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Published on: January 27, 2010
Psychometric analysis of a Taiwan-version pain assessment scale for preterm infants
Jen-Jiuan Liaw1, Luke Yang, Hsiu-Ling Chou
1School of Nursing, National Defense Medical Center, Taipei, Taiwan.
Insights
This study validated a new pain assessment scale for preterm infants, finding it reliable and feasible for clinical use. The scale helps nurses effectively measure and manage infant pain during procedures.
Area of Science:
- Neonatal care
- Pain management in infants
- Psychometrics
Background:
- Painful procedures negatively impact preterm infants' health outcomes.
- Existing pain assessment scales lack consistent reliability and validity.
- A validated, reliable tool is needed for clinical pain assessment in preterm infants.
Purpose of the Study:
- To evaluate the inter-rater reliability, internal consistency, construct validity, concurrent validity, and feasibility of a novel pain assessment scale for preterm infants.
- To provide clinicians with a dependable tool for measuring pain in this vulnerable population.
Main Methods:
- Instrument development and psychometric analysis were performed.
- Sixty preterm infants (27.6-36.3 weeks gestational age) were video-recorded during heel-stick procedures.
- Three trained nurses independently assessed pain using the new scale, the Premature Infant Pain Profile, and the Visual Analogue Scale.
Main Results:
- The pain assessment scale showed significant differences across pain phases (F = 56.86, p < 0.0001).
- Excellent internal consistency (0.84) and inter-rater reliability (0.88-0.93) were observed.
- The scale demonstrated strong correlations with the Premature Infant Pain Profile (0.74-0.83) and Visual Analogue Scale (0.72-0.81).
Conclusions:
- The developed pain assessment scale is valid, reliable, and feasible for preterm infants over 27 weeks gestational age.
- The scale's clear item definitions and scoring facilitate easy use by clinicians for timely pain assessment and intervention.
- Further validation with diverse infant populations and procedures is recommended.
Aim:
To determine the inter-rater reliability, internal consistency, construct and concurrent validity and feasibility of the pain assessment scale for preterm infants.
Background:
Repeated exposure to painful procedures has an adverse impact on preterm infants' health outcomes. Although many scales are available for assessing these infants' pain, only a few reliably and validly assess pain and no gold standard has been established in clinical practice.
Design:
Instrument development and psychometric analysis.
Methods:
Preterm infants (n = 60) born 27·6-36·3 weeks gestational age were assessed for pain 3 minutes before (phase I), during (phase II), 3 minutes after (phase III) and the tenth minute after (phase IV) heel-stick procedures. Pain scores were independently coded from video recordings and observations by three trained nurses using our pain-assessment scale, premature infant pain profile and visual analogue scale.
Results:
Scores on the pain assessment scale for preterm infants differed significantly across four phases of heel-stick procedures (F = 56·86, p < 0·0001). Internal consistency was 0·84 and inter-rater reliability was 0·88-0·93. Scores on our pain scale correlated well with scores on the premature infant pain profile (0·74-0·83) and visual analogue scale (0·72-0·81).
Conclusions:
The pain assessment scale for preterm infants integrates all possible pain indicators, with each item modified for clinicians' simple and easy pain measurement to potentially yield different information. Our scale is valid, reliable and feasible for preterm infants with gestational age > 27 weeks. Further examination of the scale's psychometrics is recommended with diverse samples of infants and different painful procedures.
Relevance To Clinical Practice:
The pain assessment scale for preterm infants clearly defines item scoring and weighting, consistently discriminates different levels of pain and helps nurses to recognise infants' pain. Nurses can easily remember the definition of each item, allowing them to use our scale to evaluate preterm infants' pain at any time and to provide pain-relief interventions when needed.
