Randi Dovland Andersen

• Arribas, Cristina; Cavallaro, Giacomo; Gonzalez, Juan-Luis; Lagares, Carolina; Raffaeli, Genny & Smits, Anne [Show all 84 contributors for this article] (2024). Global cross-sectional survey on neonatal pharmacologic sedation and analgesia practices and pain assessment tools: impact of the sociodemographic index (SDI). Pediatric Research. ISSN 0031-3998. doi: 10.1038/s41390-024-03032-7.
• Rinde, Elisabeth Rønning; Anderzén-Carlsson, Agneta; Jahnsen, Reidun Birgitta & Andersen, Randi D. (2023). "Pain is one piece of a complex jigsaw puzzle" - experiences of raising a child with cerebral palsy who has pain. Disability and Rehabilitation. ISSN 0963-8288. doi: 10.1080/09638288.2023.2290199. Full text in Research Archive Show summary

  Purpose: To explore experiences of parenting a child with CP and pain. Method: Fourteen mothers and one father of children (9-16) with CP were included. All children had pain regularly, but the frequency and intensity of their pain experiences varied. Their motor function varied from GMFCS level I to V. Cognitive abilities varied from normal to moderate cognitive deficits. All children could express themselves verbally. Semi structured individual interviews were carried out, and results were developed using inductive thematic analysis. Results: The analysis resulted in the main theme "My child's pain is just one piece of a complex jigsaw puzzle". The main theme was developed by four mutually exclusive, but related themes: "My child's struggle burdens me", "Pain and CP direct our everyday life", "I want to be in control, but cannot always be" and "We are the only ones who understand the complexity". Conclusion: Parents of children with CP experience pain as one aspect of a bigger picture. They need help and support to cope with their child's pain, and professional helpers need to address the complexity pain is a part of.IMPLICATIONS FOR REHABILITATIONParents of children with cerebral palsy (CP) experience their child's pain as one piece in a jigsaw puzzle, and counseling needs to address the complexity rather than the separate parts of the picture.Health professionals should support parents in evaluation and management of their child's pain, as a feeling of competence in pain management is important to reduce parental stress.Health professionals should inform themselves about the life situation of parents whose child with CP has pain, and encourage them to seek practical support and apply for relevant support schemes that can make their everyday life easier.Parents of children with CP should be encouraged to take part in a diagnosis-specific support group, where they can meet with others in a similar situation, in order to reduce their feeling of being alone with their challenges.

• Henriksen, Ben Tore; Krogseth, Maria; Andersen, Randi D.; Nordsveen, Maren; Thy Nguyen, Caroline & Mathiesen, Liv [Show all 7 contributors for this article] (2023). Clinical pharmacist intervention to improve medication safety for hip fracture patients through secondary and primary care settings: a nonrandomised controlled trial. Journal of Orthopaedic Surgery and Research. ISSN 1749-799X. 18(1). doi: 10.1186/s13018-023-03906-2. Full text in Research Archive Show summary

  Background: Hip fracture patients face a patient safety threat due to medication discrepancies and adverse drug reactions when they have a combination of high age, polypharmacy and several care transitions. Consequently, optimised pharmacotherapy through medication reviews and seamless communication of medication information between care settings is necessary. The primary aim of this study was to investigate the impact on medication management and pharmacotherapy. The secondary aim was to evaluate implementation of the novel Patient Pathway Pharmacist intervention for hip fracture patients. Methods: Hip fracture patients were included in this nonrandomised controlled trial, comparing a prospective intervention group (n = 58) with pre-intervention controls who received standard care (n = 50). The Patient Pathway Pharmacist intervention consisted of the steps: (A) medication reconciliation at admission to hospital, (B) medication review during hospitalisation, (C) recommendation for the medication information in the hospital discharge summary, (D) medication reconciliation at admission to rehabilitation, and (E) medication reconciliation and (F) review after hospital discharge. The primary outcome measure was quality score of the medication information in the discharge summary (range 0-14). Secondary outcomes were potentially inappropriate medications (PIMs) at discharge, proportion receiving pharmacotherapy according to guidelines (e.g. prophylactic laxatives and osteoporosis pharmacotherapy), and all-cause readmission and mortality. Results: The quality score of the discharge summaries was significantly higher for the intervention patients (12.3 vs. 7.2, p < 0.001). The intervention group had significantly less PIMs at discharge (- 0.44 (95% confidence interval - 0.72, - 0.15), p = 0.003), and a higher proportion received prophylactic laxative (72 vs. 35%, p < 0.001) and osteoporosis pharmacotherapy (96 vs. 16%, p < 0.001). There were no differences in readmission or mortality 30 and 90 days post-discharge. The intervention steps were delivered to all patients (step A, B, E, F = 100% of patients), except step (C) medication information at discharge (86% of patients) and step (D) medication reconciliation at admission to rehabilitation (98% of patients). Conclusion: The intervention steps were successfully implemented for hip fracture patients and contributed to patient safety through a higher quality medication information in the discharge summary, fewer PIMs and optimised pharmacotherapy.

