Recently, investigators have become increasingly interested in developing methods that would accurately identify neonates who are experiencing pain. Given that neonates are unable to provide verbal reports of their pain, several indirect assessment tools (e.g., facial expression, physiological and hormonal/metabolic changes in response to painful events) have been presented in the literature. In addition, previous research has uncovered several contextual variables that impact on the expression of pain in neonates, such as behavioural state, gestational age, weight, illness severity, analgesic use, and number of previous procedures. However, the methodological limitations of these studies have prevented the development of a more comprehensive model of contextual influences on pain behaviour either by not considering these variables simultaneously or by using a restricted sample. In the present study, the facial expressions of neonates in the tertiary neonatal intensive care units of a children's hospital, and a general hospital with maternity facilities, were videotaped during a routine venepuncture procedure to determine the degree to which the various contextual variables influence pain behaviour. Using covariance structure analyses, this study found support for a well-fitting model that explained 94% of the observed covariance in the data. Specifically, 27% of the variance of the facial expression of pain was influenced by behavioural state, and illness severity. There was also an indirect effect of physical maturity on pain behaviour, mediated through illness severity. The number of previous procedures was not found to impact on subsequent pain behaviour, and this path was removed from the model. Finally, the ability of analgesic medication to attenuate the experience of subsequent pain could not be tested because too few neonates received such medication during their stay in the NICU.
| Identifer | oai:union.ndltd.org:uottawa.ca/oai:ruor.uottawa.ca:10393/4378 |
| Date | January 1998 |
| Creators | Korol, Christine T. |
| Contributors | Goodman, J., |
| Publisher | University of Ottawa (Canada) |
| Source Sets | Université d’Ottawa |
| Detected Language | English |
| Type | Thesis |
| Format | 74 p. |
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