1. Beal, Judy A. DNSc, PNP, RN
  2. Wood, Sylvia H. MSN, CNM, RN

Article Content

Spence, K., Gillies, D., Harrison, D., Johnston, L., & Nagy, S. (2005).Journal of Obstetric, Gynecologic, and Neonatal Nursing,34(1), 80-86.


This prospective descriptive and correlational study tested the validity and reliability of the Pain Assessment Tool (PAT) (Hodgkinson, Bear, Thorn, & Van Blaricum, 1994). While pain in the newborn has been well documented and there are many tools for nurses to use in the neonatal intensive care unit (NICU) to assess and document pain, most of these are used inconsistently, if at all (Franck, 2002). Some of these tools have not been tested for validity and reliability, and many nurse clinicians remain confused as to which tools are most appropriate to use. Unlike the majority of existing pain assessment tools, the PAT assesses both behavioral and physiologic pain cues and is appropriate for use and testing during routine nursing assessment, not just procedural pain. In this study with 144 preterm and term infants in NICUs in two Australian children's hospitals, the user-friendly PAT was tested for both validity and interrater reliability. Two nurses simultaneously assessed infant pain using the PAT, and the inter-rater reliability showed a strong correlation (r = .85), indicating good reliability between raters and stability of scoring. Validity of the PAT was also tested (by two experienced neonatal nurses) against the CRIES score (crying, requires increased oxygenation administration, increased vital signs, expression, sleeplessness) (Krechel & Bildner, 1955) and against maternal perception of infant pain using a visual analog scale (fixed 10-point scale ranging from "no pain" to "severe pain"). The CRIES tool was developed for use in postoperative infants, incorporates both behavioral and physiologic measures, and has documented validity and reliability. A strong correlation (r =.76) was found between the PAT and CRIES but weaker correlation (r = .38) between the PAT and the mothers' perceptions of pain. Even when surgical and nonsurgical and preterm and term infants were compared, correlations remained strong. The results of this study suggest that the PAT may be a valid and reliable infant pain assessment tool for most infants. Nurses should feel comfortable using valid and reliable pain assessment tools such as the PAT. Further research is of course warranted to expand these findings to all groups of infants.


Comment by Judy Beal

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Franck, L. S. (2002). Some pain, some gain: Reflections of the past two decades of neonatal pain research. Neonatal Network, 21, 37-41. [Context Link]


Hodgkinson, K., Bear, M., Thorn, J., & Van Blaricum, S. (1994). Measuring pain in neonates: Evaluating an instrument and developing a common language. Australian Journal of Advanced Nursing, 12 (1), 17-22. [Context Link]


Krechel, S., & Bildner, J. (1995). CRIES: A new postoperative pain measurement score: Initial testing of validity and reliability. Paediatric Anaesthesia, 5, 53-61. [ISI] [Medline].