Articles: pain-measurement.
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Comparative Study
Neonatal Facial Coding System for assessing postoperative pain in infants: item reduction is valid and feasible.
The objectives of this study were to: (1). evaluate the validity of the Neonatal Facial Coding System (NFCS) for assessment of postoperative pain and (2). explore whether the number of NFCS facial actions could be reduced for assessing postoperative pain. ⋯ This study demonstrates that the NFCS is a reliable, feasible, and valid tool for assessing postoperative pain. The reduction of the NFCS to 5 items increases the specificity for pain assessment without reducing the sensitivity and validity for detecting changes in pain.
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As part of a multisite study funded by the Agency for Healthcare Research and Quality, the medical records of older adults with a hip fracture were abstracted for acute pain assessment and treatment practices. Of the 709 records reviewed, 8 patients did not have an opioid administered during the first 72 hours after admission to a non-intensive patient care unit. Using a case study approach, this article examines demographic characteristics, pain assessment, and analgesic administration for these 8 patients to illustrate specific practice problems that occur in managing acute pain in older adults. ⋯ The medical records of these hip fracture patients indicate that acute pain was underassessed and undertreated. Provision of quality pain management will require that nurses address the specific practice behaviors identified in the article and correct problems where they exist. Key strategies that can be used to improve pain management practices include implementation of standardized assessment tools and pain flow-sheets, audit and feedback of pain management data with staff, use of pain management opinion leaders and change champions, and incorporation of research-based pain management practices into performance-evaluation criteria.
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The objective of this study was too determine if patients can accurately read a visual analog scale (VAS) for pain. A 100-mm visual analog pain scale designed for patient use was printed on the top page of carbonless copy paper with a perfectly aligned hatched scale on the second (bottom) page. Patients over the age of 18 in acute pain were enrolled in this prospective, descriptive study. ⋯ One hundred thirty-eight (95.2%) read their VAS within +/-2 mm of physician readings. Ninety-five percent of patients are able to read a VAS within +/-2 mm of physician readings. The data suggests this instrument could be used by discharged patients in longitudinal pain studies or with help in management of chronic pain.
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J Pain Symptom Manage · Nov 2003
The problem of assessment bias when measuring the hospice effect on nursing home residents' pain.
This study examined the observed differential documentation of pain on nursing home (NH) resident assessments (minimum data sets [MDS]) when dying residents were and were not enrolled in hospice. We studied 9,613 NH residents who died in 6 states in 1999 and 2000. ⋯ However, hospice residents were twice as likely as non-hospice residents and 1.3 times as likely as residents who eventually enrolled in hospice to have pain documented. These counterintuitive findings suggest that there is differential documentation of pain on the MDS when hospice is involved in care, perhaps because of superior pain assessment by hospice.
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Because of the importance of pain assessment to understanding the nature and scope of pain problems, and for testing the efficacy of pain treatments, new pain measures are frequently developed. Research that describes the development and evaluation of pain measures should include detailed information concerning the validity and reliability of the measures. However, for the findings from this research to be most useful, the consumers of this research (clinicians and researchers who use pain measures) should understand the concepts of validity and reliability, and the procedures used for evaluating these in pain assessment research. The purpose of this commentary is to provide a summary of these psychometric issues, using the study and findings of Krause and Backonja as an illustrative example of the concepts.