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Behavioral and physiological pain structures of PIPP-R and parental stress: structural equation modeling approach
Sahar Gholami1, Zeinab Hemati2, Maryam Yazdi3
1Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
The Premature Infant Pain Profile-Revised (PIPP-R) tool identifies both behavioral and physiological pain factors in neonates. Behavioral pain in preterm infants is linked to parental stress, highlighting the need for multidimensional pain assessment.
Area of Science:
- Neonatal care
- Pain assessment
- Psychological stress
Background:
- Most non-acute pain assessment tools are multidimensional but yield unidimensional outputs.
- The Premature Infant Pain Profile-Revised (PIPP-R) is a common tool for assessing pain in neonates.
- Understanding the pain structure of PIPP-R and its relation to parental stress is crucial for effective infant care.
Purpose of the Study:
- To explore and determine the behavioral and physiological pain structures of the PIPP-R in preterm infants.
- To investigate the association between these pain structures and parental stress.
Main Methods:
- A cross-sectional study involving 400 preterm infants (gestational age < 37 weeks) in NICU settings.
- Utilized the PIPP-R and Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) for data collection.
- Employed latent variable modeling to analyze pain structures and their correlation with parental stress.
Main Results:
- A two-factor model comprising behavioral and physiological pain factors was identified, explaining 65% of the variance.
- Confirmatory factor analysis confirmed the robustness of these identified pain structures.
- Behavioral pain structure, independent of gestational age, showed a significant direct association with parental stress scores.
Conclusions:
- The PIPP-R effectively assesses both behavioral and physiological pain components in preterm infants.
- Behavioral pain factors in preterm infants are significantly associated with parental stress.
- Multidimensional pain assessment tools are optimal for detecting pain in preterm infants, and nurses can mitigate parental stress to improve infant pain management.
Background:
Although most non-acute pain assessment tools are multi-dimensional (behavioral and physiological measures) in their approach, the outputs of such tools are considered unidimensional. This study aimed to explore and determine the behavioral and physiological pain structures of Premature Infant Pain Profile-Revised (PIPP-R) for neonates and its association with parental stress.
Methods:
This cross-sectional study was conducted in 2022-2023 in Isfahan, Iran. We recruited 400 pre-term infants, i.e. with gestational age (GA) of less than 37weeks who were admitted to the NICU of educational hospitals. PIPP-R and Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) were used for data gathering. The latent structures of pain and its association with parental stress were explored using latent variable modeling approach.
Results:
A two-factor model, i.e. behavioral and physiological pain factors, was extracted, explaining 65% of the total variance. The results of confirmatory factor analysis showed that the identified structures in the exploratory factor analysis could be nearly replicated (CFI = 0.99، TLI = 0.98, RMSEA = 0.001). Behavioral pain structure, independent from gestational age had a significant direct association with parental stress score (β = 0.005, SE = 0.002, p = 0.026).
Conclusions:
The PIPP-R assesses both behavioral and physiological pain factors. We also found that behavioral pain factor was associated with parental stress.
Impact:
These results may provide a potential clue for physicians, nurses, and parents to manage the pain in preterm infant. The PIPP-R scores in preterm infants consist of "Behavioral and Physiological" pain factors. Single dependence on behavioral indicators (such as facial expression) has some limitations. Multidimensional tools may be the optimal method in detecting pain in preterm infants. Parental stress can affect behavioral pain structure in preterm infants. Intensive care nurses play an effective role in reducing the parental stress and pain severity of these preterm infants by including the help of mothers in procedures and providing them with psychological support.
