Psychometric properties of the Pediatric Nurses’ Knowledge and Attitudes Survey Regarding Pain (PNKAS). An Italian multisite cross-sectional validation study
Keywords:
Pediatric nursing, reliability, validity, validation study, painAbstract
Background and aim. Several studies have highlighted a lack of nursing knowledge regarding the assessment and management of pediatric pain. Because there is currently no specific tool for the assessment of pain knowledge in pediatric nursing professionals in Italy, the aim of the study was to translate into Italian, adapt, and validate the questionnaire “Pediatric Nurses’ Knowledge and Attitudes Survey Regarding Pain, in order to analyze its psychometric properties, providing a suitable tool for the assessment of pain.
Study design. A multisite cross-sectional validation study was conducted and a convenience sample of italian nurses was enrolled.
Results. A total of 233 nurses responded. Analyses demonstrated the “Pediatric Nurses’ Knowledge and Attitudes Survey Regarding Pain” factorial validity and internal consistency. The overall Cronbach’s alpha coefficient of the scale was 0.728. Pearson’s correlation coefficient was calculated between the test and retest phase, obtaining a value of r = 0.712 (p < .001). The intraclass correlation coefficient was 0.801 (95% confidence interval = 0.428-0.806). The Infit and Outfit statistical analysis fell within acceptable ranges from 0.85 to 2.50. The item difficulty ranged from −2.64 to 2.51. Out of total of 9,553 questions, 5,717 were answered correctly (correct answer rate 59.8%). No questionnaire had 80% or less of the correct answers.
Conclusion. The scale designed in this study is valid and reliable for use in the Italian context and is applicable where one wants to evaluate nursing knowledge on the subject of pediatric pain.
References
1. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020 Sep 1;161(9):1976-1982. doi: 10.1097/j.pain.0000000000001939. PMID: 32694387; PMCID: PMC7680716.
2. Damico V, Murano L, Cazzaniga F, Dal Molin A. Pain prevalence, severity, assessment and management in hospitalized adult patients: a result of a multicenter cross sectional study. Ann Ist Super Sanita. 2018 Jul-Sep;54(3):194-200. doi: 10.4415/ANN_18_03_05. PMID: 30284545.
3. Al Qadire M, Al Khalaileh M. Jordanian nurses knowledge and attitude regarding pain management. Pain Manag Nurs. 2014 Mar;15(1): 220-8. doi: 10.1016/j.pmn.2012.08.006. Epub 2012 Oct 4. PMID: 24602438.
4. Greipp ME. Undermedication for pain: an ethical model. ANS Adv Nurs Sci. 1992 Sep;15(1):44-53. doi: 10.1097/00012272-199209000-00007. PMID: 1519910.
5. Ethic Code of Italian Nurses. (2019). Number article 34. Available from: https://www.quotidianosanita.it/allegati/ allegato9419865.pdf [Last accessed: 2025, Jan 20].
6. Zhou L, Liu XL, Tan JY, Yu HP, Pratt J, Peng YQ. Nurseled educational interventions on cancer pain outcomes for oncology outpatients: A systematic review. Int Nurs Rev. 2015 Jun;62(2):218-30. doi: 10.1111/inr.12172. Epub 2015 Feb 25. PMID: 25711778.
7. Wengström Y, Rundström C, Geerling J, Pappa T, Weisse I, Williams SC, et al. The management of breakthrough cancer pain-Educational needs a european nursing survey. Eur J Cancer Care (Engl). 2014 Jan;23(1):121-8. doi: 10.1111/ ecc.12118. Epub 2013 Sep 15. PMID: 24079835.
8. Benini F, Orzalesi M, de Santi A, Congedi S, Lazzarin P, Pellegatta F, et al. Barriers to the development of pediatric palliative care in Italy. Ann Ist Super Sanita. 2016 OctDec;52(4):558-64. doi: 10.4415/ANN_16_04_16. PMID: 27999228.
9. Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ, et al. Cancer related pain: A pan-European survey
of prevalence, treatment, and patient attitudes. Ann Oncol. 2009 Aug;20(8):1420-33. doi: 10.1093/annonc/mdp001. Epub 2009 Feb 24. PMID: 19244085.
10. Saunders H. Translating knowledge into best practice care bundles: A pragmatic strategy for EBP implementation via moving postprocedural pain management nursing guidelines into clinical practice. J Clin Nurs. 2015 Jul;24(13-14):203551. doi: 10.1111/jocn.12812. Epub 2015 Mar 25. PMID: 25808053.
11. Bernardi M, Catania G, Lambert A, Tridello G, Luzzani M. Knowledge and attitudes about cancer pain management: A national survey of italian oncology nurses. European Journal of Oncol Nurs. 2007 Jul;23(11):272-9. doi: 10.1016/j.
ejon.2006.09.003. Epub 2006 Nov 16. PMID: 17112781.
12. Bernardi M, Catania G, Tridello G. Knowledge and attitudes about cancer pain management: A national survey of italian hospice nurses. Cancer Nurs. 2007 Mar-Apr;30(2):E20-6. doi: 10.1097/01.NCC.0000265299.25017.24. PMID: 17413771.
13. Latina R, Mauro L, Mitello L, D’Angelo D, Caputo L, De Marinis MG, et al. Attitude and Knowledge of Pain Management Among Italian Nurses in Hospital Settings. Pain Manag Nurs. 2015 Dec;16(6):959-67. doi: 10.1016/j. pmn.2015.10.002. PMID: 26697820.
14. American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health; Task Force on Pain in Infants, Children, and Adolescents. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics. 2001 Sep;108(3):793-7. doi: 10.1542/ peds.108.3.793. PMID: 11533354.
