A randomized controlled trial (RCT) was undertaken at the largest cardiovascular centre in Canada. Repeated measures were used to compare data from 3 interviews: at baseline, day 3, and day 5. Patients were randomly assigned to one of 3 groups at the preadmission clinic 2 to 7 days before surgery: (1) generic hospital booklet and videotape (control), (2) control + pain booklet, or (3) control + pain booklet and interview; 45 subjects completed all 3 interviews. Measures were the McGill Pain Questionnaire-Short Form and the American Pain Society Patient Outcome Questionnaire. For all groups, analgesic administration was inadequate (19.89[13.37] mg morphine equivalents/24 hours) despite unrelieved pain (6.63[2....
The incremental costs incurred by VLBW (less than 1,500 grams) infants during the first year of l... more The incremental costs incurred by VLBW (less than 1,500 grams) infants during the first year of life accounted for one-third of the $11.4 billion spent in the U.S. on health care. Developmental care for VLBW infants focuses on light and noise management, coordination of interventions to minimize sleep interruptions and positioning/bundling the infant to prevent disorganizaiton and promote self-regulation. When compared to 60 VLBW infants receiving conventional NICU care, improved physiologic stability measures and fewer days in the NICU were recorded for the 60 VLBW infants cared for by nurses and trained developmental care specialists. Because the move from the NICU to the transitional unit occurred earlier for the developmental group of VLBW infants, and their nursing intensity needs were lower, the average cost savings achieved for this group was $4,340 per infant during the first 35 days of life or less if discharged.
Home-based traction is an alternative treatment to conventional hospital-based traction for child... more Home-based traction is an alternative treatment to conventional hospital-based traction for children with orthopedic conditions such as congenital dislocated hip and Legg-Perthes disease. The application of a proposed theoretical model is used to describe the process of the home-based traction innovation. Creativity and innovation occasions a reconceptualization of stresses. The reconceptualization of stress, plus the operational support of coordinated in-home services, can help families and nurses in the community and in the hospital develop, implement, and evaluate this kind of innovative care. In applying the home-based traction professionals empower and legitimize parents as resourceful co-providers of care. The legitimizing of the alternative in-home service affords parents a more optimistic appraisal of their situation as manageable. Parents are free to develop a coordinated response to their overall circumstance, including the treatment of their one child's illness. The e...
A pediatric pain flow sheet was developed to provide health professionals with a simple means of ... more A pediatric pain flow sheet was developed to provide health professionals with a simple means of documenting the child's pain experience. This instrument was pretested and used in a research study to ascertain whether its use would make any difference to the child's postoperative pain intensity and management. Results indicated that nurses who implemented the flow sheet had patients who were in less pain, were assessed more frequently and received more narcotic analgesics.
To determine whether healthcare professionals perceive the pain of infants differently due to the... more To determine whether healthcare professionals perceive the pain of infants differently due to their understanding of that infant's level of risk for neurological impairment. Neonatal Intensive Care Units (NICU's) at two tertiary pediatric centers. Ninety-five healthcare professionals who practice in the NICU (50 nurses, 19 physicians, 17 respiratory therapists, 9 other) participated. They rated the pain (0-10 scale and 0-6 Faces Pain Scale), distress (0-10), effectiveness of cuddling to relieve pain (0-10) and time to calm without intervention (seconds) for nine video clips of neonates receiving a heel stick. Prior to each rating, they were provided with descriptions that suggested the infant had mild, moderate or severe risk for neurological impairment. Ratings were examined as a function of the level of risk described. Professionals' ratings of pain, distress, and time to calm did not vary significantly with level of risk, but ratings of the effectiveness of cuddling w...
A number of infant pain measures have been developed over the past 15 years incorporating behavio... more A number of infant pain measures have been developed over the past 15 years incorporating behavioural and physiologic indicators; however, no reliable or valid measure exists for infants who are at risk for neurological impairments (NI). The objective of this study was to establish consensus about which behavioural, physiologic and contextual indicators best characterize pain in infants at high, moderate and low levels of risk for NI. A 39- item, self-administered electronic survey that included infant physiologic, behavioral and contextual pain indicators was used in a two round Delphi consensus exercise. Fourteen pediatric pain experts were polled individually and anonymously on the importance and usefulness of the pain indicators for the 3 differing levels of risk for NI. The strength of agreement between expert raters was moderate in Round 1 and fair in Round 2. In general, pain indicators with the highest concordance for all three groups were brow bulge, facial grimace, eye squ...