• Rinde, Elisabeth Rønning; Anderzen-Carlsson, Agneta; Jahnsen, Reidun Birgitta & Andersen, Randi D. (2023). "I have to obey my pain" - children's experiences of pain burden in cerebral palsy. Disability and Rehabilitation. ISSN 0963-8288. p. 1–9. doi: 10.1080/09638288.2023.2191012. Full text in Research Archive
• Henriksen, Ben Tore; Krogseth, Maria; Thy Nguyen, Caroline; Mathiesen, Liv; Andersen, Randi Dovland & Andersson, Yvonne [Show all 7 contributors for this article] (2022). Medication management for patients with hip fracture at a regional hospital and associated primary care units in Norway: a descriptive study based on a survey of clinicians' experience and a review of patient records. BMJ Open. ISSN 2044-6055. 12(11), p. 1–10. doi: 10.1136/bmjopen-2022-064868. Full text in Research Archive Show summary

  Objective: Patients with hip fracture are at high risk of medication errors due to a combination of high age, comorbidities, polypharmacy and several care transitions after fracture. The aim was to study medication management tasks concerning patient safety: medication reconciliation, medication review and communication of key medication information in care transitions. Design: Descriptive study comprising a self-administered clinician survey (MedHipPro-Q) and a retrospective review of hospital medical records of patients with hip fracture. Setting: Regional hospital and the associated primary care units (South-Eastern Norway). Participants: The survey received responses from 253 clinicians, 61 medical doctors and 192 nurses, involved in the medication management of patients with hip fracture, from acute admittance to the regional hospital, through an in-hospital fast track, primary care rehabilitation and back to permanent residence. Respondents' representativeness was unknown, introducing a risk of selection and non-response bias, and extrapolating findings should be done with caution. The patient records review included a random sample of records of patients with hip fracture (n=50). Outcome measures: Medication reconciliation, medication review and communication of medication information from two perspectives: the clinicians' (ie, experiences with medication management) and the practice (ie, documentation of completed medication management). Results: In the survey, most clinicians stated they performed medication reconciliation (79%) and experienced that patients often arrived without a medication list after care transition (37%). Doctors agreed that more patients would benefit from medication reviews (86%). In the hospital patient records, completed medication reconciliation was documented in most patients (76%). Medication review was documented in 2 of 50 patients (4%). Discharge summary guidelines were followed fully for 3 of 50 patients (6%). Conclusion: Our study revealed a need for improved medication management for patients with hip fracture. Patients were at risk of medication information not being transferred correctly between care settings, and medication reviews seemed to be underused in clinical practice.

• Henriksen, Ben Tore; Andersson, Yvonne; Mathisen, Liv; Krogseth, Maria; Andersen, Randi D. & Nordsveen, Maren (2022). Development and initial validation of MedHipPro-Q: a questionnaire assessing medication management of hip fracture patients in different care settings. BMC Health Services Research. ISSN 1472-6963. 22(240), p. 1–13. doi: 10.1186/s12913-022-07524-2. Full text in Research Archive Show summary

  Background: A validated questionnaire to assess medication management of hip fracture patients within and outside the hospital setting was lacking. The study aims were to describe the hip fracture patient pathway, and develop a valid and feasible questionnaire to assess clinicians' experience with medication management of hip fracture patients in different care settings throughout the patient pathway. Methods: This qualitative, descriptive methodological study used strategic and snowball sampling. The questionnaire was developed, and face and content validity explored through interviews with stakeholders. Phase I described the hip fracture patient pathway, and identified questionnaire dimensions in semi-structured interviews with management and clinicians (n = 37). The patient pathway was also discussed in six meetings (n = 70). Phase II refined a first draft of the questionnaire through cognitive interviews with future respondents (n = 23). The draft was modified after each interview. Post hoc, cognitive interview data were analysed using matrix analysis to condense problems and solutions into themes and subthemes. Phase III, converted the final version to a digital format, and tested its feasibility with a subset of the cognitive interview participants (n = 21) who completed the questionnaire and provided feedback. Results: Phase I: Hip fracture patients were cared for in at least three different care settings, and went through at least four handovers between and within primary and secondary care. Three questionnaire dimensions were identified: 1) Medication reconciliation and review, 2) Communication of key information, and 3) Profession and setting. Phase II: The MedHipPro-Q was representative of how the different professions experienced medication management in all settings, and hence showed face and content validity. Post hoc analysis: Problem themes (with sub-themes) were Representativeness (-of patient pathway and -of respondent reality) and Presentation (Language and Appearance). Solution themes (with sub-themes) were: Content (added or deleted) and Presentation (modified appearance or corrected language). Phase III: Participants did not identify technical, linguistic or content flaws in the questionnaire, and the digital version was considered feasible for use. Conclusion: The novel MedHipPro-Q showed good face and content validity, and was feasible for use throughout the hip fracture patient pathway. The rigorous development process supports its construct validity and reliability.

