The Individualized Numeric Rating Scale (INRS)
Research Collaboration
The INRS was developed in collaboration with
Jean C. Solodiuk, RN PhD
Pain Treatment Service
Children's Hospital Boston
Jean.Solodiuk@childrens.harvard.edu
Jean C. Solodiuk, RN PhD
Pain Treatment Service
Children's Hospital Boston
Jean.Solodiuk@childrens.harvard.edu
Permission to use the INRS
You are free to reproduce and use the Individualized Numeric Rating Scale (INRS) for research or clinical practice. The INRS may be reproduced on forms with hospital or clinical unit letterhead or logos, or used in electronic record systems. Please cite: Solodiuk, J., & Curley, M. A. Q. (2003). Evidence based practice: Pain assessment in nonverbal children with severe cognitive impairments – The Individualized Numeric Rating Scale (INRS). Journal of Pediatric Nursing, 18(4), 295-299. Requests for any changes or alterations in the instrument or requests to translate it into another language should be made in writing to Dr. Curley.
Individualized NRS Guidelines
Description:
The Individualized NRS (Solodiuk & Curley, 2003) is a numerical rating scale that includes space for the parent or nurse to insert typical pain responses for an individual patient with cognitive impairment. Although these patients may appear insensitive to pain, they may be unable to communicate their pain, or caregivers may be unable to recognize their responses to pain.
The iNRS will be used for all children ≥ eight years who are cognitively impaired and/or critically ill and intubated.
Assessment Method:
The INRS is a 0-10 numeric rating scale individualized to the patient. Building upon the NRS (numerical rating scale in which numbers ranging from 0 to 10 are placed at equidistant points on a line where 0 equals no pain and 10 equals the worst pain imaginable), the nurse or parent uses the FLACC acronym to populate patient pain behaviors on the vertical line that corresponds to pain intensity.
Instructions:
1. Think about the child’s painful events. How does the child act when in mild, moderate or severe pain?
2. In the diagram, write in the child‘s typical pain behaviors on the line that corresponds to its pain intensity where 0 = no pain and 10 = worst possible pain.
3. When describing the child’s pain, think about changes in:
Facial expression: Squinting eyes, frowning, distorted face, grinds teeth, thrusts tongue
Leg or general body movements: tense, gestures (more or less) or touches part of body that hurts
Activity, or social interaction: Not cooperative, cranky, irritable, unhappy; not moving, less active, quiet or more active, fidgety,
Cry or vocalization: Moaning, whimpering, crying, yelling
Consolability: Less interaction, seeks comfort or physical closeness, difficult to distract/satisfy
Other changes: Tears, sweating, holds breath, gasping. For example parents may tell you that when their child is in moderate pain he/ she may become irritable or cranky. So fill in the blank under moderate pain with irritable or cranky.
The Individualized NRS (Solodiuk & Curley, 2003) is a numerical rating scale that includes space for the parent or nurse to insert typical pain responses for an individual patient with cognitive impairment. Although these patients may appear insensitive to pain, they may be unable to communicate their pain, or caregivers may be unable to recognize their responses to pain.
The iNRS will be used for all children ≥ eight years who are cognitively impaired and/or critically ill and intubated.
Assessment Method:
The INRS is a 0-10 numeric rating scale individualized to the patient. Building upon the NRS (numerical rating scale in which numbers ranging from 0 to 10 are placed at equidistant points on a line where 0 equals no pain and 10 equals the worst pain imaginable), the nurse or parent uses the FLACC acronym to populate patient pain behaviors on the vertical line that corresponds to pain intensity.
Instructions:
1. Think about the child’s painful events. How does the child act when in mild, moderate or severe pain?
2. In the diagram, write in the child‘s typical pain behaviors on the line that corresponds to its pain intensity where 0 = no pain and 10 = worst possible pain.
3. When describing the child’s pain, think about changes in:
Facial expression: Squinting eyes, frowning, distorted face, grinds teeth, thrusts tongue
Leg or general body movements: tense, gestures (more or less) or touches part of body that hurts
Activity, or social interaction: Not cooperative, cranky, irritable, unhappy; not moving, less active, quiet or more active, fidgety,
Cry or vocalization: Moaning, whimpering, crying, yelling
Consolability: Less interaction, seeks comfort or physical closeness, difficult to distract/satisfy
Other changes: Tears, sweating, holds breath, gasping. For example parents may tell you that when their child is in moderate pain he/ she may become irritable or cranky. So fill in the blank under moderate pain with irritable or cranky.
Scoring Method:
Observers note behaviors exhibited and associate them with the Individualized NRS to estimate pain intensity. Additional adjectives may be added at any time by other members of the team. Pain is scored and documented according to the noted behaviors that have been indicated on the patient’s Individualized NRS. For example:
Observers note behaviors exhibited and associate them with the Individualized NRS to estimate pain intensity. Additional adjectives may be added at any time by other members of the team. Pain is scored and documented according to the noted behaviors that have been indicated on the patient’s Individualized NRS. For example:
Articles of Interest
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Solodiuk, J.C., Scott-Sutherland, J., Meyers, M., Myette, B., Shusterman, C.,. Karian, V.E., Harris, S.K., Curley, M.A.Q. (2010). Validation of the Individualized Numeric Rating Scale (INRS): A pain assessment tool for nonverbal children with intellectual disability. Pain, 150(2), 231–236 (PMID: 20363075)
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Solodiuk, J., & Curley, M. A. Q. (2003). Evidenced based practice: Pain assessment in nonverbal children with severe cognitive impairments – The Individualized Numeric Rating Scale (INRS). Journal of Pediatric Nursing, 18(4), 295-299. (PMID: 12923744)
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