The Development of a Measurement Tool FLACC Scale - Essay Example

EVALUATE THE DEVELOPMENT OF A MEASUREMENT TOOL FLACC SCALE Introduction The FLACC scale was developed by Sandra Merkel, MS, RN, Terri Voepel-Lewis, MS, RN, and Shobha Malviya, MD, at C. S. Mott Children’s Hospital, in the University of Michigan Health System, and Ann Arbor, MI. The research was intensively undertaken by the department of Anesthesiology. The FLACC scale is diverse with the one included in the metathesaurus which does not manifest completely of the original source extracted from the LOINC. In persons who lack the ability of freely communicating, the FLACC scale is used as a behavioral scale to assist in scoring a postoperative pain among children aged between two months to seven years. The scale was developed to compensate the complex and more tasking assessment scales by providing a simple dimension for undertaking any assessment (Nilsson, Finnström & Kokinsky, 2008). In addition to the simple framework it provides, the scale also provides a reliable means and clear objective over which the pain behaviors in children who cannot communicate are quantified. They are able to perform such exercises using five classes of tool behaviors that ranges from expressions in the face, movements of the legs, any bodily activity, and cry and consol ability. LOINC release files are the files from which Metathesaurus as a representation of FLACC scale is extracted from to be used by nurses and all the other categories of health officers in the healthcare industries. The paper is, therefore, designed to evaluate the development of the FLACC scale which is a measurement scale used to detect pain in children who are not able to communicate, hence, saving time in finding and elimination pain and as a result resulting into efficiency and effectiveness in hospital operations (Aday, Begley, Lairson & Balkrishnan, 2004). Description of the FLACC Scale A FLACC scale is a measurement tool that is sued to assess pain in children aged between ages of 2 months and 7 years. Such are individuals who are believed not to be in a position of communicating their pain level accurately making it difficult for doctors or health officers to administer treatment effectively. The scale has five criteria of measuring pain and these criteria are assigned scores 0, 1 or 2 and measure pain between scores 0 to 10 with 0 indicating no pain at all and 10 representing the maximum (Burns & Grove, 2009). Due to incubation, the scale has also been employed on adults in Intensive Care Units (ICU) to bring accurate results of pain experienced in adults who are maimed. Other scales which can be used in the ICU are the Checklist of Nonverbal Pain Indicator (CNPI) (Kane & Rodosevich, 2011). In a critical healthcare sector some investigators have tried evaluating the FLACC scale with the sole objective of trying to assess the scale in terms of reliability and validity on pain detection on both adults and infants/children. The method used was that of identifying two nurses whom through independent observation on 10 critically ill adults/cannot communicate and on 5 children. Each of the doctors handled tow different scales on the patients, while one applied the FLACC scale and the other employed the CNPI selectively on the patients within a timeframe before administering analgesic and 15 minutes after the injection (Foster & Wolter-Warmerdam, 2011). Out of the 73 three observations made, FLACC scale scored highly with 2 scores of probability of 0.963 and 0.849 hence highly valid. Supporting construct validity of the tool, its significance decreases in the scale after the analgesic with a mean of 5.27 and SD of 2.3. An exact agreement of the coefficient correlation of between 0.69-0.95 indicates supports excellent reliability as the internal consistency is excellent while integrating all items. It can be generally concluded that when all the other pain behavioral scales are employed in measuring pain across all populations, the FLACC scale can still be the best to be employed in measuring pain between the scales 1-10 (Burns & Grove, 2009). Two research studies that use the measurement too Two research studies that employ the use of the FLACC scale identified are: “The FLACC: a behavioral scale for scoring postoperative pain in young children” and “The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment” (Manworren & Hynan, 2003). The former was to evaluate the reliability and validity of the FLACC pain assessment tool while incorporating the five criteria. It identifies 89 children aged between 0 months - 7 years with surgical procedures in post anesthesia care units. The scale was found to have high interrater reliability. Evidence on reliability was on the decreases depending on the amount of analgesics administered. Validity is supported through correlation whose scores are assigned by the Objective Pain Scale (OPS). The conclusion for this is that the FLACC scale gives a simple framework to quantify pain among infants hence the tool is both reliable and valid (Willis, Merkel, Voepel-Lewis & Malviya, 2003). The latter research employed its studies on children with CI scheduled for elective surgery. It evaluated the child’s ability to self report while two nurses scored pain before and after administering analgesics using the FLACC scale. 