Literature review: Pain Assessment in Cognitively Impaired Children

McJunkins, A., Green, A., & Anand, K. J. S. (2010). Pain assessment in cognitively impaired, functionally impaired children: pilot study results [Clinical practice column M. D. Gordon, (Ed.)]. Journal of Pediatric Nursing, 25(4), 307-309. doi:10.1016/j.pedn.2008.09.006

This article provides insight into methods that are more suited for the assessment of pain in children with cognitive impairment. It is guided on a clearly stated purpose, which is to make a comparison of four pain assessment tools – Visual Analogue Scale (VAS), Modified Objective Pain Scale (MOPS)  used in highlighting acute pain in cognitively impaired children; CIC. This follows a brief review of literature that provides a background to the study. Subsequently, the authors narrow down the purpose to two specific aims that their study will address. Firstly, they sought to evaluate how pain scores as obtained by tools that were developed for CIC clients compare with scores obtained using tools that were designed for use in the general population. Secondly, they sought to compare assessments of pain as provided by the nurse and parent. Since the study was not aimed to assess pain as a function of painful procedures performed, no relationships that elucidated dependent and independent variables were evident.

The study design is a quantitative one. The identification of the design was based on various criteria. Firstly, the researchers used scales to collect empirical data, the intent being to test the theory envisaged in the scale. Secondly, the basic element of analysis is numbers (a rating of pain as assessed using the various scales under examination) and statistical assays (indicating levels of pain that the scores identify; e.g. moderate and severe). Thirdly, the study uses a deductive approach, inferring implications from trends that the data reveals.

The article is from a peer-reviewed journal. This information is available in the journal’s website, journal information section, author information sub-section. From this section the review process, which includes sending manuscripts to two expert reviewers, and the process being guided by scoring criterion developed beforehand, is highlighted. The credibility of the article is reinforced further by qualifications of the authors and the editor for the column it is published in, a registered nurse holding a doctorate academic qualification. The article offers support for evidence-based practice. Despite the small sample used, which could prevent generalization of the results, the study showed that a scale developed specifically for children with cognitive impairment, revealed various “pain” behaviors that were not revealed by other general assessment scales.

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