“Optimizing the Assessment of Pain in Children” by Chen-Lim


This paper summarizes the article titled “optimizing the assessment of pain in children who are cognitively impaired through the quality improvement process”. The paper will analyze the methods of the experiment based on the objectives. Consequently, the limitations of the experiment will be documented to improve the research validity. The implications and significance of the study will be evaluated. Suggestions will be recommended for further studies based on clinical opinions.

Introduction: Methods, results, and findings

The article titled “optimizing the assessment of pain in children who are cognitively impaired through the quality improvement process” investigated the challenges of pain under treatment and assessment tools. Consequently, the authors evaluated various assessments tools and feedback strategies that assist nurses treat children with cognitive impairment (CI). The article described cognitive impairment as the inability to evaluate and report treatment interventions (Chen-Lim, Zarnowsky, Shaffer, Holtzer, & Ely, 2012). The article assessed and recommended treatment interventions for children with cognitive impairment. The authors based the review of pain management on the physiological and behavioral responses of cognitively impaired patients. Consequently, caregivers could not assess the progress of treatment intervention for children with CI. To assess the significance and research objective, the authors created the Pain Resource Nurse Program (PRNP). As a result, the selected pain resource nurse (PRN) documented therapy observations and procedures for the sample population. The authors used three methods for the research analysis. The research methods were an evidence-based review of literature, feedback from the pain resource nurse and quality improvement evaluation. Consequently, the research was conducted in accordance with the Hopkins research model. As a result, PFN were given worksheets to evaluate the quality improvement program. Consequently, the authors reviewed 10 pain assessment tools for CI patients.

The experiment was monitored by the hospital’s review board. One hundred and fifty questionnaires were administered to children with CI using two assessment tools. Pediatric pain form (PPP) and FLACC were assigned as the research variable. As a result, parents and nurses evaluated the QI program using the response capture form. The sample populations were children with cognitive impairment. The PRN observed the sample population based on the research questions. As a result, 150 questionnaires were administered and evaluated by the RN and parents. Thirty children with cognitive impairment were used for the analysis. The research findings revealed that the FLACC questionnaire improved treatment interventions. However, the research findings revealed that parents preferred the PPP to the FLACC. The parents argued that the PPP identified the patient pain and behavioral responses.

Limitations of the research

The authors cited various challenges that affected the research validity. Thus, staff characteristics and patient experience affected the quality improvement program. Hospital resources and beddings affected the research program. Some hospital locations had little bed spaces compared to other clinical units. Consequently, staff recruitment and training affected the QI program. Training duration varied across locations and staff population. Patient recruitment altered the research validity. Researchers could not identify children with normal and acute cognitive impairment. As a result, some nurses could not complete the FLACC questionnaires.

Implications of the study

The research findings revealed that the responses of parents and nurses were similar. However, the implications of the study suggested that the FLACC identified the patient’s behavioral pattern. Consequently, clinical observations revealed that the FLACC assisted the nurses in evaluating the pain descriptors. Consequently, the PPP assessment tool can be combined with the FLACC to improve the research validity.

Significance of the research findings

The research findings will improve treatment interventions and clinical studies. Consequently, nurses will understand the limitations of each assessment tool. Treatment plans for CI children can be evaluated based on specific behavioral pattern. As a result, pain under treatment can be avoided using the recommendations of the research team. Consequently, the research findings can be used as a resource tool for further studies. The research findings will influence policy implementation and evaluation of the QI program. Consequently, nurses and caregivers can adopt the recommendation of the research findings to improve treatment interventions. Thus, care givers can influence quality improvement in pain management.

Statistical significance of the study

The researchers collected sample data from children with cognitive impairment. As a result, pain assessment scale was determined on five variables. The variables include face, legs, activity, cry, and consolability. Results were collected from four hospital units. The statistical findings revealed that 70% of the participants were from four hospital units (inpatient unit). The pain descriptors were classified as the usefulness of the tool, accuracy of the child’s pain, and helpfulness. Statistical findings revealed that the FLACC assessment tool scored above 75% compared to the PPP form (Chen-Lim et al., 2012). The accuracy of the research findings revealed the significance of the statistical analysis.

Suggestion for future study

The research findings and recommendations can be adopted by various health associations. As a result, pain response nurses can improve their evaluation techniques. Consequently, college nurses and health practitioners can analyze the article as a resource material. Suggestions for further study depend on the research observations. As a result, researchers can combine the assessment tool to evaluate quality improvement. Further studies can also classify CI children based on age and gender. Consequently, the limitations of the research will guide future studies on pain management.


The article evaluated pain management using various assessment tools. Data collection influenced the validity of the result. Consequently, the assessment tools provided positive responses for the evaluation team. Children under treatment can be improved with the FLACC assessment tool.


Chen-Lim, M., Zarnowsky, C., Shaffer, S., Holtzer, B., & Ely, E. (2012). Optimizing the assessment of pain in children who are cognitively impaired through the quality improvement process. Journal of Pediatric Nursing, 27(2), 750–759.