80 observations were recorded of patients aged between 4-19 years where interclass reliability was supported by excellent intraclass correlation coefficients ranging from 0.76 and 0.90 of ICC and adequate x statistics of 0.44-0.57. Correlations between FLACC scales supported validity. Hence in children with CI, reliability and validity was supported using the FLACC scale (Manworren & Hynan, 2003). How the research has contributed to the development and/or use of FLACC Scale The research works discussed and even more have contributed much in the development and use of the FLACC scale to measure pain. This is first because of the maim caused during pain infliction and the need to relieve individuals from pain. Critically ill patients are not able to give an accurate self report during pain as a result of changes in cognition or psychological state. The above inabilities have resulted into such patients being excluded from the clinical pain trials which leave the patients in a critical state of being vulnerable to under treatment of pain hence the need for the FLACC scale which facilitated its development. Their development is further fueled by the need for use of a simple yet valid and reliable observational tool to quantify pain in critical healthcare settings for the sake of adequate pain management (Merkel, 2002). Recommendations for the use of the tools The tools are important and should, therefore, be used in recognizing and quantifying pain. The sole reason behind the importance in the use of such tools is quite simple that it is reliable and valid (Hutson, 1993). Despite this, there are areas that require improvement like improving the pain management procedures. Other policy frameworks must also be improved like the hospital staff setting, developing and implementing a plan of action to reach the goal for pain relief. In addition the method required by a patient to manage pain must be adhered to as this is in line with the ethical standards of practice. The vibrancy over which pain is assessed and monitored in hospitals must be made more vibrant. It must also be noted that the method to be used on a patient while assessing pain depends on their age, criticality of the condition and the ability to understand (Merkel, Voepel-Lewis, Shayevitz & Malviya, 1997). Conclusion The key findings of the paper are the criticality of pain in hospitals and the inability of patients to present accurately the degree of pain for treatment. This condition prompted research to find a means to detect areas of pain and know the magnitude of which the FLACC scale is highly backed up (Hutson, 1993). The FLACC scale is simple and accurate and takes care of the hospitals’ officers’ respect for patients’ right to pain management, hence, improved efficiency and effectiveness in terms of pain management in community hospitals (Aday, Begley, Lairson & Balkrishnan, 2004). References Aday, L. A., Begley, C. E., Lairson, D. R., & Balkrishnan, R. (2004). Evaluating the healthcare system: Effectiveness, efficiency, and equity. Chicago, IL: Health Administration Press. Burns, N., & Grove, S. K. (2009). The practice of nursing research: Appraisal, synthesis, and generation of evidence (6th ed.). St. Louis, MO: Elsevier. Foster, R., & Wolter-Warmerdam, K. (2011). Pediatric nurses use of the FLACC pain scale: a Q.I. study. Communicating Nursing Research, 44487. Hutson, M. A. (1993). Back pain: recognition and management. Oxford: Butterworth- Heinemann. Kane, R., & Rodosevich, D. (2011). Conducting health outcomes research. Boston, MA: Jones and Bartlett Publishers. Manworren, R., & Hynan, L. (2003). Practice applications of research. Clinical validation of FLACC: preverbal patient pain scale. Pediatric Nursing, 29(2), 140-146. Retrieved from http://ehis.ebscohost.com.akin.css.edu/ehost/detail?sid=a8ec18d1-0faa-407d-ba36- f90cabf466ba%40sessionmgr14&vid=7&hid=121&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ %3d%3d#db=rzh&AN=2003134619 Merkel, S. (2002). Pain Assessment in Infants and Young Children: The FlACC Scale. American Journal of Nursing, 102(10), 55: http://ovidsp.tx.ovid.com.akin.css.edu/sp- Merkel, S., Voepel-Lewis, T., Shayevitz, J., & Malviya, S. (1997). Practice applications of research. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatric Nursing, 23(3), 293-297. Nilsson, S., Finnström, B., & Kokinsky, E. (2008). The FLACC behavioral scale for procedural pain assessment in children aged 5-16 years. Paediatric Anaesthesia, 18(8), 767-774. https://courses.css.edu/webapps/portal/frameset.jsp?tab_tab_group_id=_34_1 doi:10.1111/j.1460-9592.2008.02655.x Willis, M., Merkel, S., Voepel-Lewis, T., & Malviya, S. (2003). FLACC Behavioral Pain Assessment Scale: a comparison with the childs self-report. Pediatric Nursing, 29(3), 195-198. Read More