School Nurses' Use of NANDA, NIC, and NOC to Describe Children's Abdominal Pain

PURPOSE To determine the use of NANDA, NIC, and NOC to describe the management of children with complaints of abdominal pain in the school setting. METHODS A cover letter, demographic form, and investigator-developed survey were mailed to a national random sample of 150 members of the National Association of School Nurses. The instrument (interrater reliability r=. 9) had five parts: abdominal pain assessment; NANDA's nursing diagnosis, pain, abdominal; the NIC intervention, “pain management”; the NOC outcomes, Symptom Severity and Pain Level; and (e) five openended questions. Of the sample, 12 were ineligible (returned, retired, not currently a school nurse), giving a net sample of 138; 64 were usable, for a 46% response rate. FINDINGS Pain and other nursing diagnoses associated with abdominal pain (constipation, diarrhea, depression, altered family processes, fatigue, nutrition: less than body requirements, self-esteem disturbance, and sleep deprivation) were associated with abdominal pain. The NIC interventions for pain management reflect the comprehensiveness of abdominal pain management. NOC indicators from the outcomes, Pain Level and Symptom Severity, used to evaluate the effectiveness of interventions were identified, as were indicator changes postintervention. The outcome Pain Level included reported pain level, frequency of pain, oral expression of pain, facial expression of pain, and length of the pain experience. For the Symptom Severity outcome, changes were seen in symptom intensity, symptom persistence, associated discomfort, and symptom frequency. Nurses' perceptions of the most frequent etiologies of abdominal pain related to psychosocial problems of family origin, inadequate nutrition, overconsumption of junk food, and menstrual complaints. Nurses recommended education on the etiologies of abdominal pain complaints. No additional interventions were identified. Nurses articulated that additional staff members or a decreased ratio of children to school nurse would facilitate health promotion, health protection, and teaching. DISCUSSION School nurses support and coordinate activities and resources to ensure that children's abdominal pain complaints are recognized and assessed appropriately. The NANDA, NIC, and NOC linkages helped to cluster data, accurately identify the child's complaint or problem, and determine if the interventions affected the desired outcomes. Data on abdominal pain can be aggregated over time to determine the most frequent abdominal pain etiologies, effective interventions, scope and cost-effectiveness of practice, and to make other recommendations. CONCLUSIONS In addition to knowledge of growth and development, school nurses need to consider factors such as religion and culture to accurately assess a child's pain response. The data support use of structured documentation for the management of abdominal pain in schools. Additional research needs to be conducted on the management of abdominal pain with larger samples and with other select classification linkages. Longitudinal studies may be useful in determining the long-term outcome of children with abdominal pain complaints, when abdominal pain is a problem, and the effect of management protocols used by the school nurse.