• Barney, Chantel C.; Andersen, Randi D.; Defrin, Ruth; Genik, Lara M.; McGuire, Brian E. & Symons, Frank J. (2021). Challenges in pain assessment and management among individuals with intellectual and developmental disabilities: German version. Der Schmerz (Berlin. Print). ISSN 0932-433X. doi: 10.1007/s00482-021-00589-8.
• Misic, Martina Carlsen; Andersen, Randi D.; Strand, Sofia; Eriksson, Mats & Olsson, Emma (2021). Nurses' perception, knowledge, and use of neonatal pain assessment. Paediatric and Neonatal Pain. ISSN 2379-5824. doi: 10.1002/pne2.12050. Show summary

  Preterm and sick newborn infants undergo several painful procedures during their hospital stay, potentially leading to short-and long-term negative consequences. Pain assessment should be performed regularly to provide optimal pain management. Nurses' knowledge of and attitude toward neonatal pain assessment affect how pain is assessed and managed in the clinical situation. The aim of this study was to explore Swedish nurses' perception, knowledge, and use of neonatal pain assessment. This descriptive, cross-sectional questionnaire study was conducted across all Swedish neonatal units (n = 38). Respondents were chosen through convenience sampling by the head nurses at each unit. Ten nurses from each unit were asked to complete the survey, which contained both closed and open questions. A majority of the units (30/38; 79%) participated and 232 surveys were returned, a response rate of 61%. Of the nurses, 91% thought that neonatal pain assessment was important. Many nurses mentioned various difficulties with pain assessment and concerns that the scales used might not assess pain correctly. About half of the nurses considered themselves to have enough knowledge of neonatal pain assessment. Those who reported having enough knowledge of pain assessment viewed the pain scales used at their units more positively. Of the nurses, 74% reported using a pain assessment scale several times per work shift. Pain management guidelines were available according to 75% of nurses, but only 53% reported that the guidelines were followed. Although nurses in general expressed a positive attitude toward pain assessment scales, this was not necessarily evident in their clinical practice. Lack of knowledge, available or accessible guidelines, or concerns regarding the validity of available pain scales seemed to limit their use.

• Andersen, Randi Dovland; Olsson, Emma & Eriksson, Mats (2020). The evidence supporting the association between the use of pain scales and outcomes in hospitalized children: A systematic review. International Journal of Nursing Studies. ISSN 0020-7489. 115(March). doi: 10.1016/j.ijnurstu.2020.103840. Show summary

  Background: Systematic use of pain intensity scales is considered a prerequisite for treatment of pain in hospitalized children, but already a decade ago, attention was called to the lack of robust evidence supporting the presumed positive association between their use and desired outcomes. Objectives: To re-evaluate the evidence supporting the association between the use of pain scales and patient and process outcomes in hospitalized children. Design: Systematic literature review. Data sources: The online databases PubMed and Cumulative Index of Nursing and Allied Health Literature (CINAHL) were searched from inception to April 15, 2020. Review methods: We performed single screening of all records followed by duplicate screening of full texts of interest with a disagreement procedure in place. Studies where the authors evaluated outcomes from the use of self-report or behavioral-based pain scales in children 0-18 years in a hospital setting were included. Emergency care settings were excluded. Results: In a majority of the 32 included studies, complex interventions that included one or more pain scales were evaluated. Process outcomes (e.g., documentation) were most frequently studied. Interventions were commonly associated with improved documentation of pain assessment, while the effect on pain management documentation was inconsistent. However, improvements in process outcomes did not necessarily result in better patient outcomes. In regard to patient outcomes (e.g., pain intensity, side effects, or satisfaction with treatment), some authors reported reduced pain intensity on group level, but the effect on other functional outcomes, child and parent satisfaction, and aspects of safety were inconsistent. Methodological issues, e.g., weak study designs and small samples, biased the results, and it was not possible to determine how pain scales contributed to the overall effects since they were studied as part of complex interventions. Conclusions: Although both a theoretically founded understanding of pain and clinical experience suggest that the use of pain scales will make a difference for hospitalized children with pain, there is still limited evidence to support this notion. As pain scales have been almost exclusively studied as an aspect of complex interventions, research that determines the active ingredient(s) in a complex intervention and their joint and individual effects on outcomes that are meaningful for the child (for example reduced pain intensity or improved function) are urgently needed.

