Assessing Children's Emotional Responses to Stressful Medical Procedures: Children's Emotional Manifestation Scale

Monday, 7 July 2008
Ho Cheung William Li, RN, MPhil, PhD , Department of Nursing Studies, The University of Hong Kong, Hong Kong, China

Learning Objective 1: describe the developing and psychometric properties of the Children's Emotional Manifestation Scale

Learning Objective 2: familiar the use of the Children's Emotional Manifestation Scale in documenting children's emotional responses during stressful medical procedures

Background. The availability of a sensitive, valid, and reliable instrument that accurately documents the manifestation of children's emotions prior to undergoing surgery or during stressful medical procedure is crucial before any intervention can be appropriately planned and evaluated. There is a lack of such an instrument with effective psychometrics in the literature.

Objectives. To develop an objective and operationalized direct behavioral observation scale that can be used to document the emotional responses of children during stressful medical procedures, and to test the psychometric properties of this newly developed scale.

Method. Based on systematic literature search, a number of observable emotional behaviors with different levels or intensities were identified. A panel of experts was set up to review this finding and develop the scale. A cross-sectional study was then employed. Children (7-12 years of age; N = 83) admitted for elective surgery were invited to participate in the study. Participants were asked to respond to the state anxiety scale, prior to their surgery. Children's heart rate and mean blood pressure were recorded inside the operating theatre. Children's emotional responses during anaesthesia was assessed by using the Children's Emotional Manifestation Scale to document

Results. The results showed that there were adequate inter-rater reliability, high internal consistency reliability, good content validity, and excellent convergent validity.

Conclusion. This study has addressed a gap in the literature by developing an objective assessment tool to document children's emotional responses during stressful medical procedures, which are under-researched in the literature. Clinical nurses can use this scale to evaluate the effectiveness of psychological interventions directed toward minimizing anxiety and bolstering coping mechanisms in children undergoing surgery.