15. Bice AA, Gunther M, Wyatt T. Increasing nursing treatment for pediatric procedural pain. Pain Manag Nurs. 2014 Mar;15(1):365-79. doi: 10.1016/j.pmn.2012.06.004. Epub 2012 Aug 18. PMID: 24602440.
16. Manworren RC. Development and testing of the Pediatric Nurses’ Knowledge and Attitudes Survey Regarding Pain. Pediatr Nurs. 2001 Mar-Apr;27(2):151-8. PMID: 12962251.
17. Zuazua-Rico D, Maestro-Gonzalez A, Cano-García C, Mosteiro-Diaz MP. Spanish Validation of Pediatric Nurses Knowledge and Attitudes Survey Regarding Pain. Pain Manag Nurs. 2023 Jun;24(3):365-370. doi: 10.1016/j.
pmn.2022.09.007. Epub 2022 Oct 26. PMID: 36307279.
18. Rieman MT, Gordon M, Marvin JM. Pediatric nurses’ knowledge and attitudes survey regarding pain: a competency tool modification. Pediatr Nurs. 2007 Jul-Aug;33(4):303-6. PMID: 17907730.
19. Kusi Amponsah A, Bam V, Stolt M, Korhonen J, Axelin A. Evaluating the content validity of two versions of an instrument used in measuring pediatric pain knowledge and attitudes in the Ghanaian context. PLoS One. 2020 Nov 6;15(11):e0241983. doi: 10.1371/journal.pone.0241983. PMID: 33156874; PMCID: PMC7647094.
20. Ferrell BR, McCaffery M. Nurses’ knowledge about Equianalgesic and opioid dosing. Cancer Nurs. 1997 Jun;20(3):201-2. doi: 10.1097/00002820-19970600000006.
21. Damico V, Murano L, Macchi G, Forastieri Molinari A, Dal Molin A. Knowledge and attitude of pain management among Italian nurses in intensive care unit: a multicentric descriptive study. Ann Ig. 2021 May-Jun;33(3):220-230. doi: 10.7416/ai.2021.2429. PMID: 33739355.
22. Zoëga S, Ward S, Gunnarsdottir S. Evaluating the quality of pain management in a hospital setting: testing the psychometric properties of the Icelandic version of the revised American Pain Society patient outcome questionnaire.
Pain Manag Nurs. 2014 Mar;15(1):143-55. doi: 10.1016/j.
pmn.2012.08.001. Epub 2012 Sep 24. PMID: 23318415.
23. Hovde KR, Granheim TH, Christophersen KA, Dihle A. The Norwegian version of the Pediatric Nurses’ Knowledge and Attitudes Survey Regarding Pain: reliability and validity. Pediatr Nurs. 2012 Sep-Oct;38(5):264-9. PMID: 23189777.
24. Gagnier JJ, Lai J, Mokkink LB, Terwee GB. COSMIN reporting guideline for studies on measurement properties of patient-reported outcome measures. Qual Life Res. 2021 Aug;30: 2197-2218. https://doi.org/10.1007/s11136-02102822-4. Epub 2021 Apr 5. PMID: 33818733.
25. Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, Erikson P; ISPOR Task Force for Translation and Cultural Adaptation. Principles of Good Practice for the Translation and Cultural Adaptation Process for PatientReported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health. 2005 Mar-Apr;8(2):94-104. doi: 10.1111/j.15244733.2005.04054.x. PMID: 15804318.
26. Google Inc. Google Forms. Available from: https://www.
google.com/forms/about/ [Last accessed: 2025 Feb 25].
27. Google Inc. Google Meet. Available from: https://meet. google.com/ [Last accessed: 2025 Feb 25].
28. IBM Corp. Released 2021. IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp.
29. MPLUS (Version 6.11). [Computer Software]. Los Angeles, CA: Muthén & Muthén.
30. Vellone E, Riegel B, Cocchieri A, Barbaranelli C, D’Agostino F, Glaser D, et al. Validity and reliability of the caregiver contribution to self-care of heart failure index. J Cardiovasc Nurs. 2013 May-Jun;28(3):245-55. doi: 10.1097/ JCN.0b013e318256385e. PMID: 22760172.
31. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013 Nov 27;310(20):2191-4. doi: 10.1001/jama.2013.281053. PMID: 24141714.
32. Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation) (Text with EEA relevance) (OJ L 119 04.05.2016, p. 1, ELI: http:// data.europa.eu/eli/reg/2016/679/oj). [Last accessed: 2025 Feb 25].
33. Hua Y, Zhang Q, Ting W, Qiu R, Yao WY, Chen XL. Pediatric Nurse Practitioners’ Knowledge and Attitudes Regarding Pain Management Study in Central China. J Contin Educ Nurs. 2019 Jun 1;50(6):275-281. doi: 10.3928/0022012420190516-08. PMID: 31136671.
34. Ortiz MI, Cuevas-Suárez CE, Cariño-Cortés R, NavarreteHernández JJ, González-Montiel CA. Nurses knowledge and attitude regarding pain: A systematic review and metaanalysis. Nurse Educ Pract. 2022 Aug;63:103390. doi: 10.1016/j.nepr.2022.103390. Epub 2022 Jun 24. PMID: 35803183.
35. Smeland AH, Twycross A, Lundeberg S, Rustøen T. Nurses’ Knowledge, Attitudes and Clinical Practice in Pediatric Postoperative Pain Management. Pain Manag Nurs. 2018 Dec;19(6):585-598. doi: 10.1016/j.pmn.2018.04.006. Epub 2018 May 16. PMID: 29778756.
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