Karin Schenk1, Eva Cignacco1, Bonnie Stevens2, Liliane Stoffel1, Dirk Bassler1, Mathias Nelle1
1) Switzerland 2) Canada
The Bernese Pain Scale for Neonates (BPSN) is a multidimensional pain assessment tool that is already widely used in clinical settings in the German speaking areas of Europe. Increasing evidence indicates that pain responses of neonates are influenced by individual contextual factors, e.g., gestational age (GA) and previous pain experience. Because the BPSN focuses entirely on behavioral and physiological indicators, a validation of the BPSN with consideration of the influence of individual contextual factors on pain responses is needed. The results of this analysis will be used for modification of the BPSN.
This prospective observational study with repeated measures design takes place in three university hospital neonatal intensive care units in Switzerland. Among preterm infants, 2-5 routine capillary heel sticks, and among full-term infants, two heel sticks during their first 14 days of life are documented. For each heel stick, three phases are produced: baseline, heel stick, and recovery. All phases are videotaped and the infant’s pain responses are rated according to the BPSN by five nurses who are blinded to the measurement phases. Individual contextual factors of interest are: GA at time of birth and the day of each heel stick; number of previous painful and non-painful procedures before each heel stick; health status at time of birth; therapeutic interventions (e.g. medication, ventilation); gender. The psychometric testing of the BPSN will involve an exploratory factor analysis and the examination of the construct validity, interrater reliability, sensitivity and specificity.
Preliminary results of the psychometric testing will be presented, including the results of the exploratory factor analysis and the interrater reliability.
The validation of the BPSN with consideration for contextual factors will lead to a modification of the existing version. The revised version is expected to more accurately measure the highly multidimensional phenomenon of acute pain in preterm and full-term infants.
