Research Critique Part 1
Alisa Rogers
Grand Canyon University
Introduction to Nursing Research
NRS 433V
June Helbig
July 28, 2013

Research Critique Part 1
Children are vulnerable in the pediatric intensive care unit (PICU) and experience pain when not needed. The nurses and physicians lack of knowledge about how critical illness affects the signs and symptoms of children’s pain

Problem Statement The clinical problem eluded that there is little known in the pediatric intensive care (PICU) settings of the nurses knowledge of pain in critically ill children. It is known that the knowledge of pain and quality of care given for pain alleviation is relevant. Not much is known regarding the nurses clinical learning patterns. Nurses used judgments in measuring pain in a variety of ways and it was found that their clinical judgments came from different levels of understanding and diverse aspects of pain. These assumptions lead to the aim of the study: to elucidate patterns in clinical knowledge development and unfold the role of the nurse as facilitator in relation to pain management in the PICU. (Mattsson, Forsner, Castren, Bolander Laksov, & Arman, 2012, p. 109) It is known that working in a PICU that nurses rely on each other and what they perceive as pain in a child may not be actual pain. Overtime clinical knowledge is developed with different encounters with patients and their families. The nurses need to focus more on their individual learning practices to a child’s pain starting on day one of admission to the PICU instead of waiting when the child is actually in pain. The nurses could then identify their true pain level knowing baselines. This study was significant due to any child in a PICU setting has the inability to communicate their level of pain and their needs. That complicates the pain process with the nurses having to judge their behaviors, expressions and vital signs by using their knowledge of pain in a critically ill child.

Purpose and Research Questions
The purpose of the study is for nurses to gain clinical knowledge of pain development in children in a PICU and gain the role as facilitator for pain management. The study utilized the qualitative method using semi-structured interviews in all the PICUs in Sweden (N=3). The study included thirty registered nurses with twenty seven being women and three men. They used tape recorded interviews that lasted 20-60 minutes in length. A semi-structured interview guide with questions influenced by Benner and Wrubel and Benner, Tanner, and Chesla were used. (Mattsson, Forsner, Castren, Bolander Laksov, & Arman, 2012, p. 110) The discussions included emotional involvement, problem engagement, environmental hindrances, and environmental facilitations. (Mattsson, Forsner, Castren, Bolander Laksov, & Arman, 2012, p. 110) The intent of the interviews was to capture the culture of the workplaces for the influence of the answers. I don’t believe that what I know about the questions was related to the problem. I feel that the emotional involvement, problem engagements were related but the environmental hindrances and environmental facilitations were not. I would have liked to seen specific questions that were asked in a structured manner. The study did utilize appropriate qualitative methods to answer the research questions.

Literature Review The author of the study did not cite quantitative and qualitative studies related to pain management in the PICU on nurses knowledge. It was stated that little was known about nurses’ clinical learning patterns or collegial facilitation within the PICU. (Mattsson, Forsner, Castren, Bolander Laksov, & Arman, 2012, p. 108) The study included ethical considerations for the consent of the study. The study was broken down into several sections including the context of the study, content analysis, results, practical learning dimensions, scholarship of nursing dimensions, safety, and orientation. There were 42 references ranging from 1989 to 2011 with the largest references coming from four different years. 6 was from 2004, 7 from 2008, 7 from 2009 and 5 from 2011. Only 19 of the references utilized were within the 5 year limit. The author did not differentiate in any weakness in the studies but adequate information was available to build an argument on the lack of nurse’s knowledge on children’s pain in the PICU.

Conceptual/Theoretical Framework The author did not allude to any specific perspective from which the study was developed nor any framework that developed from the findings. The results stated that the workplace culture supports or hinders learning and collaboration. Knowledge development is closely connected to workplace culture. The findings also clarify that nurses need to feel safe in their environment to facilitate their own personal knowledge. (Mattsson, Forsner, Castren, Bolander Laksov, & Arman, 2012, p. 107) In conclusion the study stated that nurses need to embrace effective learning about children’s pain starting on day one. The problems when taking care of a vulnerable child’s pain associates to the nurses structure of learning, lack of assessment within their scope of clinical practice and the focus on their individual learning needs. The nurse’s knowledge was interrelated to their culture and their work environment. That showed that the nurses need to focus on their individual learning and embrace scholarly learning about children’s pain starting on day one of admission. (Mattsson, Forsner, Castren, Bolander Laksov, & Arman, 2012, p. 116)

References
Mattsson, J., Forsner, M., Castren, M., Bolander Laksov, K., & Arman, M. (2012, May 1). A qualitative national study of nurses’ clinical knowledge development of pain in pediatric intensive care. Journal of Nursing Education and Practice, 2, 107-118. http://dx.doi.org/10.5430/jnep.v2n2p107