Abstract

Introduction
As virtual experiences are increasingly used in healthcare 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 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 employed.

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. VH 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. VH vignettes may be useful in studying the influence of facial actions on nurses’ choices for children’s pain assessment and treatment.

Keywords

• Vignettes
• Pediatric Intensive Care
• Pediatric Nurses
• Children’s Pain
• Sickle Cell Disease