Differences in pain assessment and decisions regarding the administration of analgesics between novices, intermediates and experts in pediatric nursing

This article describes a study examining the influence of expertise on nurses' pain assessments and decisions regarding pharmacological interventions in children. In an experimental design, novices (n = 271), intermediates (n = 222), and experts (n -202) in pediatric nursing, various cases were presented. Each case consisted of a combination of a vignette and a video. Subjects were asked (1) to assess the child's pain intensity, (2) to specify their confidence in the assessment, and (3) to state whether or not they would administer a non-narcotic analgesic. The results indicated that expertise did not influence assessments of pain intensity. However, expertise did have a distinct impact on both the subjects' confidence in their decisions, and the decision to administer analgesics. Experienced nurses were most confident and were most inclined to administer analgesics. The findings of this study are placed in the context of a general theory on the development of expertise, which assumes that experts' decision-making is based on cognitive structures that describe features of prototypical or even actual patients, so called "illness scripts". From this theory it can be deduced that mainly practical experience is responsible for the (lack of) differences in decision-making between novices, intermediates and experts.