The Application Study Of Three Types Of Pain Behavioural Observation Scales For Pain Measurement In Young Children With Burns

Objective:This study was to assess if the COMFORT behavioral scale, FLACC scale and POCISscale are reliable and valid instruments to measure burns pain in young children, and todiscuss the factors of affecting the clinical application.Methods:The process of dressing change for those young children with burns of meeting theinclusion criteria in clinical was recorded on video. The24segments of videos wereselected from the recorded, which were divided into three groups: A. the process ofopening dressing until the moment of being ready to treating burn wound, B. the processof treating the burn wound, C. the process of binding up after the treatment. Each groupconsists of eight segments videos with two minutes for each segment video. Byconvenience sampling,55nursing undergraduate interns were selected from a3-A-gradehospital of Guangzhou. At first, they were trained to learn about application of the threescales, then conditions of pain related to the young children with burns were gradedamong24segments videos. Besides, the second time for grading were conducted aftertwo months of the first time for that. And the reliability and validity of assessment resultswere analyzed.Results:(1).The inter-raters reliability of COMFORT behavioral scale is0.82-0.85, Cronbach’salpha is0.869-0.873, and the related coefficient is0.597between the first time and secondtime assessment. The inter-raters reliability of FLACC scale is0.79-0.82, Cronbach’salpha is0.709-0.799, and the related coefficient is0.645between two assessments. Theinter-raters reliability of POCIS scale is0.78-0.80, Cronbach’s alpha is0.846-0.856, andthe related coefficient is0.657between two assessments. The Pearson Correlation amongthe three scales are all above0.822, and P=0.000.(2).The pain assessment results varyamong each group of COMFORT behavioral scale and FLACC scale (P-value is0.013,0.023and0.019,0.007respectively). There is no significant difference for the assessment results among each groups of POCIS scale.(P-value is0.102,0.099).(3).The item withthe highest score is “alertness”（4.16,4.12）in the COMFORT behavior scale, and theitem with the lowest score is “muscle tone”（3.32,3.35）; the items with the highest scorein the FLACC scale are “cry” and “consolability”（1.45,1.38）and the item with thelowest score is “activity”（1.12,1.19）; the item with the highest score in the POCIS scaleis “facial”（0.94,0.94）and the item with the lowest score is “breath”（0.81,0.79）.Conclusion:From the above research, we can conclude that the inter-raters reliability, test-retestreliability as well as the Cronbach’s alpha are preferably among the three scales. What’smore, it has a higher consistency of assessment results among the scales, and theCOMFORT behavior scale and the FLACC scale are able to distinguish the various stagesof pain degree of assessment objects while the POCIS scale can’t distinguish the variousstages of pain condition effectively. Due to the limitation of research methods, the validityof each scale needs to be further researched.