The interpretation of infant pain: physiological and behavioral indicators used by NICU nurses

The purpose of this descriptive study was to identify the indicators used by neonatal nurses to interpret the experience of pain in infants in a Neonatal Intensive Care Unit (NICU). A sample of 72 NICU nurses completed a structured questionnaire to identify the physiological and behavioral indicators they used to interpret the experience of pain in the infants entrusted to their care. The 10 pain indicators used by more than 50% of the nurses, listed in decreasing order of frequency, were: fussiness, restlessness, grimacing, crying, increasing heart rate, increasing respirations, wiggling, rapid state changes, wrinkling of forehead, and clenching of fist. These findings are consistent with existing literature, are compatible with the stress cues identified in Als' Synactive Theory of Development, and lend support to the use of such measures for the assessment of infant pain.