• Olsson, Emma; Misic, Martina Carlsen; Andersen, Randi D.; Ericson, Jenny; Eriksson, Mats & Thernström Blomqvist, Ylva [Show all 7 contributors for this article] (2020). Study protocol: parents as pain management in Swedish neonatal care – SWEpap, a multi-center randomized controlled trial. BMC Pediatrics. ISSN 1471-2431. 20:474, p. 1–9. doi: 10.1186/s12887-020-02356-7. Full text in Research Archive
• Barney, Chantel; Andersen, Randi D.; Defrin, Ruth; Genik, Lara M.; McGuire, Brian E. & Symons, Frank J. (2020). Challenges in pain assessment and management among individuals with intellectual and developmental disabilities. Pain Reports. ISSN 2471-2531. 5(4). doi: 10.1097/PR9.0000000000000822. Show summary

  Introduction: Intellectual and developmental disabilities (IDD) include conditions associated with physical, learning, language, behavioural, and/or intellectual impairment. Pain is a common and debilitating secondary condition compromising functional abilities and quality of life. Objectives: This article addresses scientific and clinical challenges in pain assessment and management in individuals with severe IDD. Methods: This Clinical Update aligns with the 2019 IASP Global Year Against Pain in the Vulnerable and selectively reviews recurring issues as well as the best available evidence and practice. Results: The past decade of pain research has involved the development of standardized assessment tools appropriate for individuals with severe IDD; however, there is little empirical evidence that pain is being better assessed or managed clinically. There is limited evidence available to inform effective pain management practices; therefore, treatment approaches are largely empiric and highly variable. This is problematic because individuals with IDD are at risk of developing drug-related side effects, and treatment approaches effective for other populations may exacerbate pain in IDD populations. Scientifically, we are especially challenged by biases in self-reported and proxy-reported pain scores, identifying valid outcome measures for treatment trials, being able to adequately power studies due to small sample sizes, and our inability to easily explore the underlying pain mechanisms due to compromised ability to self-report. Conclusion: Despite the critical challenges, new developments in research and knowledge translation activities in pain and IDD continue to emerge, and there are ongoing international collaborations.

• Andersen, Randi D.; Nakstad, Britt; Jylli, Leena; Campbell-Yeo, Marsha & Anderzén-Carlsson, Agneta (2019). The complexities of nurses' pain assessment in hospitalized preverbal children. Pain Management Nursing. ISSN 1524-9042. 20, p. 337–344. doi: 10.1016/j.pmn.2018.11.060. Show summary

  Background: Preverbal children are at increased risk for underassessment of pain. Pain is a social transaction involving the child in pain and the nurse assessor. However, our understanding of the nurse’s part in this transaction is limited. Purpose: The aim of this study was to explore nurses’ assessment of pain in hospitalized preverbal children based on self-selected clinical examples. Methods: In this qualitative, descriptive design, 22 nurses from five different hospital units in Norway and Canada participated in individual, semi-structured interviews. All units had an observational pain scale for preverbal children available for use. Data were analyzed using inductive thematic analysis. Results: Nurses’ assessment of pain in hospitalized preverbal children emerged as a non-linear complex process incorporating different actions and reflections in response to the child’s situation and expression of distress. Information from parents was routinely included in the assessment, although further parental involvement varied considerably. While each assessment was personalized to the individual child, the nurse used previous experiences to interpret observations of and information from the child and the parents. Few nurses described using structured pain scales, but when used, these scales were included as only one aspect of their overall assessment. Conclusions: Nurses preferred pain assessment based on clinical judgment and tailored to the individual child. Implications: Implementation strategies that aim to integrate structured pain scales with clinical judgment to assess pain may be more likely to succeed. Further examination of this approach is warranted.

