title: Children's Emotional Manifestation Scale: development and testing.
abstract: OBJECTIVE
  The objectives of this study were to develop an objective and operationalized behavioural observation scale that can be used to document children's emotional responses during stressful medical procedures, and to test the psychometric properties of this newly developed scale.
  
  
  BACKGROUND
  The availability of a valid and reliable instrument that accurately documents the manifestation of children's emotions prior to undergoing surgery or during stressful medical procedures is crucial before any intervention can be appropriately planned and evaluated. There is a lack of such an instrument with effective psychometric properties in the literature.
  
  
  METHODS
  A cross-sectional study was employed. A convenience sample of 82 children admitted for day surgery was recruited in this study.
  
  
  METHODS
  Based on systematic literature search, a number of observable emotional behaviours with different levels or intensities were identified. A panel of nurse experts was set up to review this finding and develop the scale. Intra-class correlation was used to estimate the inter-rater reliability coefficient. Internal consistency reliability was assessed by determining the Cronbach's alpha. Content validity was established by six nurse experts' ratings. The validity of the scale was also confirmed by convergent validity.
  
  
  RESULTS
  The results showed that there was adequate inter-rater reliability, high internal consistency reliability, good content validity and excellent convergent validity.
  
  
  CONCLUSIONS
  This study has addressed a gap in the literature by developing an objective tool to document children's emotional responses during stressful medical procedure, which are under-researched in the literature.
  
  
  CONCLUSIONS
  The Children's Emotional Manifestation Scale was developed to provide a simple, objective and consistent method for nurses to document children's emotional behaviour during stressful medical procedures. Clinical nurses can also use this scale to evaluate preoperative interventions directed towards minimizing anxiety and bolstering coping mechanisms in children undergoing surgery.
authors.affiliation: The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China. williamli@cuhk.edu.hk
authors.forename: Ho Cheung William
authors.initials: HC
authors.lastname: Li
authors.forename: Violeta
authors.initials: V
authors.lastname: Lopez
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000523:psychology; D002648:Child; D002652:Child Behavior; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D004644:Emotions; D005149:Facial Expression; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D009730:Nursing Assessment / Q000379:methods*; D015403:Nursing Evaluation Research; D015588:Observer Variation; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D002666:Psychology, Child; D011594:Psychometrics; D015983:Selection Bias; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D014705:Verbal Behavior