P Hummel1, P Lawlor-Klean, M G Weiss. 1. Department of Neonatology and Pediatrics, Gloria Smith/American Nurses Foundation Scholar, Loyola University Medical Center, Maywood, IL 60153, USA. phummel@lumc.edu
Abstract
OBJECTIVE: To establish evidence of clinical validity and reliability of the Neonatal Pain, Agitation, and Sedation Scale (N-PASS) in neonates with acute heelstick pain. STUDY DESIGN: Prospective psychometric evaluation, randomized crossover design. Two nurses administered the N-PASS simultaneously and independently during an actual and sham heelstick done in randomized order. One nurse also administered the Premature Infant Pain Profile (PIPP) concurrently with the N-PASS. Heelsticks were videotaped for repeat analysis. RESULT: Construct (discriminate) validity was established through the Wilcoxon Signed-ranks test, comparing the distribution of the heelstick and sham N-PASS scores. The mean pain scores were 3.93 (2.30) and 0.81 (1.21) for the heelstick and sham procedures, respectively (Z=-6.429, P<0.0001). Convergent validity was demonstrated by correlation with the PIPP scores (Spearman rank correlation coefficient of 0.75 and 0.72 for raters 1 and 2, respectively). Inter-rater reliability was high, measured by intra-class coefficients; the ICC estimates (95% CI) of the pain scale were 0.86 (0.78, 0.92) and 0.93 (0.88, 0.96) for a single rating and average of two independent ratings, respectively (P<0.0001). Internal consistency, measured by Cronbach's alpha, was evident (0.84 to 0.89). Test-retest reliability was demonstrated by repeat scoring of videotaped heelsticks, measured by Spearman's rho correlation (0.874, P<0.0001). CONCLUSION: This research provides beginning evidence that the N-PASS is a valid and reliable tool for assessing acute heelstick pain in infants 0 to 30 days of age, 23 to 40 weeks gestation.
RCT Entities:
OBJECTIVE: To establish evidence of clinical validity and reliability of the Neonatal Pain, Agitation, and Sedation Scale (N-PASS) in neonates with acute heelstick pain. STUDY DESIGN: Prospective psychometric evaluation, randomized crossover design. Two nurses administered the N-PASS simultaneously and independently during an actual and sham heelstick done in randomized order. One nurse also administered the Premature InfantPain Profile (PIPP) concurrently with the N-PASS. Heelsticks were videotaped for repeat analysis. RESULT: Construct (discriminate) validity was established through the Wilcoxon Signed-ranks test, comparing the distribution of the heelstick and sham N-PASS scores. The mean pain scores were 3.93 (2.30) and 0.81 (1.21) for the heelstick and sham procedures, respectively (Z=-6.429, P<0.0001). Convergent validity was demonstrated by correlation with the PIPP scores (Spearman rank correlation coefficient of 0.75 and 0.72 for raters 1 and 2, respectively). Inter-rater reliability was high, measured by intra-class coefficients; the ICC estimates (95% CI) of the pain scale were 0.86 (0.78, 0.92) and 0.93 (0.88, 0.96) for a single rating and average of two independent ratings, respectively (P<0.0001). Internal consistency, measured by Cronbach's alpha, was evident (0.84 to 0.89). Test-retest reliability was demonstrated by repeat scoring of videotaped heelsticks, measured by Spearman's rho correlation (0.874, P<0.0001). CONCLUSION: This research provides beginning evidence that the N-PASS is a valid and reliable tool for assessing acute heelstick pain in infants 0 to 30 days of age, 23 to 40 weeks gestation.
Authors: Kelly Vasquenza; Kathy Ruble; Allen Chen; Carol Billett; Lori Kozlowski; Sara Atwater; Sabine Kost-Byerly Journal: Pain Manag Nurs Date: 2014-09-26 Impact factor: 1.929