• Olsson, Emma; Anderzén-Carlsson, Agneta; Atladóttir, Sigridur Maria; Axelin, Anna; Campbell-Yeo, Marsha & Eriksson, Mats [Show all 11 contributors for this article] (2018). Cultural adaptation and harmonization of four Nordic translations of the revised Premature Infant Pain Profile (PIPP-R). BMC Pediatrics. ISSN 1471-2431. 1(349). doi: 10.1186/s12887-018-1322-5.
• Andersen, Randi D.; Munsters, Josanne M. A.; Vederhus, Bente Johanne & Gradin, Maria (2018). Pain assessment practices in Swedish and Norwegian neonatal care units. Scandinavian Journal of Caring Sciences. ISSN 0283-9318. 32(3), p. 1074–1082. doi: 10.1111/scs.12553. Show summary

  Background: The use of measurement scales to assess pain in neonates is considered a prerequisite for effective management of pain, but these scales are still underutilised in clinical practice. Aim: The aim of this study was to describe and compare pain assessment practices including the use of pain measurement scales in Norwegian and Swedish neonatal care units. Methods: A unit survey investigating practices regarding pain assessment and the use of pain measurement scales was sent to all neonatal units in Sweden and Norway (n = 55). All Norwegian and 92% of Swedish units responded. Results: A majority of the participating units (86.5%) assessed pain. Swedish units assessed and documented pain and used pain measurement scales more frequently than Norwegian units. The most frequently used scales were different versions of Astrid Lindgren’s Pain Scale (ALPS) in Sweden and Echelle Douleur Inconfort Noveau-Ne (EDIN), ALPS and Premature Infant Pain Profile (PIPP) in Norway. Norwegian head nurses had more confidence in their pain assessment method and found the use of pain measurement scales more important than their Swedish colleagues. Conclusion: The persisting difference between Swedish and Norwegian units in pain assessment and the use of pain measurement scales are not easily explained. However, the reported increased availability and reported use of pain measurement scales in neonatal care units in both countries may be seen as a contribution towards better awareness and recognition of pain, better pain management and potentially less suffering for vulnerable neonates.

• Andersen, Randi D.; Axelin, Anna; Kristjansdottir, Gudrun & Eriksson, Mats (2017). PEARL - Pain in early life: A new network for research and education. Journal of Perinatal & Neonatal Nursing. ISSN 0893-2190. 31(2), p. 91–95. doi: 10.1097/JPN.0000000000000257.
• Andersen, Randi D.; Langius-Eklöf, Ann; Nakstad, Britt; Bernklev, Tomm & Jylli, Leena (2017). The measurement properties of pediatric observational pain scales: A systematic review of reviews. International Journal of Nursing Studies. ISSN 0020-7489. 73(August), p. 93–101. doi: 10.1016/j.ijnurstu.2017.05.010. Show summary

  Background: Valid observational pain scales are needed to assess pain and ensure sufficient treatment of pain in children that lack the verbal ability to self-report pain. Published reviews attempt to synthesize results from primary studies validating these scales and based on the findings recommendations may be given, for example which pain scales are the most appropriate for use in different pediatric populations. Objectives: The aims of this review were to describe how systematic reviews have evaluated and recommended observational pain scales for use in children aged 0–18 years and appraise the evidence underlying these recommendations. Design: Systematic review of reviews. Data sources: The Cochrane Library, PubMed/MEDLINE, CINAHL, Web of Science, and PsychINFO were searched from inception to September 2016. Reference lists and gray literature were searched for additional studies. Review methods: Study selection and data extraction were performed by two reviewers independently with a disagreement procedure in place. Methodological quality or study validity was measured using the Assessment of Multiple Systematic Reviews (AMSTAR) checklist and risk of bias or internal validity was measured using the Risk of Bias in Systematic Reviews (ROBIS) tool. The review protocol was registered with PROSPERO: registration number CRD42016035264. Results: Twelve reviews met the inclusion criteria. Together; they included 65 different observational pain scales for use in children, of which 28 were recommended at least once. Face, Legs, Activity, Cry, Consolability (FLACC)/revised version of Face, Legs, Activity, Cry, Consolability (rFLACC), COMFORT/COMFORT behavioral scale and Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) were evaluated and recommended most frequently. Few of the included reviews assessed the methodological quality of the studies included in the review. The narrative analysis consisted mostly of a reiteration of the results from the primary studies. In general, more recent reviews showed a lower risk of bias than older ones. Conclusions: Included reviews exhibited low quality of evidence; thus, their recommendations regarding pain scales for use in clinical practice or research with children that lack the verbal ability to self-report pain should be interpreted with caution.

