| Background:Pain is the fifth vital sign of the human body.In the second trimester,the fetus has the ability of pain perception,and the pain threshold is lower than that of normal adults.Long-term repeated pain stimulation not only disrupts the vital signs and homeostatic environment of newborns,increases the difficulty of diagnosis and treatment,but also affects the development and structure of their brain,reduces the quality of the population,and causes a serious burden on families and society.Therefore,it is an important issue for medical workers to pay attention to neonatal pain management and ensure its effective relief.Pain assessment is the core foundation and prerequisite of pain management.Neonates do not have the ability of language expression,and their pain assessment must rely on others,so the pain assessment scale has become the first choice of pain assessment tool recognized by the international community.However,the practice of neonatal pain assessment at home and abroad was not ideal,with the global rate of neonatal pain assessment being only 6%-50.3%.The limitation of existing assessment scales is the key reason that restricts the improvement of neonatal pain assessment rate at home and abroad and restricts the development of neonatal pain management.Therefore,it is an urgent practical problem to break through the limitations of existing scales,such as single application scope,complex evaluation method and long time to use,and develop a neonatal pain assessment tool with simple evaluation method and strong practicability,which is applicable to different clinical situations at the same time.Under the circumstances,our research group constructed the Lan’s Neonatal Pain Scale,the original scale was developed and the version of acute pain was formed,its reliability and validity was good.This study explored the application versions of the scale in three clinical situations:postoperative pain,mechanical ventilation pain and continuous pain.In addition,this study conducted reliability and validity testing and applicability evaluation of it,to provide an effective evaluation tool for neonatal pain management in China,so as to improve the clinical neonatal pain assessment rate,provide an important basis for pain management,and ultimately reduce the adverse effects of pain on neonates.Objective:1.To adjust and form the application version of Lan’s Neonatal Pain Scale for postoperative pain assessment of neonates and test reliability and validity of it.2.To adjust and form the application version of Lan’s Neonatal Pain Scale for mechanical ventilation pain assessment of neonates and test reliability and validity of it.3.To adjust and form the application version of Lan’s Neonatal Pain Scale for continuous pain assessment of neonates and test reliability and validity of it.4.To evaluate the clinical feasibility,applicability and application prospect of the scale by training nurses to use the scale for pain assessment.Methods:1.The formation and reliability and validity test of Lan ’s Neonatal Pain Scale-Postoperative Pain VersionThe convenience sampling method was adopted to select 67 newborns with surgery for the first time who hospitalized in a third-grade A children’s hospital in Chongqing as the research objects.General data were collected and pain response videos were recorded.Two nurses independently used LNPS and N-PASS for pain assessment,respectively.Then factor analysis method,correlation coefficient method and critical ratio method are used for item analysis and item screening to determine the selected items.The receiver operating characteristic curve was draw to classify the degree of pain,the postoperative pain version was formed,and the reliability and validity of the scale were evaluated.2.The formation and reliability and validity test of Lan ’s Neonatal Pain Scale-Mechanical Ventilation Pain VersionThe convenience sampling method was adopted to select 92 newborns with mechanical ventilation who hospitalized in a third-grade A children’s hospital in Chongqing as the research objects.General data were collected and pain response videos were recorded.Two nurses independently used LNPS and COMFORT-neo for pain assessment,respectively.Then factor analysis method,correlation coefficient method and critical ratio method are used for item analysis and item screening to determine the selected items.The receiver operating characteristic curve was draw to classify the degree of pain,the mechanical ventilation pain version was formed,and the reliability and validity of the scale were evaluated.3.The formation and reliability and validity test of Lan ’s Neonatal Pain Scale-Continuous Pain VersionThe convenience sampling method was adopted to select 52 newborns who were diagnosed as neonatal necrotizing enterocolitis during hospitalization and received conservative medical treatment in a third-grade A children’s hospital in Chongqing as the research objects.General data were collected and pain response videos were recorded.Two nurses independently used LNPS and EDIN for pain assessment,respectively.Then factor analysis method,correlation coefficient method and critical ratio method are