Developing and Testing the Effectiveness of the Mesko-Eliades Pain Area Locator Tool to Assess Pain Location In Children

Purpose: Before surgery, many patients cite postoperative pain as their utmost concern. Nevertheless, studies indicate almost half of postoperative patients report inadequate pain relief. Children, like adults, experience pain from a variety of causes. Pain management in the pediatric population has, and continues to be a concern since pediatric patients are at special risk of sub-standard pain control. Expanding on findings that picture communication provides a mechanism to assess pain location, this presentation reviews the development and testing of a picture communication tool, the Mesko-Eliades Pain Area Locator (PAL), that has been shown to effectively assess pain location. Parent satisfaction with the use of the PAL among post-anesthesia pediatric patients (ages 3 to 9 years) undergoing a broad range of same-day surgical procedures will be presented.

Methods: Employing a quantitative, comparative design, a convenience sample of post-operative patients undergoing same day surgeries was recruited at a freestanding, Magnet designated pediatric hospital. Post-operative pain location assessment was performed in the PACU by two individuals: 1) a PACU nurse completed standard pain assessment; 2) a non-PACU data collector performed a second pain location assessment with the PAL. Parent Satisfaction was measured through completion of a ten item satisfaction survey.

 Results: To determine consistency between the pain assessment by the nurse and data collector (using the PAL to determine pain location), the proportion of agreement, ranging from 0 to 1, was calculated for 41 participants. The mean proportion of agreement was 0.24 (SD = 0.435) which is significantly lower than 1, t = -11.136, p = .000. Parent survey responses exceeded historical data. For the item “Nurses concern for comfort”, the response of 100% was higher compared to historical data (m = 93.3%).  For the item “Degree pain was controlled”, the mean response of 97.3% was higher compared to historical data (m = 93%).

 Conclusion: Post-anesthesia pediatric patients undergoing a broad range of same-day surgical procedures effectively used the PAL to identify location of pain. There was an inconsistency between the nurse’s assessment of pain location and the pain location identified by the child using the PAL. Parents were highly satisfied with the PAL. Perianesthesia clinical practice standards are advanced by the findings that patients undergoing a variety of pediatric surgical procedures effectively used the PAL post-operatively to identify location of pain and parent satisfaction with the PAL increased compared to standard pain location assessment. Studies establishing reliability and validity and randomized intervention studies on the use of the PAL are indicated.