• Anand, Kanwaljeet J; Eriksson, Mats; Boyle, Elaine; Avila-Alvarez, Alejandro; Andersen, Randi D. & Sarafidis, Kosmas [Show all 22 contributors for this article] (2017). Assessment of Continuous Pain in Newborns admitted to NICUs in 18 European Countries. Acta Paediatrica. ISSN 0803-5253. doi: 10.1111/apa.13810. Show summary

  Aim: Continuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown. Methods: A prospective cohort study in 243 Neonatal Intensive Care Units (NICUs) from 18 European countries recorded frequency of pain assessments, use of mechanical ventilation, sedation, analgesia, or neuromuscular blockade for each neonate upto 28 days after NICU admission. Results: Only 2113/6648 (31·8%) of neonates received assessments of continuous pain, occurring variably among tracheal ventilation (TrV, 46·0%), noninvasive ventilation (NiV, 35·0%), and no ventilation (NoV, 20·1%) groups (p<0·001). Daily assessments for continuous pain occurred in only 10·4% of all neonates (TrV: 14·0%, NiV: 10·7%, NoV: 7·6%; p<0·001). More frequent assessments of continuous pain occurred in NICUs with pain guidelines, nursing champions, and surgical admissions prompted (all p<0·01), and for newborns <32 weeks gestational age, those requiring ventilation, or opioids, sedatives-hypnotics, general anesthetics (O-SH-GA) (all p<0·001), or surgery (p=0·028). Use of O-SH-GA drugs increased the odds for pain assessment in the TrV (OR:1·60, p<0·001) and NiV groups (OR:1·40, p<0·001). Conclusion: Assessments of continuous pain occurred in less than one-third of NICU admissions, and daily in only 10% of neonates. NICU clinical practices should consider including routine assessments of continuous pain in newborns.

• Carbajal, Ricardo; Eriksson, Mats; Courtois, Emilie; Boyle, Elaine; Avila-Alvarez, Alejandro & Andersen, Randi D. [Show all 22 contributors for this article] (2015). Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study. The Lancet Respiratory Medicine. ISSN 2213-2600. 3(10), p. 796–812. doi: 10.1016/S2213-2600(15)00331-8.
• Ulveseter Lode, Ingrid; Andersen, Randi D. & Eriksson, Mats (2015). Bruk av hud-mot-hud-kontakt i norske nyfødt intensivavdelinger. Sykepleien Forskning. ISSN 1890-2936. p. 152–160. doi: 10.4220/Sykepleienf.2015.54359.
• Andersen, Randi D.; Bernklev, Tomm; Langius-Eklöf, Ann; Nakstad, Britt & Jylli, Leena (2015). The COMFORT behavioural scale provides a useful assessment of sedation, pain and distress in toddlers undergoing minor elective surgery. Acta Paediatrica. ISSN 0803-5253. 104(9), p. 904–909. doi: 10.1111/apa.13045. Show summary

  Aim: The COMFORT behavioural scale was developed to assess sedation, pain and distress in children unable to report pain. Our aims were to test construct validity of the scale in toddlers undergoing minor surgery and determine the inter-rater reliability of the scale. Methods: We consecutively enrolled 45 children aged 12–36 months from a Norwegian surgical outpatient care unit. The level of sedation, pain and distress was assessed before and after surgery with the COMFORT behavioural scale. Inter-rater reliability was estimated and construct validity was tested based on a priori defined hypotheses. A 2.5-point (15%) change in the scale was considered clinically important. Results: We obtained 307 scores covering most of the scale’s range, but a floor effect was clearly present. Inter-rater reliability was high between assessors (intraclass correlation coefficient = 0.96; 95% CI 0.92–0.98). Clinically important differences were seen between baseline and light sedation (3.1 points, p < 0.001) and between light and deep sedation (4.6 points, p = 0.002). The difference between baseline and our definition of a pain/distress state was not clinically important (1.5 points, p = 0.039). Conclusion: The COMFORT behavioural scale can provide one aspect of an overall clinical assessment of sedation, and probably pain and distress, in toddlers before and after surgery.

• Andersen, Randi D.; Jylli, Leena & Ambuel, Bruce (2014). Cultural adaption of patient and observational outcome measures: A methodological example using the COMFORT behavioral rating scale. International Journal of Nursing Studies. ISSN 0020-7489. 51(6), p. 934–942. doi: 10.1016/j.ijnurstu.2013.10.006.
• Olsson, Emma; Andersen, Randi D.; Axelin, Anna; Jonsdottir, Rakel B; Maastrup, Ragnhild & Eriksson, Mats (2012). Skin-to-skin care in neonatal intensive care units in the Nordic countries: a survey of attitudes and practices. Acta Paediatrica. ISSN 0803-5253. 101(11), p. 1140–1146. doi: 10.1111/j.1651-2227.2012.02802.x.
• Andersen, Randi D.; Greve-Isdahl, Margrethe & Jylli, Leena (2007). The opinions of clinical staff regarding neonatal procedural pain in two Norwegian neonatal intensive care units. Acta Paediatrica. ISSN 0803-5253. 96. doi: 10.1111/j.1651-2227.2007.00190.x.