used for item analysis and item screening to determine the selected items.The receiver operating characteristic curve was draw to classify the degree of pain,the continuous pain version was formed,and the reliability and validity of the scale were evaluated.4.Evaluation of the application effect of the Lan’s Neonatal Pain Scale18 nurses of neonatal departments in 6 Grade III A hospitals in Chongqing were selected as the research objects.The methods of theoretical teaching,operational teaching,video interpretation,manual interpretation and on-site Questions & Answer were used to train the use of the scale.The training effects were evaluated by theoretical assessment before and after the training and operational assessment after the training.Questionnaires were used to investigate nurses’ cognition and evaluation of the scale,including its clinical feasibility,practicability and satisfaction.Results:1.Lan’s Neonatal Pain Scale-Postoperative Pain Version contains a total of 5 items,which are "Heart rate","Percutaneous oxygen saturation","Consolability","Reaction to pain stimulation" and "Facial expression".Each item is scored 0-2 points and the total score is 0-10 points.The pain rating of it was 0-3 painless or mild pain,4-7 moderate pain,and 8-10 severe pain.The internal consistency reliability was 0.905,the split-half reliability was 0.935,the inter-rater reliability was 0.943,and the test-retest reliability was 0.969,indicating that the scale had good reliability.The correlation coefficient between each item and the total score of the scale was 0.575-0.942(P<0.01),showing a medium and high correlation.The factor loadings of each item were 0.648,0.712,0.953,0.954 and 0.956,all greater than 0.5.The criterion-related validity was 0.914(P<0.01),indicating that the scale validity was good.2.Lan ’ s Neonatal Pain Scale-Mechanical Ventilation Pain Version contains a total of 4 items,which are "Heart rate","Consolability","Reaction to pain stimulation" and "Facial expression".Each item is scored0-2 points and the total score is 0-8 points.The pain rating of it was 0-3painless or mild pain,4-8 moderate or severe pain.The internal consistency reliability was 0.880,the split-half reliability was 0.870,the inter-rater reliability was 0.817,and the test-retest reliability was 0.927,indicating that the scale had good reliability.The correlation coefficient between each item and the total score of the scale was 0.663-0.911(P<0.01),showing a medium and high correlation.The factor loadings of each item were 0.614,0.940,0.946 and 0.924,all greater than 0.5.The criterion-related validity was 0.880(P<0.01),indicating that the scale validity was good.3.Lan’s Neonatal Pain Scale-Continuous Pain Version contains a total of 4 items,which are " Percutaneous oxygen saturation ","Consolability","Reaction to pain stimulation" and "Facial expression".Each item is scored0-2 points and the total score is 0-8 points.The pain rating of it was 0-5painless or mild pain,6-8 moderate or severe pain.The internal consistency reliability was 0.870,the split-half reliability was 0.863,the inter-rater reliability was 0.980,and the test-retest reliability was 0.920,indicating that the scale had good reliability.The correlation coefficient between each item and the total score of the scale was 0.610-0.930(P<0.01),showing a medium and high correlation.The factor loadings of each item were 0.522,0.938,0.952 and 0.960,all greater than 0.5.The criterion-related validity was 0.903(P<0.01),indicating that the scale validity was good.4.After training of how to use Lan’s Neonatal Pain Scale,the average score of theoretical examination was 92.222±3.687,which was higher than the average score of theoretical examination before training,the difference was statistically significant(P<0.01).The total correct rate of theoretical examination after training was 91.67%,which was higher than that before training of 77.78%,and the difference was statistically significant(P<0.01).And the total correct rate of operation examination after training was94.44%,which shows that the training nurses have a good mastery degree of the training content.5.The results of the questionnaire survey showed that the average score of all the 11 evaluation items of the scale evaluation was higher than4,indicating that the trained nurses had a good estimate of the scale and a high degree of satisfaction.Conclusion:1.LNPS-P,LNPS-V and LNPS-C all had good reliability and validity,and the sensitivity of the items was good.The scale had a reasonable number of items and was simple to use.It can be used as a neonatal pain assessment tool for postoperative pain,mechanical ventilation pain and continuous pain,and can provide theoretical basis and practical paradigm for the same type of research in the future.2.The training on the use of the Lan’s Neonatal Pain Scale can effectively improve the participants’ theoretical level and operational level about the use of the scale.3.Lan’s Neonatal Pain Scale was easy to learn and had good feasibility,practicability and satisfaction,and was worthy of further popularization and application. |
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