In Canada, the incidence of Fetal Alcohol Spectrum Disorder (FASD) has been estimated to be 1 in ... more In Canada, the incidence of Fetal Alcohol Spectrum Disorder (FASD) has been estimated to be 1 in 100 live births. Caused by prenatal exposure to alcohol, FASD is the leading cause of neuro-developmental disabilities among Canadian children, and youth. To measure the health-related quality of life (HRQL) of Canadian children and youth diagnosed with FASD. A prospective cross-sectional study design was used. One-hundred and twenty-six (126) children and youth diagnosed with FASD, aged 8 to 21 years, living in urban and rural communities throughout Canada participated in the study. Participants completed the Health Utilities Index Mark 3 (HUI3). HUI3 measures eight health attributes: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain. Utilities were used to measure a single cardinal value between 0 and 1.0 (0 = all-worst health state; 1 = perfect health) to reflect the global HRQL for that child. Mean HRQL scores and range of scores of children and youth with ...
Objective. The objective of this project was to develop core competencies in pain assessment and ... more Objective. The objective of this project was to develop core competencies in pain assessment and management for prelicensure health professional education. Such core pain competencies common to all prelicensure health professionals have not been previously reported.
The aim of this systematic review was to evaluate the effectiveness of toolkits as a knowledge tr... more The aim of this systematic review was to evaluate the effectiveness of toolkits as a knowledge translation (KT) strategy for facilitating the implementation of evidence into clinical care. Toolkits include multiple resources for educating and/or facilitating behaviour change. Systematic review of the literature on toolkits. A search was conducted on MEDLINE, EMBASE, PsycINFO and CINAHL. Studies were included if they evaluated the effectiveness of a toolkit to support the integration of evidence into clinical care, and if the KT goal(s) of the study were to inform, share knowledge, build awareness, change practice, change behaviour, and/or clinical outcomes in healthcare settings, inform policy, or to commercialise an innovation. Screening of studies, assessment of methodological quality and data extraction for the included studies were conducted by at least two reviewers. 39 relevant studies were included for full review; 8 were rated as moderate to strong methodologically with clin...
Extremely low gestational age infants (<28 weeks at birth) experience significant pain from re... more Extremely low gestational age infants (<28 weeks at birth) experience significant pain from repeated therapeutic procedures while hospitalized in the neonatal intensive care unit. As part of a program of research examining pain in preterm infants, we conducted a qualitatively driven mixed-methods design, supplemented with a qualitative and quantitative component, to understand how health care professionals (HCPs) assess and manage procedural pain for tiny and underdeveloped preterm infants. Fifty-nine HCPs from different disciplines across four tertiary-level neonatal units in Canada participated in individual or focus group interviews and completed a brief questionnaire. Four themes from the content analysis were (a) subtlety and unpredictability of pain indicators, (b) infant and caregiver attributes and contextual factors that influence pain response and practices, (c) the complex nature of pain assessment, and (d) uncertainty in the management of pain. The information gleaned...
Archives of disease in childhood. Fetal and neonatal edition, 2014
To determine the nature and frequency of painful procedures and procedural pain management practi... more To determine the nature and frequency of painful procedures and procedural pain management practices in neonatal units in Kenya. Cross-sectional survey. Level I and level II neonatal units in Kenya. Ninety-five term and preterm neonates from seven neonatal units. Medical records of neonates admitted for at least 24 h were reviewed to determine the nature and frequency of painful procedures performed in the 24 h period preceding data collection (6:00 to 6:00) as well as the pain management interventions (eg, morphine, breastfeeding, skin-to-skin contact, containment, non-nutritive sucking) that accompanied each procedure. Neonates experienced a total of 404 painful procedures over a 24 h period (mean=4.3, SD 2.0; range 1-12); 270 tissue-damaging (mean=2.85, SD 1.1; range 1-6) and 134 non-tissue-damaging procedures (mean=1.41, SD 1.2; range 0-6). Peripheral cannula insertion (27%) and intramuscular injections (22%) were the most common painful procedures. Ventilated neonates and neona...
Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur
Chronic pain negatively affects an adolescent's life; however, little is known about the soci... more Chronic pain negatively affects an adolescent's life; however, little is known about the social impact of chronic pain for adolescents. More is known about the general peer relationships of adolescents with chronic pain than their close friendships. Close friendships begin to take on more importance during adolescence as these relationships facilitate the development of an adolescent's sense of personal identity and increasing independence from family influences. Thus, chronic pain may create friendship challenges for adolescents beyond those typically experienced during this developmental trajectory, which may negatively impact their abilities to secure social support. To better understand the challenges adolescents with chronic pain face with regard to their friendships. An interpretative phenomenological study using individual interviews was conducted. Two themes emerged. 'Rethinking the self with pain' describes the intrusive nature of chronic pain, challenging t...
Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur
Although documentation of children's pain by health care professionals is frequently undertak... more Although documentation of children's pain by health care professionals is frequently undertaken, few studies have explored the nature of the language used to describe pain in the medical records of hospitalized children. To describe health care professionals' use of written language related to the quality and quantity of pain experienced by hospitalized children. Free-text pain narratives documented during a 24 h period were collected from the medical records of 3822 children (0 to 18 years of age) hospitalized on 32 inpatient units in eight Canadian pediatric hospitals. A qualitative descriptive exploration using a content analysis approach was used. Pain narratives were documented a total of 5390 times in 1518 of the 3822 children's medical records (40%). Overall, word choices represented objective and subjective descriptors. Two major categories were identified, with their respective subcategories of word indicators and associated cues: indicators of pain, includ...
Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur
Current approaches to evaluating pain in children with chronic arthritis suffer from methodologic... more Current approaches to evaluating pain in children with chronic arthritis suffer from methodological problems. A real-time data capture approach using electronic diaries has been proposed as a new standard for pain measurement. However, there is limited information available regarding the development and feasibility of this approach in children. The aim of the present study was to pilot test the e-Ouch electronic pain diary in terms of compliance and acceptability in adolescents with arthritis to further refine the prototype. A descriptive study design -- with two iterative phases of testing, modifying the prototype and retesting -- was used. A purposive sample of 13 adolescents with mild to severe pain and disability was drawn from a large rheumatology clinic in a university-affiliated pediatric tertiary care centre in Canada over a four-week period in December 2004. Participants were signalled with an alarm to use the diary three times per day for a two-week period. Adolescents com...
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2008
Despite a solid evidence base for pain management, pain is not always well managed in practice. I... more Despite a solid evidence base for pain management, pain is not always well managed in practice. Interventions to implement pain management evidence need to be shifted from a focus on individual characteristics to knowledge translation strategies that are grounded in theory and attend to the organizational context and social dimension of translating evidence into practice. The authors examine Appreciative Inquiry (AI) as an innovative knowledge translation intervention in the area of pain management in nursing. Their aims are to advance the current state of knowledge translation interventions in pain management and to examine the usefulness of potential interventions based on their congruence with theory. The theory and practice of AI are compared to the concept of knowledge translation and the elements of the Promoting Action on Research Implementation in Health Services framework. Discussion is grounded in pain management in nursing.
Canadian family physician Médecin de famille canadien, 2007
I have heard that thousands of Canadian kids are affected by fetal alcohol spectrum disorders. Ha... more I have heard that thousands of Canadian kids are affected by fetal alcohol spectrum disorders. Has there been any attempt to estimate what it costs our society? In a recent Canadian study, the lifetime cost of fetal alcohol spectrum disorders was estimated at $1 million per case. With an estimated 4000 new cases yearly, this translates to $4 billion annually.
Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur, 2001
The administration of sucrose with and without non-nutritive sucking (NNS) has been examined for ... more The administration of sucrose with and without non-nutritive sucking (NNS) has been examined for relieving procedural pain in newborn infants. The calming and pain-relieving effects of sucrose are thought to be mediated by endogenous opioid pathways activated by sweet taste. The orogustatory effects of sucrose have been demonstrated in animal newborns, and in preterm and full term human infants during painful procedures. In contrast to sucrose, the analgesic effects of NNS are hypothesized to be activated through nonopioid pathways by stimulation of orotactile and mechanoreceptor mechanisms. Although there is uncertainty as to whether the effects of sucrose and NNS are synergistic or additive, there is sufficient evidence to support the efficacy of combining the two interventions for procedural pain relief in infants. In this review article, the underlying mechanisms of sucrose and NNS, separately and in combination for relieving procedural pain in preterm and full term infants, are...
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2000
Patients have been found to receive inadequate analgesia despite moderate to severe pain after co... more Patients have been found to receive inadequate analgesia despite moderate to severe pain after coronary artery bypass graft (CABG) surgery. The purpose of this pilot study was to evaluate a preadmission educational booklet for patients undergoing their first uncomplicated CABG. A randomized controlled trial (RCT) was undertaken at the largest cardiovascular centre in Canada. Repeated measures were used to compare data from 3 interviews: at baseline, day 3, and day 5. Patients were randomly assigned to one of 3 groups at the preadmission clinic 2 to 7 days before surgery: (1) generic hospital booklet and videotape (control), (2) control + pain booklet, or (3) control + pain booklet and interview; 45 subjects completed all 3 interviews. Measures were the McGill Pain Questionnaire-Short Form and the American Pain Society Patient Outcome Questionnaire. For all groups, analgesic administration was inadequate (19.89[13.37] mg morphine equivalents/24 hours) despite unrelieved pain (6.63[2....
