Point to the pain
Phyllis Mesko has worked the recovery floor at Akron Children’s Hospital for 41 years.  She has the reassuring calm of a seasoned caregiver who’s asked thousands of children the same question.

“Where does it hurt?”

But she doesn’t listen for an answer.  She watches.  

Mesko holds a sheet of paper.  On it, vivid lightning bolts shoot out from body parts.The drawings depict pain in the neck, the belly, back, or head. 

Mesko asks the child to point to the location of pain in the picture.

A mother's innovation
Using pictures to communicate is something Mesko came up with not in the recovery room but at home with her son, Mark.  He was born with autism.   

Mark learned to talk. Then, around the age of 6, he stopped using words. Instead, he developed a different way to communicate.

“He would go through magazines, he would go through catalogues. If he wanted to go somewhere to eat, he’d find you a menu to show you what he wanted.  You really did know what he wanted. If he wanted to go to a store he would go through the ads in the Sunday paper and get the scissors and cut them out and hand them to you.”

Now in his late 20’s, Mesko’s son relies exclusively on visual communication.  For explaining situations beyond a single image, like a trip to the hospital, Mesko creates what she calls ‘social stories’.   

“And I had a picture communication of a blood pressure, of a scale, of anything that I knew would happen to him.  So as a nurse I knew what to expect, and as the mother, I knew what I needed to teach him.”

Picture communication at Children's
Mesko realized that what worked for her son may help children rendered temporarily non-verbal in the hospital, like those recovering from tonsillectomies.  She brought her idea of  picture communication to Akron Children’s and started asking patients who couldn’t or wouldn’t speak to point to a picture of where it hurts.

Then Mesko was offered a chance to take the idea further.

Aris Eliades is director of nursing research at Akron Children’s.  She invited Mesko to be the hospital’s first nurse scholar -- a program in which nurses are awarded a grant, and time, to do research.  Eliades saw a need for data.  She says while pain intensity is well studied, there is huge gap in the research literature looking at pain location.

Mesko then made the transition from caregiver to researcher.  She studied responses from children recovering from tonsillectomies and unable to speak, using her picture sheets.

Eliades says the study showed that ‘where it hurts’ is often not where they expected.

“The nurse would attribute it to the surgical site and the patient would say it’s something else, totally something else.”

Research reveals source of pain
Nurse Mesko discovered kids were uncomfortable for a variety of reasons.

“Maybe they didn’t like that little clip on their finger, maybe the IV board was too tight, or a piece of plastic on it. Maybe they just didn’t like having an IV; maybe they were just hungry, or they wanted their parents.”

Picture communication resulted in fewer painkillers given to kids after surgery, and higher patient satisfaction.

And after more than four decades as a nurse, being a researcher gave new life to Phyllis Mesko’s career.  

“I very much enjoy my job in recovery room, but this has taken me to a totally new level.”

Mesko presented her results this month at a national nurses’ conference in Seattle.  Her work will be published in the journal of PeriAnethesia Nursing.  She’s planning a larger study of picture communication for children recovering from a range of surgeries.  She says pointing to a picture of where it hurts could someday become standard practice.  

I’m jstc with this week’s Exploradio.