Pre- and early verbal children are especially vulnerable to pain, yet their pain often passes unnoticed and untreated. Treatment of pain should be based on objective assessment using a structured pain measurement scale, but their use is still not well integrated into clinical practice and the evidence-base on how measurement scales influences pain assessment, treatment and the evaluation of treatment is weak. This project, which utilizes a combination of qualitative and quantitative methods, includes a systematic review on structured pain assessment scales for use in non-verbal populations, a translation and cultural adaptation study and a validation study, both concerning the translation and validation of the Norwegian version of the COMFORT behavioral scale, and an interview study on the pain assessment process. The project will result in a validated Norwegian version of the COMFORT behavioral scale and a better understanding of the pain assessment process and the use of structured pain measurement scales. These are necessary first steps towards the implementation of better pain assessment strategies in clinical practice. Better assessment is a prerequisite to ensure high quality pain treatment, and in that regard will this project serve as an important contribution towards better quality of life and better treatment safety for this vulnerable patient group.
The main aim of this project is to contribute towards a more valid and reliable assessment of pain in hospitalized pre- and early verbal children. Specific aims: Determine which observational pain assessment scales are recommended for use in children and the strength of these recommendations (I); Explore the use of cognitive interviews in the translation and cultural adaptation of observational scales, exemplified using the COMFORT behavioral scale (II); test construct validity and determine inter-rater reliability of the scale (III); and describe how nurses assess pain in pre- and early verbal children and the integration of structured pain assessment scales into the assessment process (IV).