The incremental costs incurred by VLBW (less than 1,500 grams) infants during the first year of l... more The incremental costs incurred by VLBW (less than 1,500 grams) infants during the first year of life accounted for one-third of the $11.4 billion spent in the U.S. on health care. Developmental care for VLBW infants focuses on light and noise management, coordination of interventions to minimize sleep interruptions and positioning/bundling the infant to prevent disorganizaiton and promote self-regulation. When compared to 60 VLBW infants receiving conventional NICU care, improved physiologic stability measures and fewer days in the NICU were recorded for the 60 VLBW infants cared for by nurses and trained developmental care specialists. Because the move from the NICU to the transitional unit occurred earlier for the developmental group of VLBW infants, and their nursing intensity needs were lower, the average cost savings achieved for this group was $4,340 per infant during the first 35 days of life or less if discharged.
Home-based traction is an alternative treatment to conventional hospital-based traction for child... more Home-based traction is an alternative treatment to conventional hospital-based traction for children with orthopedic conditions such as congenital dislocated hip and Legg-Perthes disease. The application of a proposed theoretical model is used to describe the process of the home-based traction innovation. Creativity and innovation occasions a reconceptualization of stresses. The reconceptualization of stress, plus the operational support of coordinated in-home services, can help families and nurses in the community and in the hospital develop, implement, and evaluate this kind of innovative care. In applying the home-based traction professionals empower and legitimize parents as resourceful co-providers of care. The legitimizing of the alternative in-home service affords parents a more optimistic appraisal of their situation as manageable. Parents are free to develop a coordinated response to their overall circumstance, including the treatment of their one child's illness. The e...
A pediatric pain flow sheet was developed to provide health professionals with a simple means of ... more A pediatric pain flow sheet was developed to provide health professionals with a simple means of documenting the child's pain experience. This instrument was pretested and used in a research study to ascertain whether its use would make any difference to the child's postoperative pain intensity and management. Results indicated that nurses who implemented the flow sheet had patients who were in less pain, were assessed more frequently and received more narcotic analgesics.
To determine whether healthcare professionals perceive the pain of infants differently due to the... more To determine whether healthcare professionals perceive the pain of infants differently due to their understanding of that infant's level of risk for neurological impairment. Neonatal Intensive Care Units (NICU's) at two tertiary pediatric centers. Ninety-five healthcare professionals who practice in the NICU (50 nurses, 19 physicians, 17 respiratory therapists, 9 other) participated. They rated the pain (0-10 scale and 0-6 Faces Pain Scale), distress (0-10), effectiveness of cuddling to relieve pain (0-10) and time to calm without intervention (seconds) for nine video clips of neonates receiving a heel stick. Prior to each rating, they were provided with descriptions that suggested the infant had mild, moderate or severe risk for neurological impairment. Ratings were examined as a function of the level of risk described. Professionals' ratings of pain, distress, and time to calm did not vary significantly with level of risk, but ratings of the effectiveness of cuddling w...
A number of infant pain measures have been developed over the past 15 years incorporating behavio... more A number of infant pain measures have been developed over the past 15 years incorporating behavioural and physiologic indicators; however, no reliable or valid measure exists for infants who are at risk for neurological impairments (NI). The objective of this study was to establish consensus about which behavioural, physiologic and contextual indicators best characterize pain in infants at high, moderate and low levels of risk for NI. A 39- item, self-administered electronic survey that included infant physiologic, behavioral and contextual pain indicators was used in a two round Delphi consensus exercise. Fourteen pediatric pain experts were polled individually and anonymously on the importance and usefulness of the pain indicators for the 3 differing levels of risk for NI. The strength of agreement between expert raters was moderate in Round 1 and fair in Round 2. In general, pain indicators with the highest concordance for all three groups were brow bulge, facial grimace, eye squ...
In Canada, the incidence of Fetal Alcohol Spectrum Disorder (FASD) has been estimated to be 1 in ... more In Canada, the incidence of Fetal Alcohol Spectrum Disorder (FASD) has been estimated to be 1 in 100 live births. Caused by prenatal exposure to alcohol, FASD is the leading cause of neuro-developmental disabilities among Canadian children, and youth. To measure the health-related quality of life (HRQL) of Canadian children and youth diagnosed with FASD. A prospective cross-sectional study design was used. One-hundred and twenty-six (126) children and youth diagnosed with FASD, aged 8 to 21 years, living in urban and rural communities throughout Canada participated in the study. Participants completed the Health Utilities Index Mark 3 (HUI3). HUI3 measures eight health attributes: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain. Utilities were used to measure a single cardinal value between 0 and 1.0 (0 = all-worst health state; 1 = perfect health) to reflect the global HRQL for that child. Mean HRQL scores and range of scores of children and youth with ...
Uploads
Papers by Bonnie Stevens