Behavioral Observation of Infants With Life-Threatening or Life-Limiting Illness in the Neonatal Intensive Care Unit.
Christine A Fortney, Stephanie D Sealschott, Rita H Pickler
PMID 32555012WHAT IT FOUND
In critically ill NICU infants, trained observer pain and distress scores did not match bedside nurses' N-PASS scores or mothers' symptom reports.
Higher technology dependence was related to nurse scores and mother reports.
Key findings
01COMFORT-B scores were not correlated with nurse-documented N-PASS scores or mothers' symptom scores.
02Technology dependence scores had a small negative relationship with COMFORT-B scores and moderate positive relationships with mothers' symptom scores and nurse-documented N-PASS scores.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done in a Midwestern NICU only, so the results may not apply to other units. The infants had many different diagnoses and ages, which may make the relationships harder to interpret. COMFORT-B observations were time-consuming and costly, and scheduling was difficult in the busy NICU. N-PASS scores were collected by bedside nurses who may have had minimal training and no routine checks of agreement between nurses. Electronic health record data can be missing, biased, or unreliable for research. Mothers' symptom surveys were collected weekly and were not timed to the other measures. The analysis used only the early weeks because scores decreased and remained low later. The study compared assessment scores, not treatment effects.
Declared interests
Publication type indicates NIH extramural research support, and the authors report no conflicts of interest.
The easy way to misread this
Do not conclude that trained observer COMFORT-B scores are more accurate than bedside nurse N-PASS scores. The authors say that is an untested assumption, and the scores came from different observers with different training and documentation routines.