Adolescent pediatric pain tool for multidimensional measurement of pain in children and adolescents.

Very few multidimensional tools are available for measurement of pain in children and adolescents. We critically reviewed the scientific literature to examine the psychometrics and utility of the Adolescent Pediatric Pain Tool (APPT), a multidimensional self-report tool that evaluates the intensity, location, and quality (including affective, evaluative, sensory, and temporal) dimensions of pain. The APPT is available in English and Spanish for children and adolescents, and was modeled after the McGill Pain Questionnaire in adults. We found good evidence for construct validity, reliability, and sensitivity of the APPT for the measurement of pediatric pain. The APPT was used to measure pain in children with different conditions, such as cancer, sickle cell disease, orthopedic, traumatic injuries, and allergy testing. Although the APPT was designed to assess the multiple dimensions of pain, the majority of the reports included results only for the intensity ratings. Unlike the numerical and pediatric faces rating scales, which are widely used in clinical practice and research, the APPT is not limited to the single dimension of pain intensity. It measures multiple dimensions, and may be able to discriminate between nociceptive and neuropathic pain. The APPT is one of a few multidimensional pain measures that can help to advance the science of pediatric pain and its management. When the APPT is used in practice or research, the multiple dimensions of pain may be characterized and compared in different painful conditions. It may guide the use of multimodal interventions in children and adolescents with a variety of pain conditions.

Pain experience in children with advanced cancer.

BACKGROUND: It is important for health care professionals to understand the pain experience in children with advanced cancer. There has been increased attention to this topic, but systematic studies are limited. OBJECTIVE: To examine pain symptoms and management in children with advanced cancer using child self-report and nurse documentation. METHODS: A prospective, longitudinal method was used to collect data from 62 children over a 5-month period. Children were English and Spanish speaking, ages 6 to 17 years, with advanced cancer. Nurses also provided data. RESULTS: Across all interviews, pain was reported 56% of the time by all children. Nurses documented pain only 23% of the time. Children most frequently reported head pain (31%), followed by abdomen, lower back, leg, and feet pain (20% to 30%). Children consistently reported more intense pain compared with nurses. Nonopioids were used more frequently (45%) than opioids (32%), and nurses' perception of pain intensity was more highly correlated with administration of opioids (r = .72, P < .001). Children who died during their participation in this study received more opioids over time. Pain intensity was relatively stable over time. Nurses noted ethnicity related differences with higher pain levels for Caucasian children, who received analgesics more frequently. DISCUSSION: The children consistently reported pain. Child self-report and nurse documentation of pain differed, as did pain management among children who died compared with those who did not. Ethnicity differences in the identification and management of pain by nurses begs further study. Overall, nurses were aware of and responsive to pain and pain management.

Symptoms in children with advanced cancer: child and nurse reports.

BACKGROUND: Systematic studies on the specific symptom experience in children with advanced cancer are limited. OBJECTIVE: The objective of the study was to examine the common symptoms and to explore commonly occurring symptoms over time. METHODS: A prospective and longitudinal study design was used. Data were collected at 10 data points from 60 children over a 5-month period. Children ranged from 6 to 17 years old, spoke English or Spanish, were diagnosed with advanced cancer, and were receiving healthcare in 1 of 4 Southern California hospitals. Nurses' documentations of symptoms were examined. RESULTS: The study sample was composed of children 6 to 12 years old (52%) and 13 to 17 years old (48%); 42% were female, and 58% were male. Fifty-five percent were Latino, and 30% were Caucasian. Pain, nausea, drowsiness, and energy loss were reported by children in more than 50% of the interviews. Children's and nurses' reports of symptoms were similar except children reported significantly more frequency and intensity of pain. CONCLUSION: Children with advanced cancer were able to report and describe their symptoms. There were few differences by gender, age, and ethnicity. IMPLICATIONS FOR PRACTICE: It is important that children's symptoms are clearly communicated to nurses, and these study findings may be used to anticipate and manage the symptoms experienced by children with advanced cancer.

A glimpse into the lives of 3 children: their cancer journey.

Three stories of children with advanced cancer are presented in this article. The goal was to ascertain what these children were experiencing and thinking as well as what interventions were helpful. Interviews used open-ended questions as well as the Memorial Symptom Assessment Scale, Symptom Management Record, the Body Outline, Child Depression Inventory, Revised Children's Manifest Anxiety Scale, Pediatric Quality of Life Inventory, Common Toxicity Criteria, Lansky's Play Performance Scale, and Spirituality quality of life (QOL) and provided an opportunity for the children to describe their symptoms and QOL. The findings illustrated that the child's social, psychological, and spiritual concerns are important for nurses to address along with the child's physical needs.

