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Nursing Research and Practice
Volume 2014, Article ID 628198, 7 pages
Research Article

The Facial Affective Scale as a Predictor for Pain Unpleasantness When Children Undergo Immunizations

1School of Health Sciences, University of Borås, 501 90 Borås, Sweden
2Institute of Health and Care Sciences, University of Gothenburg, P.O. Box 457, 405 30 Gothenburg, Sweden
3Department of Nursing, Health and Culture, University West, 461 86 Trollhättan, Sweden
4Division of Activity, Health and Care, Department of Social and Welfare Studies, Linköping University, 601 74 Norrköping, Sweden
5School of Health, Pedagogy and Social Studies, Dalarna University, 791 88 Falun, Sweden

Received 14 November 2013; Revised 16 January 2014; Accepted 30 January 2014; Published 5 March 2014

Academic Editor: Caprice Knapp

Copyright © 2014 Stefan Nilsson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Needle fear is a common problem in children undergoing immunization. To ensure that the individual child’s needs are met during a painful procedure it would be beneficial to be able to predict whether there is a need for extra support. The self-reporting instrument facial affective scale (FAS) could have potential for this purpose. The aim of this study was to evaluate whether the FAS can predict pain unpleasantness in girls undergoing immunization. Girls, aged 11-12 years, reported their expected pain unpleasantness on the FAS at least two weeks before and then experienced pain unpleasantness immediately before each vaccination. The experienced pain unpleasantness during the vaccination was also reported immediately after each immunization. The level of anxiety was similarly assessed during each vaccination and supplemented with stress measures in relation to the procedure in order to assess and evaluate concurrent validity. The results show that the FAS is valid to predict pain unpleasantness in 11-12-year-old girls who undergo immunizations and that it has the potential to be a feasible instrument to identify children who are in need of extra support to cope with immunization. In conclusion, the FAS measurement can facilitate caring interventions.