A Reliable Pain Assessment Tool for Clinical Assessment in the Neonatal Intensive Care Unit

Authors

  • Kaye Spence,

    Corresponding author
    1. Kaye Spence, AM, MN, is a clinical nurse consultant, Department of Neonatology, The Children's Hospital at Westmead and associate professor (adjunct) at the University of Western Sydney, NSW, Australia.
      Address for correspondence: Kaye Spence, AM, MN, Department of Neonatology, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia. E-mail: kaye@chw.edu.au
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  • Donna Gillies,

    1. Donna Gillies, PhD, is head of the Research Development Unit, School of Nursing, Family and Community, the University of Western Sydney, NSW, Australia.
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  • Denise Harrison,

    1. Denise Harrison, MN, is a clinical nurse educator at Royal Children's Hospital, Melbourne, and a doctoral candidate at the University of Melbourne, Victoria, Australia.
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  • Linda Johnston,

    1. Linda Johnston, PhD, is professor of neonatal nursing research, the Royal Children's Hospital, Melbourne, and deputy head of school, associate head, School of Nursing, the University of Melbourne, Victoria, Australia.
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  • Sue Nagy

    1. Sue Nagy, PhD, is adjunct professor, the University of Technology, Sydney, and adjunct professor, the Nursing and Health Services Research Consortium, NSW, Australia.
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Address for correspondence: Kaye Spence, AM, MN, Department of Neonatology, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia. E-mail: kaye@chw.edu.au

Abstract

Objective: The aim of this study was to validate a clinician-friendly pain assessment tool for all groups of critically ill infants cared for in the specific neonatal intensive care units (NICUs) studied.

Design: A prospective study was undertaken to test the Pain Assessment Tool (PAT). Interrater reliability of the PAT score was assessed by two nurses who simultaneously determined an infant's PAT score. The PAT was validated against the CRIES score—crying, requires increased oxygen administration, increased vital signs, expression, sleeplessness—and the mother's assessment of her infant's discomfort using the Visual Analogue Scale (VAS).

Setting: The NICUs at two children's hospitals.

Patients: Participants were 144 preterm and term infants. Infants on a ventilator and those who had undergone surgery were included.

Results: The interrater reliability of the PAT was .85 with a mean difference of 0.17 (standard deviation: 1.73). There was a strong correlation between the PAT and CRIES scores (r = 0.76) and a moderate correlation (.38) between the PAT score and the VAS scores of the infant's mother. The correlation coefficient between the PAT score and CRIES score was significant for all groups (p < .01).

Conclusions: The PAT score was shown in this study to be a valid, reliable, and clinician-friendly pain assessment measurement tool for all infants nursed in the NICU.

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