Children's Emotional Manifestation Scale: development and testing


  • Ho Cheung William Li RN BSc (Hons) MPhil (Nursing),

  • Violeta Lopez PhD FRCNA

Ho Cheung William Li
The Nethersole School of Nursing
Esther Lee Building
The Chinese University of Hong Kong
New Territories
Hong Kong
Telephone: (852) 26098103


Aims and objectives.  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.

Design.  A cross-sectional study was employed. A convenience sample of 82 children admitted for day surgery was recruited in this study.

Method.  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.

Relevance to clinical practice.  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.