INTER-RATER RELIABILITY AND FEASIBILITY OF USING THE COMFORT-B (Thai) AND THE MODIFIED FLACC (Thai) PAIN SCALE BY NURSES AFTER EDUCATION AND SKILL TRAINING IN POST-SURGICAL PAIN FOR VENTILATED THAI CHILDREN
Keywords:
inter-rater reliability, feasibility, The COMFORT-B (Thai), The modified FLACC (Thai)Abstract
This study aimed to evaluate the inter-rater reliability and feasibility of the COMFORT-B (Thai) scale and the modified FLACC (Thai) scale by nurses after education and skill training in assessing post-surgical pain in ventilated Thai children between a standardized person and nurses in a Pediatric Intensive Care Unit (PICU). Nineteen nurses received on-ward training from the researcher in pediatric pain knowledge and skills and how to use both scales in assessing post-surgical pain in ventilated children from videos and the real situation. Then, each nurse simultaneously and independently observed and evaluated post-surgical pain in ventilated children from sets of videos using these scales. Interrater reliability between the standardized person and nurses was analyzed by Cohen's Kappa, and the feasibility of using these two scales was analyzed by percentage.
Results revealed that the overall Kappa scores of the COMFORT-B (Thai) and the modified FLACC (Thai) scale between the standardized person and all nurses were .86 and .89, respectively, which can be categorized as very good. For the feasibility of the modified FLACC (Thai) scale, all items were rated as either 3 or 4 by 100% of nurses. Nurses’ agreement with the feasibility of the COMFORT-B (Thai) was rated as either 3 or 4 by < 70% in the items of the scale being quick and easy to use to assess post-surgical pain in ventilated children. These findings indicate that teaching and workshop training on how to use these scales until nurses meet the acceptable agreement percentage of ≥ 80% will enhance their knowledge and skills to use the pain scales adequately in clinical practice.
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