【作者】 贾勇刚；

【导师】 谭惠仪；

【作者基本信息】 暨南大学 ， 临床护理， 2012， 硕士

【摘要】 研究目的：检验三种行为观察量表在评估烧伤婴幼儿患者创面换药过程中疼痛的信度和效度，探讨量表在临床应用中的影响因素。研究方法：将临床上符合纳入标准的烧伤婴幼儿患者创面换药过程进行录像记录，从中选取24段视频，分为A、B、C三组，分别为打开敷料至创面处理前组、创面处理过程组和处理后的包扎过程组，每组8段视频，每段时长2分钟。采用便利抽样的方法选取广州市某三甲医院55名护理本科实习生，首先对他们进行三种行为观察量表即COMFORT行为量表、FLACC量表和POCIS量表的应用培训，然后对24段视频中患儿的疼痛情况进行评分。第一次评分两个月后再进行第二次评分。对评分结果进行信度和效度分析。结果：(1).COMFORT行为量表的测量者间信度为0.82-0.85，克朗巴赫α系数为0.869-0.873，前后两次评分结果间的相关系数为0.597；FLACC量表的测量者间信度为0.79-0.82，克朗巴赫α系数为0.709-0.799，前后两次评分结果间的相关系数为0.645；POCIS量表的测量者间信度为0.78-0.80，克朗巴赫α系数为0.846-0.856，前后两次评分结果间的相关系数为0.657。三个量表间的Pearson相关系数均大于0.822，且P=0.000。(2).COMFORT行为量表和FLACC量表各组间的疼痛评分结果有差异，前后两次评分的P值分别为0.013、0.023和0.019、0.007，POCIS量表各组间的评分结果没有显著差异（P值分别为0.102、0.099）。(3).COMFORT行为量表中得分最高的项目是“警觉状态”（4.16、4.12），最低的是“肌肉张力”（3.32、3.35）；FLACC量表中得分最高的项目是“哭闹”和“可安抚程度”（1.45、1.38），最低的是“身体情况”（1.12、1.19）；POCIS量表中得分最高的项目是“面部”（0.94、0.94），最低的是“呼吸”（0.81、0.79）。结论：(1).三种量表的测量者间信度、重测信度和克朗巴赫α系数均较好，量表间的评分结果一致性较高。(2).COMFORT行为量表和FLACC量表能够区分评估对象烧伤创面换药过程中不同阶段的疼痛程度，而POCIS量表不能有效区分不同阶段的疼痛情况。(3).由于研究方法的局限性，各量表的效度有待进一步的研究。更多还原

【Abstract】 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.更多还原