Authors:
Juanita F. Keck, DNS,
RN
Janis Gerkensmeyer, MSN, RN
Betsy Joyce, EdD, RN
Julia Schade, DNS,
RN
Indiana University School of Nursing
It is well documented that children receive inadequate intervention for pain (Beyer et. al, 1983; Burokas, 1985; Gadish et al, 1988; Schecter et al, 1986). Systematic assessment of pain has been shown to contribute to improved pain management by improving the communication of need for pain intervention (Faries et al., 1991, McMillan et al., 1988, Paice et al., 1991). Documentation requires valid and reliable tools to measure pain intensity. In addition, the tools need to be liked by nurses and present a low degree of nurse and patient burden in terms of ease of administration and scoring plus degree of effort required of the children when responding to the scales.
Two instruments were identified which met the criteria for nurse preference and low burden, the FACES scale and a verbal descriptor scale (Wong and Baker, 1988). The psychometric properties of the two scales had been inadequately supported, however. The purpose of this research was to assess test-retest reliability and discriminant and concurrent validity of the instruments among children undergoing painful procedures and to assess patient preference for the instruments. One-hundred-eighteen children participated in the study, 83% of whom experienced venipuncture-produced pain. Fifty nine (50.4%) were male, 58 (49.6%) were female. A visual analogue scale with verbal descriptor guides and a numerical scale, both with known reliability and validity when used with pediatric populations, were used to determine concurrent validity. Concurrent validity was supported by moderate to high, significant correlations between the instruments ranging from r=.63 to .94 (mean r=.82). Discriminant validity was determined by correlating pain intensity scores obtained prior to the painful procedures with those obtained while the children experienced pain. Discriminant validity was supported by low, non-significant correlations between the two testing situations (range of absolute r values = .04 to .23; mean r=.1). Test-retest reliability was determined by the correlation of pain intensity measured 15 minutes apart. Test-retest reliability was supported by high correlations between the two testing times for both experimental scales. Pearson r values ranged from .83 to .95 (mean r = .91).
There is concern that ability to utilize the instruments may vary by age of the child. Therefore, children were divided into three age groups according to Piaget's developmental levels: pre-operational, 3-7 years old (N=37); concrete operations, 8-12 (N=42); and fully operational, 13 to 18 (N=36). Validity and reliability were supported for all three groups.
The FACES scale was the most often preferred (N=69 or 59% for total sample, 83% aged 3-7; 65 % aged 7-12; 47% aged 13 to 18). The VAS was the least preferred by all age groups. The 13-18 year olds preferred the numerical and word descriptor scales in similar numbers (23% vs 20%).
No significant differences in any of the scales were found for sex or age of the children.
The FACES and word descriptor instruments appear be valid and reliable instruments for measuring pain intensity among verbal children with procedural pain across the three developmental levels of cognitive development.
The study was funded by Sigma Theta Tau, Alpha Chapter and the Indiana University School of Nursing Project Development Program grant.
See also: Keck: Reliability and Validity of the Faces and Word Descriptor Scales to Measure Procedural Pain
March 15, 2002
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