title: Development and validation of a virtual human vignette to compare nurses' assessment and intervention choices for pain in critically ill children.
abstract: BACKGROUND
  As virtual experiences are increasingly used in health care training and research, it is important that adequate processes are applied for developing valid scenarios. We describe the development and validation of virtual human (VH) vignettes, computer-generated scenarios with animated patients and clinical information, for a mixed-methods study regarding nurses' assessment and intervention choices for critically ill children's pain.
  
  
  METHODS
  We followed the case development and review process for high-fidelity simulation case scenarios, including the use of validated written vignettes and content experts. Forty nurses described their pain assessment and intervention choices for the newly derived VH vignettes and completed a pain questionnaire. Nurses' reports of VH vignette consistency with their professional experience and recognition of VH facial expressions were evaluated to establish face validity. Their pain ratings for the VH and written (questionnaire) vignettes were evaluated for convergent validity. Qualitative content analysis, descriptive statistics, correlations, and paired t tests were used.
  
  
  RESULTS
  Most nurses (68.4%) supported vignette consistency with their professional experience. Facial expression recognition was 98.4%. Smiling children's pain was rated significantly lower than grimacing children in both VH and written vignettes. Pain was rated significantly lower for grimacing children in the VH vignettes than the written vignettes. Virtual human vignette pain ratings were strongly correlated with their written counterparts.
  
  
  CONCLUSIONS
  This process was effective for developing VH vignettes that demonstrated good face validity with participants and convergent validity with written vignettes. Virtual human vignettes may be useful in studying the influence of facial actions on nurses' choices for children's pain assessment and treatment.
authors.affiliation: From the College of Nursing, University of Iowa (C.M.L.), Iowa City, IA; Center of Excellence for End-of-Life Transition Research, Department of Biobehavioral Science, College of Nursing, University of Iowa (D.J.W.), Department of Women, Children, & Family Health Science, College of Nursing, University of Illinois at Chicago (C.V.H.V.), Electronic Visualization Laboratory, Computer Science, University of Illinois at Chicago (A.J.), Department of Health Systems Science, College of Nursing, University of Illinois at Chicago (C.C., P.E.H., C.G.P.), Chicago, IL; and Computer Science, Connecticut College (S.L.), New London, CT.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: LaFond
authors.forename: Catherine
authors.initials: C
authors.lastname: Van Hulle Vincent
authors.forename: Sangyoon
authors.initials: S
authors.lastname: Lee
authors.forename: Colleen
authors.initials: C
authors.lastname: Corte
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Hershberger
authors.forename: Andrew
authors.initials: A
authors.lastname: Johnson
authors.forename: Chang G
authors.initials: CG
authors.lastname: Park
authors.forename: Diana J
authors.initials: DJ
authors.lastname: Wilkie
mesh_terms: D002648:Child; D002983:Clinical Competence; D003198:Computer Simulation; D003194:Computer-Assisted Instruction / Q000379:methods; D016638:Critical Illness / Q000451:nursing*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D015278:Intensive Care Units, Pediatric; D009741:Nursing Staff, Hospital; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods*; D012959:Socioeconomic Factors; D014584:User-Computer Interface