Author:
Susan Eaton St. Jean,
B.S.N.
Children experience pain, although their behavioral cues may be subtle and not interpreted accurately by adults. They are able to describe their pain, and developmentally appropriate tools can assist children rating their pain. The purpose of this descriptive comparative study was to compare the levels of perceived pain intensity, as measured by three pain assessment instruments, to the standard stimulus of venipuncture. Research questions also considered the differences between pain intensity among ages. Within the 6-10 year age group, and whether differences in the instruments depended upon differences in the age of the children.
The subjects were 25 children who required venipuncture for blood samples in the hospital outpatient/admitting area, and were not experiencing any other pain. Following venipuncture by hospital personnel, the investigator asked the children to rate the intensity of perceived pain during venipuncture, using three pain assessment tools: visual analogue scale, Faces Scale and Poker Chip Tool. Parents were asked to complete a form to collect demographic data.
Descriptive analysis of the pain intensity scores for 26 venipunctures was done for the three pain instruments, and cross-tabulation of scores with age level was shown. Children were divided into older and younger age groups, using the median age of the sample, which was 7.5 years. Differences in pain ratings among the instruments and among the ages within the 6-10 year olds were compared by analysis of variance and Spearman Rho correlation. The instruments were converted to 5-point ordinal level of measurement for some analyses.
Findings showed that in this sample there was a full range of responses to the standard stimulus of venipuncture, from no pain to severe pain. The pain responses within each child were highly correlated among the 3 instruments. Analysis showed a trend for girls to perceive the pain as more intense than the boys. The analysis showed no differences in responses on individual instruments, based on age of the children, although the mean VAS rating was lower in the older age group. Findings within each child across instruments suggest that children's responses may become more consistent among instruments as age increases. The intensity of pain responses varied according to the child's previous venipuncture experience, in addition to who performed the venipuncture.
Recommendations for further study include obtaining a larger sample, having one person perform all the venipunctures, and limiting comparison to scales of ordinal measurement for improved consistency of data analysis.
The results of this study have implications for nursing practice, by emphasizing the value of self-report when nurses assess children's pain, and promoting the use of appropriate pain assessment tools to supplement observation of behavioral cues This study may sensitize nurses by providing information about the child's perception of venipuncture, a stimulus commonly performed during hospitalization, and how pain perception may vary with age, developmental level, gender, and previous experience of the child.
Submitted to the School of Nursing of West Virginia University
In Partial Fulfillment of the Requirements for The Degree of Master of Science in Nursing (Morgantown, West Virginia, 1994)
March 15, 2002
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