本文選題：疼痛 + 新生兒��； 參考：《杭州師范大學(xué)》2017年碩士論文

【摘要】：目的:引進和翻譯嬰兒疼痛行為指征量表(BIIP),形成中文版BIIP(C-BIIP)并檢驗其信效度,為建立適合我國新生兒的疼痛評估方法提供研究基礎(chǔ)。同時,將其應(yīng)用于臨床一個月后調(diào)查護士對C-BIIP的使用反饋,以探索其在國內(nèi)的適用性,為我國新生兒疼痛評估提供良好的評估工具。方法:取得源量表作者同意后。首先,對BIIP進行翻譯、回譯及語義分析,確定中文版BIIP。其次,于2016年7月—2016年10月,對浙江省3家三級醫(yī)院NICU中符合納入標準的197例早產(chǎn)兒和199例足月兒采血過程進行錄像,分別記錄采血操作前30秒,操作中2分鐘及操作后1分鐘3段視頻。由經(jīng)過培訓(xùn)和考核的2名NICU護士分別使用C-BIIP和FLACC行為評分量表對3段視頻獨立評分。最后,于2016年11月,在臨床開展為期一個月的、以C-BIIP為基礎(chǔ)的疼痛評估質(zhì)量改進。一個月后調(diào)查護士的使用反饋。將所得資料錄入SPSS17.0進行統(tǒng)計分析,計算量表的信效度并對其臨床實用性進行評價。結(jié)果:(1)C-BIIP的信度測定結(jié)果:內(nèi)部一致性Cronbach a系數(shù)為0.904(早產(chǎn)兒)、0.895(足月兒);重測信度Spearman相關(guān)系數(shù)分別為0.947(早產(chǎn)兒)、0.938(足月兒);評分者信度前、中、后3個階段為0.921—0.959(早產(chǎn)兒)、0.921—0.959(足月兒)。(2)C-BIIP的效度測定結(jié)果:條目水平內(nèi)容效度和平均量表水平內(nèi)容效度均為1;語義清晰度得分為4.3—4.7;與FLACC量表的Spearman相關(guān)系數(shù)為0.948(早產(chǎn)兒)、0.896(足月兒);結(jié)構(gòu)效度通過探索性因子分析進行檢測,提取2個公因子,能解釋總方差的77.740%(早產(chǎn)兒)和80.876%(足月兒),且各項目在相應(yīng)因子上有較滿意的因子載荷量(0.4);3個采血階段患兒C-BIIP數(shù)值差異有統(tǒng)計學(xué)意義(早產(chǎn)兒:F=635.76,足月兒:F=675.54,P0.001),表明其反應(yīng)度好。(3)59.1%的護士認為C-BIIP的應(yīng)用不太費時,50%的護士在1分鐘內(nèi)就能對患兒完成疼痛評估。超過90%的護士認為C-BIIP容易掌握且可操作性強,81.8%的護士認為C-BIIP使用簡便。77.3%的護士認為C-BIIP能有效反應(yīng)患兒的疼痛且敏感性較好。86.4%的護士愿意在臨床工作中使用C-BIIP評估患兒的疼痛。此外,護士認為C-BIIP在臨床推廣的最大影響因素是“醫(yī)院和科室缺乏規(guī)定”(72.7%);其次為“缺乏培訓(xùn),不會使用”(63.6%)。結(jié)論:(1)C-BIIP具有良好的信度和效度,量表的穩(wěn)定性好、可靠性高,可用于我國新生兒患者操作性疼痛的評估;(2)C-BIIP簡潔易懂、使用方便、費時少,易被NICU的護士所接受,可在臨床推廣使用,以進一步提高疼痛管理的質(zhì)量。
[Abstract]:Objective: to introduce and translate the baby's pain behavior index scale (BIIP), to form a Chinese version of BIIP (C-BIIP) and to test its reliability and validity, and to provide the basis for establishing a suitable method for evaluating the pain of the newborn in our country. At the same time, the application of it to investigate the feedback of the nurses on the use of C-BIIP after a month of clinical application is to explore the applicability of the nurse in China. Neonatal pain assessment provides a good assessment tool. Method: after the source of the author's consent. First, BIIP translation, translation and semantic analysis, to determine the Chinese version of BIIP. second, from July 2016 to October 2016, 3 grade three hospitals in Zhejiang province in accordance with the standard 197 cases of preterm infants and 199 cases of full moon blood collection process. The video was recorded for 30 seconds before the operation, 2 minutes in the operation and 1 minutes after the operation. 2 NICU nurses who had been trained and examined used the C-BIIP and FLACC behavior scale to score the 3 segments of video separately. Finally, in November 2016, the quality of the C-BIIP based pain assessment was changed in clinical practice for one month. A month later, the use feedback of the nurses was investigated. The data were recorded into SPSS17.0 for statistical analysis, the reliability and validity of the scale were calculated and its clinical practicability was evaluated. Results: (1) the reliability of C-BIIP was measured: the internal consistency Cronbach a coefficient was 0.904 (preterm infant), 0.895 (Zu Yueer); the retest reliability Spearman correlation coefficient was respectively 0.947 (preterm infant), 0.938 (Zu Yueer); the former 3 stages were 0.921 to 0.959 (preterm infants), 0.921 to 0.959 (Zu Yueer). (2) C-BIIP validity test results: the content validity of the item level and the average content validity were 1; the semantic definition score was 4.3 - 4.7, and the Spearman correlation coefficient of the FLACC scale was 0.9. 48 (preterm infant), 0.896 (Zu Yueer); structural validity was detected by exploratory factor analysis and 2 common factors were extracted, which could explain 77.740% of the total variance (preterm infant) and 80.876% (foot month), and each item had a satisfactory factor load (0.4) on the corresponding factors. The difference of C-BIIP values in 3 blood collecting stages was statistically significant (preterm infants: F=635.76, F=675.54, P0.001) showed a good reactivity. (3) 59.1% of the nurses thought the application of C-BIIP was not too time-consuming, 50% of the nurses were able to assess the pain in the child within 1 minutes. More than 90% of the nurses thought C-BIIP was easy to master and maneuverable, and 81.8% nurses thought C-BIIP was able to use a simple.77.3% nurse. Nurses who responded effectively to children with pain and sensitivity to.86.4% were willing to use C-BIIP to assess the pain of children in clinical work. In addition, the nurses thought that the biggest influencing factor of C-BIIP was "lack of regulations in hospitals and departments" (72.7%); secondly, "lack of training, no use" (63.6%). Conclusion: (1) C-BIIP is good. The reliability and validity of the scale, the stability of the scale, high reliability, can be used in the evaluation of operational pain in our newborns; (2) C-BIIP is simple, easy to understand, easy to use, time consuming, easy to be accepted by the nurses of NICU, and can be used in clinical practice to further improve the quality of pain management.

【學(xué)位授予單位】：杭州師范大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R473.72
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本文編號：1847036