View all works in Cristin

• Henriksen, Ben Tore; Andersen, Randi D.; Krogseth, Maria; Mathiesen, Liv; Davies, Maren Nordsveen & Andersson, Yvonne (2022). 5PSQ-003 Development and applicability of the MedHipPro-Q: a questionnaire assessing medical doctors’ experience with medication management in the hip fracture patient pathway.
• Andersen, Randi D. (2021). This is not the end: a long-awaited update of the definition of pain. Paediatric and Neonatal Pain. ISSN 2379-5824. 3(3), p. 99–100. doi: 10.1002/pne2.12058.
• Andersen, Randi D.; Genik, Lara; Alriksson-Schmidt, Ann I.; Anderzén-Carlsson, Agneta; Burkitt, Chantel & Bruflot, Sindre Klakegg [Show all 15 contributors for this article] (2021). Pain burden in children with cerebral palsy (CPPain) survey: Study protocol. Paediatric and Neonatal Pain. ISSN 2379-5824. doi: 10.1002/pne2.12049. Show summary

  Pain is a significant health concern for children living with cerebral palsy (CP). There are no population‐level or large‐scale multi‐national datasets using common measures characterizing pain experience and interference (ie, pain burden) and management practices for children with CP. The aim of the CPPain survey is to generate a comprehensive understanding of pain burden and current management of pain to change clinical practice in CP. The CPPain survey is a comprehensive cross‐sectional study. Researchers plan to recruit approximately 1400 children with CP (primary participants) across several countries over 6‐12 months using multimodal recruitment strategies. Data will be collected from parents or guardians of children with CP (0‐17 years) and from children with CP (8‐17 years) who are able to self‐report. Siblings (12‐17 years) will be invited to participate as controls. The CPPain survey consists of previously validated and study‐specific questionnaires addressing demographic and diagnostic information, pain experience, pain management, pain interference, pain coping, activity and participation in everyday life, nutritional status, mental health, health‐related quality of life, and the effect of the COVID‐19 pandemic on pain and access to pain care. The survey will be distributed primarily online. Data will be analyzed using appropriate statistical methods for comparing groups. Stratification will be used to investigate subgroups, and analyses will be adjusted for appropriate sociodemographic variables. The Norwegian Regional Committee for Medical and Health Research Ethics and the Research Ethics Board at the University of Minnesota in USA have approved the study. Ethics approval in Canada, Sweden, and Finland is pending. In addition to dissemination through peer‐reviewed journals and conferences, findings will be communicated through the CPPain Web site (www.sthf.no/cppain), Web sites directed toward users or clinicians, social media, special interest groups, stakeholder engagement activities, articles in user organization journals, and presentations in public media.

• Andersen, Randi D. (2020). To know where we came from. Paediatric and Neonatal Pain. ISSN 2379-5824. 2(2), p. 20–21. doi: 10.1002/pne2.12032.
• Andersen, Randi D.; Barney, Chantel; Sheriko, Jordan; Bruflot, Sindre Klakegg; Andersen, Guro Lillemoen & Ramstad, Kjersti [Show all 8 contributors for this article] (2019). Pain Burden in Young People with Cerebral Palsy. Show summary