Children with advanced cancer: responses to a spiritual quality of life interview.

PURPOSE: The purpose of this study was to describe the responses of children with advanced cancer to a spiritual quality of life (SQL) interview. DESIGN AND METHODS: Sixty children, ages 6-17, responded to an SQL interview every 2 weeks, for 5 months. The questionnaires were analyzed using content analysis. RESULTS: Children's responses were primarily relational in nature, particularly to their parents. Seventy-eight percent of the interviewees reported they did something to "feel close to God." Children prayed for a "sense of normalcy" (59%) and relational concerns (31%). PRACTICE IMPLICATIONS: Children's care will be enhanced when given the opportunity to express their spiritual and relational concerns.

A bold adventure in innovation: an international off-campus master's degree program.

In response to the global shortage of nursing faculty, Loma Linda University School of Nursing offered an off-campus master's degree program to prepare nurse educators who would commit to remain in their home countries following graduation. The program was approved by the Western Association of Schools and Colleges to be offered in both English and Spanish. Students and faculty met for 1 month each year for 4 years at one of two international sites: Thailand or Argentina. Forty-five of 49 students completed the program. The cultural diversity in both cohorts enriched classroom discussions, social interaction, and student-faculty conversations. The program was a life-changing experience for all involved and helped to meet the global need for nursing faculty. The faculty reported that it broadened their world view and opened their minds to the potential for innovation to transform nursing education.

The pain experience of children with leukemia during the first year after diagnosis.

BACKGROUND: Children with cancer experience pain related to the disease process, the treatment, and the associated procedures. For children with leukemia, the pain experienced after diagnosis has received scant attention. OBJECTIVE: To examine the pain experience, management strategies, and outcomes during the first year after the diagnosis of acute leukemia. METHODS: A longitudinal descriptive approach was used to collect data at seven data points from 95 English- and Spanish-speaking children, ages 4 to 17 years, receiving care in one of three southern California hospitals, and from their English- and Spanish-speaking parents. Age-appropriate instruments were used to examine the variables of pain intensity, location, pattern over time, and quality, as well as strategies for managing pain, perceived effectiveness of management strategies, and functional status. RESULTS: All the children reported pain over the course of the year. Pain intensity scores incorporated the full range of possible responses. For the children 4 to 7 years old, the highest and lowest mean scores, respectively, were 2 and 1.6 (scale, 0-4). For the children 8 to 17 years old, the highest and lowest mean scores, respectively, were 50.1 and 39.5 (scale, 0-100). The most common location of pain was the legs (26.5%) in all seven interviews. Other frequently noted sites were the abdomen (16.6%), head/neck (16.6%), and back (14.2%). The words used most frequently by the older English- and Spanish-speaking children to describe pain were "uncomfortable" (incómodo) and "annoying" (molesto). According to the interviews, the most frequently used strategy for pain management was stressor modification (e.g., medication, sleep, hot/cold, and massage). The most common coping strategies according to a Likert scale rating were "watch TV" (n = 426), "lie down" (n = 421), "wish for it to go away" (n = 417), and "tell my mother or father" (n = 416). The pain intensity scores after pain management were significantly lower for the younger children in three of the seven interviews and for the older children in all seven interviews. For both the younger and older children, functional status (i.e., the ability to engage in routine activities) was above the median score at the seven interviews. CONCLUSIONS: Children with leukemia experience pain throughout the first year of treatment. In this study, the pain was responsive to the management strategies used by the parents and children.

Multisite research: a systems approach.

Multisite research is becoming increasingly common because of the need for an adequate sample size and for generalizability of results beyond a single facility. Collaboration in a research project poses unique challenges due to the number of persons and facilities involved. The use of a systems approach to structure the research process in a study of pain in children with leukemia is described, using the principles to structure, conduct, and conclude the multisite project.

Pain and leukemia: the stories of three children.

The stories of the pain experience of three children with acute leukemia during the first year after diagnosis are presented in this report. To provide a broad picture, children who represent various characteristics were selected: ages 6, 9, and 15 years; two male and one female; two Latino and one Caucasian; two English-speaking and one Spanish; two with acute lymphocytic leukemia and one with acute myelocytic leukemia. Consideration of the disease, procedures, treatment, and normal childhood pain experiences will provide the nurse who cares for these children guidance in knowing why and when pain may occur, which will lead to timely interventions for the pain.