Description:   A post graduate grant provided the opportunity for two nurse practitioners to compare and contrast American and Italian child health practices.  At Bambino Gesu Hospital in Rome, the nurse practitioners observed painful procedures without sedation or pain management (i.e. bone marrow aspiration and endoscopy).   One major difference noted was the inadequate pain assessment and treatment.    The nurse practitioners introduced the Baker-Wong FACES and FLACC pain scales to the Italian team.  The Italian staff was receptive to information regarding the “fifth vital sign”.  During the 6 weeks, the American nurse practitioners in collaboration with the Italian transdisciplinary team of physicians, nurses and child life staff introduced and translated the pain scales. 

Outcome:    Six months later, the translated version of the FACES and FLACC pain scales were approved by the hospital administration and implemented hospital wide.  The Italian team is now using the pain scales as part of their assessments.    

Conclusions:  Introduction of the pain scale resulted in an increased awareness of pain and pain management. Collaboration between the two teams continues a year later and one Italian physician recently visited the American hospital for further collaboration. There are plans to meet again at both institutions to continue improving healthcare internationally. 

Implications for nursing practice:  The American nurse practitioners acted as change agents, educators and collaborators. As change agents, they implemented change despite language and cultural barriers.   As educators, they taught their colleagues about the importance of assessing and treating pain.  The nurse practitioners collaborated with the Italian team to implement a pain scale that is culturally sensitive, easily utilized, and affects patient care in a positive manner.