Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Lisa Kennedy Sheldon

Second Advisor

Teri Aronowitz

Third Advisor

Esther Seibold


Objectives of this exploratory study were to identify how school nurses assess pain in schoolchildren with special needs, determine how school nurses decide to implement methods of assessment, establish which method of assessment is best and examine possible solutions to improve pain assessment practices. Assessing and managing pain is one of the many responsibilities of school nurses. Assessing pain is challenging when schoolchildren have special needs. Nurses providing direct care to students with special needs currently lack evidence or guidelines to direct pain assessment practices.

The conceptual model that guided this study was Neuman's Systems Model, and the middle range theory was the Social Communication Model of Pain. This mixed methods study utilized an investigator-developed, web-based survey. Members of the Massachusetts Educational Collaborative Nurses Association (MECNA) and the National Association of School Nurses (NASN) formed the sample frame. Eight hundred thirty school nurses participated during the data collection period of September to October 2014.

School nurses assessed pain in students with special needs using objective clinical assessment, consultation with teachers, and consultation with parents/guardians. In general, nurses in the school setting implemented assessment methods previously used in other practice areas. School nurses reported pain assessments for students with special needs are adequate in directing the selection of pain management interventions, but could be improved with more training, evidence-based guidelines, and lower nurse-to-student ratios.

Nurse respondents requested more education on pain assessment in school settings. New public policies are needed to lower nurse-to-student ratios so nurses can adequately assess pain in students with special needs and make decisions about safe, effective pain management interventions. Evidence-based policies, procedures, and guidelines need to be developed for use in schools. Future research is needed to understand the perspectives of school nurses, teachers, parents, and students on pain assessment and intervention in school settings.


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