A Systematic Integrative Review of Infant Pain Assessment Tools

Lenora J. Duhn, RN, MSc; Jennifer M. Medves, RN, PhD


Adv Neonatal Care. 2004;4(3) 

In This Article

Critiquing Existing Pain Assessment Tools

The terms measurement, tool, and instrument have been used interchangeably in the literature, but for the purposes of this article, the term tool will be used. The creation of an assessment tool to examine a construct such as pain is a complex, time-consuming process. The decision to develop a new tool must come after careful consideration of existing tools and their strengths and limitations. Tool development requires significant expertise in both the concept and the research process required to develop and test a tool that will evaluate, discriminate, or predict the concept. An outline of the development process is presented in Sidebar 1. Clinicians are encouraged to avoid a common pitfall of underestimating the work of tool development and magnifying the deficiencies of existing tools.[20]

When searching for a valid pain assessment tool, it is important to compare and contrast key charac-teristics of each tool, keeping in mind the setting and population included in the testing. Table 1 defines key terms; these concepts can serve as an impor-tant basis of comparison when evaluating tools for clinical use.

Pain assessment tools must be reliable, valid, have clinical utility, and be feasible to use.[1,21] The NANN Pain Assessment and Management Guideline for Practice acknowledges that although neonatal pain assessment should be done with a reliable and valid multidimensional tool, "very few multidimensional pain measures have established adequate psychometric properties and clinical utility for use with infants."[13] The guideline cites the Premature Infant Pain Profile (PIPP)[22] and the CRIES tool[23] as meeting this criteria. The Neonatal Infant Pain Scale (NIPS)[24] is noted as having a high degree of validity and reliability, but has limited reported clinical utility.


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