Modes of thought, feeling, and action in infant pain assessment by pediatric nurses

The components of the assessment process are identified and compared from an ethnography of the methods used by 65 pediatric nurses to assess the level of pain in a sample of infants younger than 1 year of age. Nine different modes of thought, feeling, and action were referenced in reaching judgments about pain levels. The five predominant modes were: deductive, clinical, inductive, testing, and knowing the infant. Over time, the participants had developed a preference for particular combinations of the elements which constitute these modes: repeated use of these preferred assessment methods gave more experienced pediatric nurses distinctive styles of pain assessment. Nurses demonstrated a wider “repertoire” of knowledge about how to assess pain than they customarily used: the selection of particular repertoire items varied by nurses' initial estimates, experience level, and personal assessment style. Findings support the proposition that an understanding of the infant pain assessment process must include nurses' selection and customary use of knowledge and data available to them, as well as the intrinsic nature of that information.