  Background/Objectives: To describe a multinational survey we are conducting to explore and describe the pain burden in young people 0-18 years with cerebral palsy (CP) Description: Pain is the most common co-morbidity in pediatric CP. Unrelieved pain is an important health issue associated with limitations in performing normal daily activities, decreased social participation, mental health problems, sleep problems, and decreased health-related quality of life. The pain burden of an individual is a combination of the pain he/she is experiencing and its influence on all aspects of life. Pain in pediatric CP is undermanaged and there is an urgent need for change in clinical practice. Still, intervention and treatment studies in pediatric CP are mostly lacking. To devise targeted interventions with a real potential for diminishing pain and pain related suffering in this vulnerable pediatric population more knowledge regarding the pain burden these children encounter is needed. To address the issue, we are conducting a multinational survey of three cohorts in Norway, Minnesota, and Atlantic Canada respectively. The Norwegian cohort will be recruited from participants in the Cerebral Palsy Register of Norway, with a national coverage of >90%. The American and Canadian cohorts will be recruited from the patient populations at key treatment facilities (IWK Health Centre in Halifax and Gillette Children’s Specialty Healthcare in Minnesota). Parental proxy report will be collected for all participants in addition to self-report from young people > 8 years of age and cognitively able to self-report. A stakeholder meeting of international colleagues from diverse backgrounds including nursing, physiotherapy, psychology, special education, medicine, and the patient voice, reached consensus on survey constructs and a set of published and previously validated measures. These measures address aspects of pain, pain impact, pain management, daily activities and functioning, participation, mental health, and health-related quality of life. The team members beyond their different professional backgrounds brought a variety of experience and perspectives that strengthened the discussion. The survey is part of the CPPain-Project. CPPain has a prospective cohort comparative design and will include before and after measurements and process evaluation of a nested intervention. The objective of the CPPain-project is to include young people with CP and their parents, who have the best knowledge of the young person’s pain burden, as key players in describing the problem, devising and implementing solutions, and evaluating treatment effects in close collaboration with researchers, health care providers and professional caretakers. This multinational survey will be the first component of a multi-step process towards the development of patient-centered interventions to reduce pain burden in young people with CP. Significance: We expect this project to result in in-depth knowledge of the pain burden in young people with CP. There is a need for better international estimates of pain prevalence, pain burden and of pain predictors in this population. As pain is a subjective and personal experience, aspects of pain burden are difficult to evaluate in others. A better understanding of similarities and differences between self- and parent-reported pain and pain burden in children and adolescents with CP is needed. The knowledge generated through this survey is required to develop targeted pain-diminishing interventions in this vulnerable group of children with CP.

• Andersen, Randi D. (2017). Can we trust observational pain assessment scales for use in children.
• Andersen, Randi D.; Jylli, Leena; Langius-Eklöf, Ann; Bernklev, Tomm & Nakstad, Britt (2018). Do you see my pain? Aspects of pain assessment in hospitalized preverbal children. Karolinska Institutet. ISSN 978-91-7831-015-9. Show summary

  Background and aim: Pain in hospitalized preverbal children is underassessed and undermanaged. According to the Social Communication Model of Pain, pain is both a personal experience and a social construction, influenced not only by the child in pain, but by the observer and the context. Nurses’ pain assessment is biased towards underestimation. The use of structured pain scales is strongly advocated, but pain scales have been difficult to implement into clinical practice. To improve clinical pain assessment and reduce unnecessary pain for hospitalized preverbal children, a better understanding of aspects concerning these scales is needed, and nurses’ views regarding clinical pain assessment and their understanding and practical use of structured pain scales need to be further explored. The overall aim of this thesis was to contribute to knowledge regarding how to reduce unnecessary pain and suffering in hospitalized preverbal children by exploring aspects that influence nurses' assessment of pain in the clinical setting. Material and Methods: This PhD thesis consists of four different studies using both qualitative and quantitative methods. In study I the COMFORT behavioral scale was translated into Norwegian using the forward-back-translation method and culturally adapted in 12 cognitive interviews with clinicians who would later be using the scale in clinical practice. The translated scale’s responsiveness to change and inter-rater reliability were tested in study II, based on repeated measurements from 45 preverbal children before and after minor outpatient surgery. Study III was a systematic review appraising the evidence underlying the recommendations presented in 14 systematic reviews on the measurement properties of observational pain scales. Study IV was a semi-structured interview study with 22 nurses in Norway and Canada and examined their pain assessment practices based on self-selected clinical examples. Results: Cognitive interviews identified several problems with the content validity of the Norwegian and original versions of the COMFORT behavioral scale. The responsiveness of the translated version was supported for assessment of sedation, but not for assessment of pain/distress. Scale recommendations given in systematic reviews addressing the measurement properties of observational pain scales had low evidence value and should be interpreted with caution. Observational pain scales were infrequently used in clinical practice and pain scores were not considered pain –specific. Instead; nurses expressed strong preferences for pain assessment based on clinical judgment and individually tailored to the child and the situation. When assessing pain, nurses combined experience-based and childspecific knowledge with one or more specific strategies to interpret observations of and information from the child. Described strategies included identifying a probable cause for pain, eliminating other sources of distress, evaluating behavioral change and/or effect of interventions on behavior, using a personal and contextual approach, and using behavioral pain scores. Conclusions: A preverbal child’s pain will probably be better seen, evaluated and managed if nurses apply a systematic and comprehensive assessment approach that integrates clinical judgement and structured pain scales.

View all works in Cristin