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Evaluation of NICU Nurses' Competence in Pain Assessment 5 Years After Implementation of the COMFORTneo Scale

Stenkjaer, Rikke Louise CCRN, MVO; Pedersen, Preben Ulrich PhD, RN; Hundrup, Yrsa Andersen PhD, RN; Weis, Janne PhD, CCRN

Section Editor(s): Dowling, Donna PhD, RN; ; Thibeau, Shelley PhD, RNC-NIC;

doi: 10.1097/ANC.0000000000000636
Original Research

Background: Adequate pain management of preterm and sick newborn infants is a critical issue in the neonatal intensive care unit, as the infants are small and vulnerable with limited resources to deal with pain and stressful experiences. The use of pain assessment instruments, however, must be applied correctly to achieve consistency and improve continuity in care and treatment among clinicians.

Purpose: To assess the development of neonatal intensive care unit nurses' interrater agreement in using the COMFORTneo pain assessment tool 5 years after initial implementation, and to identify items needing further development through analysis of discrepancies among nurses' COMFORTneo scores.

Methods: An evaluation study with a pre- and postdesign comparing nurses' interrater reliability in assessing infant pain using the COMFORTneo pain assessment tool at baseline and 5-year follow-up.

Results: Eighty-five percent of the nurses in the follow-up group (n = 26) had improved their skills 5 years after the implementation, and the improvement was significant (P < .000). We also found that interrater reliability was satisfactory (κ scores ≥0.65) for all the items of the COMFORTneo tool. However, to obtain “very good” interrater reliability (κ scores ≥0.80) 3 items were identified needing increased focus.

Implications for Practice: A thorough implementation of a national clinical guideline has been partially effective in ensuring that nurses used the COMFORTneo in their daily practice, which increased their competence in pain assessment.

Implications for Research: Further research into the education of nurses on the efficacy of pain scales, nonpharmacologic and pharmacologic therapies, and individualized pain assessment is needed to better address pain management.

Department of Neonatology, Rigshospitalet University Hospital, Copenhagen, Denmark (Ms Stenkjaer and Dr Weis); and Danish Centre of Clinical Guidelines and Danish Centre of Systematic Reviews, Health Science and Technology, University of Aalborg, Denmark (Drs Pedersen and Hundrup).

Correspondence: Rikke Louise Stenkjaer, CCRN, MVO, Department of Neonatology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark (

The authors declare no conflicts of interest.

© 2019 by The National Association of Neonatal Nurses