Pain assessment in paediatric intensive care: the Italian COMFORT behaviour scale
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Pain assessment in paediatric intensive care: the Italian COMFORT behaviour scale

Daniele Fagioli Nurse unit manager, Clinical pharmacy unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Costanza Evangelista Nurse research fellow, Respiratory unit, University Department of Paediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Orsola Gawronski Nurse, Professional development, continuing education and nursing research service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Emanuela Tiozzo Who is responsible for the professional development, Continuing education and nursing research service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Francesca Broccati Nurse, Emergency department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Lucilla Ravà Statistician, Clinical epidemiology unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Immacolata Dall’Oglio Nurse manager, Professional development, continuing education and nursing research service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Giancarlo Antonielli COMFORT-B study group, Emergency department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Antonella Borgiani COMFORT-B study group, Emergency department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Federica Cancani COMFORT-B study group, Emergency department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Micaela Monoscalco COMFORT-B study group, Emergency department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Claudia Zambrini COMFORT-B study group, Emergency department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Francesca Stoppa COMFORT-B study group, Emergency department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

Background Assessment of pain in paediatric intensive care units (PICUs) is crucial to minimise the risks of inadequate sedation.

Aim To translate and validate the Italian version of the COMFORT behaviour scale (CBS) in a PICU in terms of its psychometric, construct, feasibility and reproducibility properties.

Method Before and after tracheal suctioning, 71 observations were performed on 35 sedated and mechanically ventilated patients in three PICUs. Pain and distress were assessed using the CBS and the Nurse Interpretation of Sedation Score (NISS).

Results Interrater agreement and interrater reliability were high before the procedure and moderate after (pre: 100%, Cohen’s kappa = 1; post: 79%, Cohen’s kappa = 0.558). The scale’s internal consistency was calculated before and after the procedure (Cronbach’s alpha = 0.81 and 0.91). Agreement between the CBS and the NISS was low before and after the procedure (20% and 28%). The agreement between the tools was low because the NISS, a tool based on expert opinion, is not as precise as the CBS and could be affected by cultural biases.

Conclusion The Italian version of the CBS proved to be valid and reproducible for the objective measurement of pain and distress in a wide age range of patients admitted to PICUs.

Nursing Children and Young People. 30, 5,27-33. doi: 10.7748/ncyp.2018.e1081

Citation

Fagioli D, Evangelista C, Gawronski O et al (2018) Pain assessment in paediatric intensive care: the Italian COMFORT behaviour scale. Nursing Children and Young People. doi: 10.7748/ncyp.2018.e1081

Peer review

This article has been subject to open peer review and has been checked for plagiarism using automated software

Correspondence

immacolata.dalloglio@opbg.net

Conflict of interest

None declared

Acknowledgements

The authors would like to thank emergency department nurse manager Luisa Cirulli, reanimation unit nurse manager Marina Franci and the nurses who participated in the study: Claudia Barberini, Valerio Confalone, Valentina Costantini, Silvia Cristoforo, Pamela De Vita, Daniela Carbonari, Donatella Malossi, Cristiana Moro and Laura Tomei. They also thank Marina Cuttini, head of the research unit of perinatal epidemiology, clinical care and management innovation research, for the work she put into this project. The authors also acknowledge the support for linguistic revision provided by Rachele Mascolo, research fellow of professional development, continuing education and nursing research service, Bambino Gesù Children’s Hospital, Rome, Italy, and thank Monique van Dijk for granting permission to translate the COMFORT behaviour scale into Italian

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