Authors:
Lynn B. Clutter, MSN, RN,
C, CNS
Donna L. Wong, PhD, RN, FMN
Victoria Keller
Amy Baker
Lefkowicz
This study investigated the influence of two types of instruction, the original set and an abbreviated word set, on 4- and 5-year old children's ability to use the FACES to rate the intensity of injection pain. To provide evidence of the instrument's construct validity, the two set of instructions were used pre- and post injection to determine if children's pain scores differed significantly.
The study was an experimental repeated measures with a control group design. The subjects were randomized either to the original or the abbreviated word instruction group. A convenience sample was comprised of 148 children ages 4 to 5 years who received an injected vaccine. There were 56 four-year old and 92 five-year old subjects. Of the total sample 58 were males. Before data collection, the tester randomly assigned prospective subjects to Group 1 (n=80; mean age 59.8 months) to receive the original instructions or to Group 2 (n=68; mean age 61.7 months) to receive the abbreviated word instructions. The abbreviated word instructions had the following words under the facial expression: FACE 0: no hurt; FACE 1: hurts little bit; FACE 2: hurts little more; FACE 3: hurts even more; FACE 4: hurts whole lot; FACE 5: hurts worst. Before and after the injection, the child was asked, "Which face shows how much hurt you have now?"
The results of ANOVA indicated that age and sex had no significant influence on pain rating scores. Because very few nonwhite children were tested, the effect of race was not considered. T-tests were performed on the mean pre scores, the mean post-scores, and the mean post minus the pre-scores for the two groups. All differences in the corresponding mean values were found to be insignificant with calculated t values equal to or less than 0.93. The analysis indicated that the Wong-Baker FACES Pain Rating Scale with words under the faces provided sufficiently clear instruction for 4- to 5 year-old children to use the scale successfully for rating pain intensity. To determine known-groups validity, confidence intervals were calculated. The mean post-injection score was significantly higher than the mean pre-injection score based on 95% confidence intervals for Group 1 (1.132 to 2.018) and for Group 2 (1.204 to 2.267). These values, which do not include zero, indicate that there were significant differences between the mean pre-pain score and mean post-pain score in both groups.
March 15, 2002
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