Generating basic knowledge about neonatal distress behavior associated with acute pain (newborn distress related pain behavior)

One of the most difficult challenges facing researchers and clinicians is assessing pain in the newborn infant. Twenty-five years of investigation have furthered our understanding of many aspects of newborn pain, however, no uniform technique exists to reliably assess neonatal pain. Behaviors provide one of the most promising avenues for generating basic understanding of complex behavioral phenomenon and they are key to developing the kinds of descriptive knowledge required to further pain assessment and measurement efforts. In this research, basic descriptive knowledge about newborn pain behavior was generated using ethological methods.; In Phase One, the videotaped behaviors of ten newborn male infants were repeatedly observed as each underwent circumcision and non-noxious but distress-inducing events such as diaper change and restraint application. A reliable ethogram (an exhaustive listing) was developed that contained 235 molar and molecular behavioral items for describing variation in neonatal motor movement, body postures, responsiveness, self-comfort, respiration and vocalization. In Phase Two, precise duration and frequency measures of behaviors were obtained along with descriptions of the pain context from 67 minutes of videotaped data, involving four other male neonates who had undergone the same surgery. The same distress events were coded at 1-second intervals (4010 seconds total) using the ethogram from Phase One. Rank ordering of the duration scores led to the identification of 40 distress behaviors as they occurred along the continuum of distress; 13 behaviors as they occurred specific to the acute noxious event; and 25 behaviors that occurred following the three distress events. Two neonates exhibited increased sensitivity to otherwise neutral stimuli and increased frequency and prolonged durations of extreme distress following circumcision.; The thesis includes four manuscripts; two present the findings of the sequential phases of the research. One manuscript gives an overview of the research literature on neonatal pain responses and another discusses the utility of ethological methods for developing nursing knowledge about human behaviors. The document concludes with a summary chapter containing recommendations for further study.