Assessment in nonverbal populations (infants, mentally impaired, etc.): Understanding caregivers' attributions of infant pain

Abstract

Infants' limited abilities to communicate and moderate pain imposes heavy demands on caregivers responsible for accurately detecting when infants are suffering. To examine variability in this capacity, one hundred and twenty-three caregivers (41 parents, 41 nurses and 41 paediatricians) provided estimates of pain after viewing video clips of infants from five different age groups (2, 4, 6, 12 and 18 months). Each video clip displayed an infant who had just received a routine immunization injection. Earlier research presented by our lab had indicated: 1) parents attributed greater pain than paediatricians, while nurses did not differ from either group; 2) younger infants were perceived to be in significantly less pain. Analyzing caregivers' ratings of the importance of different judgment cues for pain and their responses on pain-related belief statements facilitated an understanding of how each sample formed their judgments. Reliable, systematic differences were found in how the different groups prioritized cues for their pain judgments. Parents, nurses and paediatricians were remarkably similar in rating ‘sounds’, ‘facial expressions’, ‘body movements’ and the needle injection as most important to judging pain in younger infants. However for the older infants, while paediatricians continued to rate the same four cues as important, nurses and parents attached moderate or greater importance to a broader range of cues (11 of the 12 cues supplied). Discriminant function analyses using the importance ratings of the 12 cues demonstrated that optimal discrimination between caregiver groups resulted in parents being differentiated from both samples of medical professionals. Looking at age group differences, caregivers demonstrated different beliefs regarding the cognitive capabilities of infants of differing age groups. Across samples of caregivers, more participants were willing to attribute pain-related cognitive processing abilities to older infants than younger infants. An integration of these findings provides an improved understanding of caregiver judgment processes.