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J Adv Nurs. 2008 Aug;63(4):334-42. doi: 10.1111/j.1365-2648.2008.04694.x.

Association between self-report pain ratings of child and parent, child and nurse and parent and nurse dyads: meta-analysis.

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Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia.



This paper is a report of a meta-analysis to investigate the association between self-report pain ratings for the dyads of child and parent, child and nurse and parent and nurse.


Existing research has shown conflicting results with regard to agreements of self-report pain ratings between the three dyads.


The CINAHL, Medline, Ovid and PsycINFO databases were searched using keyword, such as 'children/adolescents', 'parents/nurses', 'pain assessment', 'pain ratings', 'association' and 'agreement'. Studies published in English in or after 1990 were included.


Meta-analysis methodology was applied to 12 pain assessment studies published between 1990 and 2007 which met the inclusion criteria. In the 12 studies a common effect size was estimated using the Pearson's correlation coefficient. Therefore, a fixed-effects model was chosen for this meta-analysis.


We found moderate summary effect sizes between self-reported pain ratings for the dyad of child and parent (r = 0.64) and the child and nurse dyad (r = 0.58) and a weak summary effect size of r = 0.49 for the dyad of parent and nurse. The summarized effect sizes for each of the three dyads varied across the studies. A test of homogeneity (Q-statistic) indicated that all effect size estimates were not homogeneous.


Parents' and nurses' perceptions of children's pain should only be considered as estimates rather than expressions of the pain experienced, and not the same as children's self-reports. There is a need for education on selection of appropriate pain assessment scales in relation to the age and development of the child.

[Indexed for MEDLINE]

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