Indicators of pain in neonates at risk for neurological impairment.
J Adv Nurs
; 65(2): 285-96, 2009 Feb.
Article
en En
| MEDLINE
| ID: mdl-19040693
ABSTRACT
AIM:
This paper is a report of a study to compare the importance and usefulness ratings of physiological and behavioural indicators of pain in neonates at risk for neurological impairment by nurse clinicians and pain researchers.BACKGROUND:
Neonates at risk for neurological impairment have not been systematically included in neonatal pain measure development and how clinicians and researchers view pain indicators in these infants is unknown.METHODS:
Data triangulation was undertaken in three Canadian Neonatal Intensive Care Units using data from (a) 149 neonates at high, moderate and low risk for neurological impairment, (b) 95 nurse clinicians from the three units where infant data were collected and (c) 14 international pain researchers. Thirteen indicators were assessed following heel lance in neonates and 39 indicators generated from nurse clinicians and pain researchers were assessed for importance and accuracy. Data were collected between 2004 and 2005.RESULTS:
Across risk groups, indicators with the highest accuracy for discriminating 'pain' among neonates were brow bulge (77-83%), eye squeeze (75-84%), nasolabial furrow (79-81%), and total facial expression (78-83%). Correlations between nurse ratings and neonatal accuracy scores ranged from moderate to none (mild risk r = 0.52, P = 0.07; moderate r = 0.43, P = 0.15; high r = -0.12, P = 0.69). Researchers demonstrated a better understanding of the importance of pain indicators (mild risk, r = 0.91, P < 0.001; moderate 0.85, P < 0.001; 0.0002; high r = 0.64, P = 0.019) than nurse clinicians. CONCLUSION/DISCUSSION:
Facial actions were rated as the most important indicators of neonatal pain. However, as neurological impairment risk increased, physiological indicators were rated more important by nurse clinicians and pain researchers, opposite to pain indicators demonstrated by neonates.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Dolor
/
Dimensión del Dolor
/
Recien Nacido Prematuro
/
Conducta del Lactante
/
Expresión Facial
Tipo de estudio:
Clinical_trials
/
Diagnostic_studies
/
Etiology_studies
/
Risk_factors_studies
Límite:
Humans
/
Newborn
País/Región como asunto:
America do norte
Idioma:
En
Revista:
J Adv Nurs
Año:
2009
Tipo del documento:
Article
País de afiliación:
Canadá