Authors:
Shirley J. Carey,
Ph.D.
Janis Whatley, M.S.
Carol Turpin, M.N.
Judy Smith, RN.
Crawford; Long Hospital of Emory University
To identify which of three pain intensity measurement scales is most appropriate for use with patients admitted to the inpatient units of the study hospital. Three questions were addressed: Is one of the scales easier for most parents? Is the choice of scales influenced by age, race, SES, diagnosis, or type of pain experienced? Do patients perceive that an intensity scale helps them describe their pain experience more effectively? Design: A four page questionnaire containing two visual analogue scales (VAS) and a cognitive number rating scale was used. One VAS contained a 100mm line; the other, six faces depicting graduated levels of distress (Wong & Baker, 1986). Each scale used a 0 (no pain) to 10 (worst pain possible) rating format.
JCAHO accredited, 536 bed, adult, general service hospital located in downtown Atlanta.
Patients (N=267) admitted over a three week period. Approximately half of the sample was black (55.2%), female (56.2%), reported 12 years or less formal education (52.6%), and married (49.8%). The mean age of patients was 49 with 31.6% over age 61. Stratification of the sample using the Four Factor Index of Social Status (Hollingshead, 1975) indicated 28.6% in the two highest strata, 18% in the third, 21.3% in the semiskilled, and 32% in the unskilled group. The primary admitting diagnosis for 39.5% of the sample reflected acute pain, 40.3% chronic pain, and 20.2% no pain.
Patient volunteers rated the intensity of pain using each of the three scales once over a 24 hour period. Information related to length of time between ratings, choice of preferred scale, views of the helpfulness of a rating format, whether the scales needed further explanation, as well as work, education, and diagnoses were obtained.
The scale selected most frequently as easier to use was the VAS containing faces (48.6%); followed by the number (35.3%) and line scales (16.1%). Statistical procedures using demographic information failed to provide insight into the choice of preferred scale. A majority (85.8%) indicated a rating scale as helpful in describing the pain experience to providers. The means for pain intensity ranged from 5.09 to 5.75. The interval between pain ratings for the majority (>71%) was less than two hours. Subjects tended to tell the nurse about their pain only when the intensity exceeded the midpoint of the scale. A reliability coefficient for the scales was computed at alpha=0.88.
Patients given pain intensity rating scales for describing their pain experience to providers found the instruments helpful; however most failed to report their pain until they perceived the pain to be increasing toward the worst possible pain end of the continuum. Patient education related to the goal of pain relief needs to be incorporated into the admission process. Further study with the VAS containing faces in the adult population is recommended as is the applicability of this VAS for assessment of pain relief in adult patients.
Shirley J. Carey, Director Nursing Research
Crawford Long
Hospital of Emory University
550 Peachtree St.
NE, Atlanta, GA. 30365
March 15, 2002
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