婴儿疼痛行为指征量表的信效度检测及其适用性研究

发布时间：2018-05-05 08:50

  本文选题：疼痛 + 新生儿　； 参考：《杭州师范大学》2017年硕士论文

【摘要】：目的:引进和翻译婴儿疼痛行为指征量表(BIIP),形成中文版BIIP(C-BIIP)并检验其信效度,为建立适合我国新生儿的疼痛评估方法提供研究基础。同时,将其应用于临床一个月后调查护士对C-BIIP的使用反馈,以探索其在国内的适用性,为我国新生儿疼痛评估提供良好的评估工具。方法:取得源量表作者同意后。首先,对BIIP进行翻译、回译及语义分析,确定中文版BIIP。其次,于2016年7月—2016年10月,对浙江省3家三级医院NICU中符合纳入标准的197例早产儿和199例足月儿采血过程进行录像,分别记录采血操作前30秒,操作中2分钟及操作后1分钟3段视频。由经过培训和考核的2名NICU护士分别使用C-BIIP和FLACC行为评分量表对3段视频独立评分。最后,于2016年11月,在临床开展为期一个月的、以C-BIIP为基础的疼痛评估质量改进。一个月后调查护士的使用反馈。将所得资料录入SPSS17.0进行统计分析,计算量表的信效度并对其临床实用性进行评价。结果:(1)C-BIIP的信度测定结果:内部一致性Cronbach a系数为0.904(早产儿)、0.895(足月儿);重测信度Spearman相关系数分别为0.947(早产儿)、0.938(足月儿);评分者信度前、中、后3个阶段为0.921—0.959(早产儿)、0.921—0.959(足月儿)。(2)C-BIIP的效度测定结果:条目水平内容效度和平均量表水平内容效度均为1;语义清晰度得分为4.3—4.7;与FLACC量表的Spearman相关系数为0.948(早产儿)、0.896(足月儿);结构效度通过探索性因子分析进行检测,提取2个公因子,能解释总方差的77.740%(早产儿)和80.876%(足月儿),且各项目在相应因子上有较满意的因子载荷量(0.4);3个采血阶段患儿C-BIIP数值差异有统计学意义(早产儿:F=635.76,足月儿:F=675.54,P0.001),表明其反应度好。(3)59.1%的护士认为C-BIIP的应用不太费时,50%的护士在1分钟内就能对患儿完成疼痛评估。超过90%的护士认为C-BIIP容易掌握且可操作性强,81.8%的护士认为C-BIIP使用简便。77.3%的护士认为C-BIIP能有效反应患儿的疼痛且敏感性较好。86.4%的护士愿意在临床工作中使用C-BIIP评估患儿的疼痛。此外,护士认为C-BIIP在临床推广的最大影响因素是“医院和科室缺乏规定”(72.7%);其次为“缺乏培训,不会使用”(63.6%)。结论:(1)C-BIIP具有良好的信度和效度,量表的稳定性好、可靠性高,可用于我国新生儿患者操作性疼痛的评估;(2)C-BIIP简洁易懂、使用方便、费时少,易被NICU的护士所接受,可在临床推广使用,以进一步提高疼痛管理的质量。
[Abstract]:Objective: to introduce and translate the baby's pain behavior index scale (BIIP), to form a Chinese version of BIIP (C-BIIP) and to test its reliability and validity, and to provide the basis for establishing a suitable method for evaluating the pain of the newborn in our country. At the same time, the application of it to investigate the feedback of the nurses on the use of C-BIIP after a month of clinical application is to explore the applicability of the nurse in China. Neonatal pain assessment provides a good assessment tool. Method: after the source of the author's consent. First, BIIP translation, translation and semantic analysis, to determine the Chinese version of BIIP. second, from July 2016 to October 2016, 3 grade three hospitals in Zhejiang province in accordance with the standard 197 cases of preterm infants and 199 cases of full moon blood collection process. The video was recorded for 30 seconds before the operation, 2 minutes in the operation and 1 minutes after the operation. 2 NICU nurses who had been trained and examined used the C-BIIP and FLACC behavior scale to score the 3 segments of video separately. Finally, in November 2016, the quality of the C-BIIP based pain assessment was changed in clinical practice for one month. A month later, the use feedback of the nurses was investigated. The data were recorded into SPSS17.0 for statistical analysis, the reliability and validity of the scale were calculated and its clinical practicability was evaluated. Results: (1) the reliability of C-BIIP was measured: the internal consistency Cronbach a coefficient was 0.904 (preterm infant), 0.895 (Zu Yueer); the retest reliability Spearman correlation coefficient was respectively 0.947 (preterm infant), 0.938 (Zu Yueer); the former 3 stages were 0.921 to 0.959 (preterm infants), 0.921 to 0.959 (Zu Yueer). (2) C-BIIP validity test results: the content validity of the item level and the average content validity were 1; the semantic definition score was 4.3 - 4.7, and the Spearman correlation coefficient of the FLACC scale was 0.9. 48 (preterm infant), 0.896 (Zu Yueer); structural validity was detected by exploratory factor analysis and 2 common factors were extracted, which could explain 77.740% of the total variance (preterm infant) and 80.876% (foot month), and each item had a satisfactory factor load (0.4) on the corresponding factors. The difference of C-BIIP values in 3 blood collecting stages was statistically significant (preterm infants: F=635.76, F=675.54, P0.001) showed a good reactivity. (3) 59.1% of the nurses thought the application of C-BIIP was not too time-consuming, 50% of the nurses were able to assess the pain in the child within 1 minutes. More than 90% of the nurses thought C-BIIP was easy to master and maneuverable, and 81.8% nurses thought C-BIIP was able to use a simple.77.3% nurse. Nurses who responded effectively to children with pain and sensitivity to.86.4% were willing to use C-BIIP to assess the pain of children in clinical work. In addition, the nurses thought that the biggest influencing factor of C-BIIP was "lack of regulations in hospitals and departments" (72.7%); secondly, "lack of training, no use" (63.6%). Conclusion: (1) C-BIIP is good. The reliability and validity of the scale, the stability of the scale, high reliability, can be used in the evaluation of operational pain in our newborns; (2) C-BIIP is simple, easy to understand, easy to use, time consuming, easy to be accepted by the nurses of NICU, and can be used in clinical practice to further improve the quality of pain management.

【学位授予单位】：杭州师范大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.72
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本文编号：1847036