Doctors and physicians have always relied on the information the patient to diagnose and treat diseases. Some diseases can be treated without lab tests and this reduces the costs involved in treatment of patients. However, it situations where the patient cannot talk, it becomes challenging because the doctor has find a way to discover whether the patient is feeling pain or not. Treating infants and children who do not know how to talk takes this direction. As such, doctors and physicians use instruments like FLACC(Face, Legs, Activity, Cry, and Consolability)scale to determine the feeling of their patient. The FLACC scale for children is therefore a vital scale that doctors and physicians must use if they are going to diagnose and treat infants and children well. This paper evaluates the findings of three researches that gave a green light for the use of FLACC scale in clinics to assess the intensity of pain among preverbal patients.

FLACC Behavioral Pain Assessment Scale: a Comparison with the Child’s Self-Report

The study aimed at furthering the existing knowledge on the reliability of the FLACC pain assessment scale as a tool to assess pain in children. The researchers observed who had undergone surgical process for the pain intensity after 20 hours and reported their observations in their findings. The procedures involved in the analysis of the pain intensity included recording of FLACC scores by an investigator. Further a self-report from children was also used to determine the intensity of pain that children experienced after a surgical operation

Intensive review of literature was done to analyze the existing knowledge in the understanding of pain in postoperative children aged 3 and 7 years. The literature revealed that children used expressive behaviors such as crying, facial grimaces, body posture, rigidity, changes in sleep, and consolability as an indication that they are feeling pain when they cannot speak.

The sample for the study included children aged between 3 and 7 years who were in postoperative stages. The procedure involved observation of the child behaviors at least 18 hours after the operation to ensure that there were effects of general anesthesia and that the children were also able to self-report their pain. No discussion of the child’s pain was done by the observer to avoid biasness in the final report.

The findings of the study indicated a correlation between FLACC and FACES scores for the entire sample of children. Separate data analysis for children aged below 5 and those aged above 5 was done with the result indicating that there was no correlation of FLACC and FACES score for children aged below 5 while a positive and significant correlation was reported for those aged above 5. The discussion following the results indicates that the selection of appropriate tools to analyze pain in postoperative children was a factor of the tool’s reliability and validity as well as its suitability for and utility in a clinical setup. Thus, the researchers concluded that the FLACC scale was a reliable and valid tool that can be used for assessing pain in children and thus could be used in different pediatric settings. The findings of the study casts doubts on the existing literature that indicate disparities in self-report and pain behaviors among children aged 3-7 years.

The FLACC: A Behavioral Scale for Scoring Postoperative Pain in Young Children

The study investigated five categories of pain behaviors including facial expression, leg movement, activity, cry, and consolation. The aim of the research was to investigate the reliability and validity of the FLACC pain assessment tools using the identified pain behaviors.

The study involved eighty nine children with ages ranging from 2 months and 7 years in postoperative stages. The researchers measured the interrater reliability, changes in the FLACC scores after administration of analgesics, and the comparison of FLACC scores with existing pain ratings. The research aimed at determining the interrater reliability in testing the reliability of FLACC tools through measuring of changes in the FLACC scores after the administration of the analgesics to postoperative children and comparing the FLACC changes with the existing pain rating tools.

The reviewed literature had revealed that there was a correlation between the existing pain ratings and the FLACC scores used by nurses. However, the use of pain rating indicators was limited because they were lengthy and cumbersome. There was therefore need to have a simple and consistent way of identifying, documenting, and evaluating postoperative pain in children.  Further, the reliability and validity of the pain rating tools in use were contradicting and thus necessitating the importance of testing their reliability and validity through a study to support the correlations assigned by Objective Pain Scale and the nurses’ global ratings of pain.

The study was done in three parts.  The first part consisted thirty children who were tested for interrater reliability of the FLACC tool. The second part had twenty nine children observed for FLACC scores before and after administration of analgesics. The last group was used to compare the FLACC scores and the OPS scores to determine the correlation between the two scores. The result indicated a strong correlation between the two FLACC scores indicating a reliable interrater. Analysis of the variation in the scores did not point to significant differences even when the duration was changed.The analyses of the findings indicate that reliability and validity of pain assessment tools formed important criteria when selecting a particular tool for use in clinical setup. The lengthy and cumbersomeness of the existing pain assessment tools were a major impediment to the utilization of those tools in assessing pain in young children.

Clinical Validation of FLACC: Preverbal Patient Pain Scale

The study investigated the validity of FLACC in the assessment of pain by measuring changes in scores in response to the administration of analgesics. The sample of the study was 147 children under the age of three who were admitted in the intensive care unit, post-anesthesia unit, surgical and trauma unit, and infant unit. The evaluation of changes in the FLACC score was based on the five behaviors that were an indication of feeling of pain in children. The study used a sample of 147 children who were not able to speak up about the presence or intensity of pain using a self-report pain assessment tool

The objectives of the study were to validate the use of FLACC pain assessment tools in clinical treatment and pain management inventions in preverbal patients. The evaluation was carried out in five pediatric specialty units. Further, the researchers were evaluating the relationship between different types of analgesics administered during the FLACC assessment in each of the five identified units. Three types of analgesics were used in the research. The selection of children was based on particular characteristics to ensure that the child was qualified a preverbal pain feeling child.

The observation made in the indicated pointed to higher pre-analgesia in FLACC scores than in post-analgesia scores and significantly higher for patients who receive oploids than those who did not receive oploids. However, there were no significant differences in the peak FLACC scores in all patients regardless of whether the patients had received analgesics or not.

The conclusions of the study were that FLACC pain assessment tools did aid nurses in indentifying and evaluating the pain in preverbal children and the tools could be relied on in clinical judgment in determining analgesic choice instead of providing an alternative FLACC scores for selection of analgesics to be administered to the patient.

The discussion on the findings indicate the FLACC pain assessment tools were reliable and valid tools which could be used to supplement the clinical judgment to pediatric nurses by providing a standardized way of interpreting and quantifying pain behaviors in young patients. The discussion therefore gives a FLACC pain assessment tool a positive rating as a reliable and valid tool that can be used in assessing pain in surgery, trauma, or any other painful disease among children.

Recommendation on the Use of the FLACC Scale in Nursing

The results and findings of the three researches indicate that FLACC scale is a reliable and valid tool that can be used in clinics for assessment of pain among preverbal patients. The FLACC pain assessment tool provide nurses with a simpler and consistent way of assessing pain in patients who cannot speak, and thus enabling them to identify, document, and evaluate the intensity of pain in their patients. All the studies evaluated have given a positive rating on the validity and reliability of the FLACC scale as a tool to assess pain among children aged between 2 months and 7 years.  However, care should be taken to consider the existing clinical setup and the prevailing conditions.

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