Contents | Previous | Next |
B1. Brief Pain Inventory (Short Form)
B2. Initial Pain Assessment Tool
B4. The Memorial Pain Assessment Card
B7. Poker Chip Tool Instructions Sheet
B11. Flowsheet for Pain Management Documentation
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Source: Pain Research Group, Department of Neurology, University of Wisconsin- Madison. Used with permission. May be duplicated and used in clinical practice. |
|
||||||||||||||||||||||||||||||||||||||||||
Note: May be duplicated and used In clinical practice. Source: McCaffery and Beebe. 1989. Used with permission. |
|
1 If used as a graphic rating scale, a 10 cm
baseline is recommended. 2 A 10-cm baseline is recommended for VAS scales. Source: Acute Pain Management Guideline Panel. 1992. |
Child Form | Parent Form |
Tell me what pain is. | What word(s) does your child use in regard to pain? |
Tell me about the hurt you have had before. | Describe the pain experiences your child has had before. |
Do you tell others when you hurt? If yes, who? | Does your child tell you or others when he/she is hurting? |
What do you do for yourself when you are hurting? | How do you know when your child is in pain? |
What do you want others to do for you when you hurt? | How does your child usually react to pain? |
What don't you want others to do for you when you hurt? | What do you do for your child when he/she is hurting? |
What helps the most to take your hurt away? | What does your child do for him/herself when he/she is hurting? |
Is there anything special that you want me to know about you when you hurt? (If yes, have child describe.) | What works best to decrease or take away your child's pain? |
Is there anything special that you would like me to know about your child and pain? (If yes, describe.) |
After discussing with the child several things that have hurt the child in the past:
Reprinted with permission of J.M. Eland from McCaffery and Beebe, 1989. May be duplicated for use in practice. |
English Instructions:
|
1 Developed in 1975 by Nancy 0. Hester, University of Colorado Health
Sciences Center. Denver. CO. 2 Spanish instructions by Jordan-Marsh. M., Hall. 0.. Yoder. L. Watson. R., McFartane-Sosa. G.. & Qarcia, M. (1990). The Harbor-UCLA Medical Center Humor Project tor Children. Los Angeles: Harbor-UCLA Medical Center. |
Instructions "This is a line with words to describe how much pain you
may have. This side of the line means no pain and over here the line means
worst possible pain." (Point with your finger where "no pain" is, and
run your finger along the line to "worst possible pain." as you say it.)
"If you have no pain, you would mark like this." (Show example.) "If
you have some pain, you would mark somewhere along the line, depending on
how much pain you have." (Show example.) "The more pain you have, the
closer to worst pain you would mark. The worst pain possible is marked like
this." (Show example.)
|
Reprinted with permission from Savedra, Tester, Holzemer, et al., 1989. [updated 1992] |
Children are presented with one of three different randomly ordered face sheets. They select the face that best represents how they feel in relation to their pain conditions from "the happiest feeling possible" to the "saddest feeling possible." This figure is actually the scoring card used to quantify children's responses. The numbers represent the magnitude of pain affect (between 0 and 1) shown in each face, based on previous research on children. |
Reprinted with permission of McGrath from Patt, 1993 |
Pain management log for _______________________________
Please use this pain assessment scale to fill out your pain control log:
|
Source: McCaffery & Beebe, 1989. Used with permission Note: Maybe
duplicated for use in clinical practice. |