2.3.

Instruments
2.3.1. Self-reported pain response
The self-reported pain response was measured at baseline and after venous sampling using the 5-
point Poker Chip Scale (PCS) by Hester, Foster, and Kristensen (1990). The scale uses four red
plastic chips and one white chip, which are placed in a horizontal line in front of the child. The
chips represent levels of pain. The white chip means does not hurt at all (0 points), one red chip
means hurts a little (1 point), and four chips mean hurts the most (4 points). The child chooses
the number of chips that equals the pain he or she feels. The PCS was designed to measure pain
intensity in children aged 4 years and older and has been used successfully in children as young
as 3 years (Wong & Baker, 1988). Wong and Baker (1988) calculated the reliability and validity
of six pediatric pain assessment scales and found the PCS to be the best for 3- to 7-year-olds. It
has an acceptable concurrent validity (r = .64) and test–retest reliability (r = .56). We obtained a
Cronbach's alpha of .58 in this study.

2.3.2. Behavioral pain response

An important reason for the lack of utilization of any instrument has to do with issues of
practicality and versatility of the instrument in the practice setting. Although many pain
measurement scales have been developed and validated, the clinical relevance of many of these
tools has not been adequately tested. This hinders their integration into clinical practice
(Gharaibeh&Abu-Saad, 2002). Because of its ease of use, we used the Faces Rating Scale (FRS)
of Wong and Baker (1988) to measure the behavioral pain response at baseline and after venous
sampling. The same nurse observed and rated the level of pain. The scale consists of six black-
and-white cartoon faces ranging from a smiling face for no pain (0 points) to a tearful face for
the worst pain (5 points), with varying degrees of sadness in between. A Cronbach's alpha value
of .66 was obtained for this test in this study.

2.3.3. Physiological pain response

The physiological pain response was measured using heart rate and serum levels of cortisol and
glucose, which were collected during venous sampling with a 24-gauge needle. The heart rate
was calculated by listening with a stethoscope for 30 seconds. It was measured at baseline and
after venous sampling. Increased heart rate was assumed to indicate greater pain. Serum cortisol
was measured during venous sampling. The time at which the sample was taken was noted.
Increased levels of cortisol indicate greater pain. Serum glucose was also measured during
venous sampling, with increased glucose indicating greater pain.

2.3. Instrumen

2.3.1. respon nyeri dilaporkan sendiri

Respon nyeri yang dilaporkan sendiri diukur pada awal dan setelah pengambilan sampel vena
menggunakan 5-point Poker Chip Scale (PCS) oleh Hester, Foster, dan Kristensen (1990). Skala
menggunakan empat chip plastik merah dan satu chip putih, yang ditempatkan di garis horizontal
di depan anak. Chip mewakili tingkat rasa sakit. Chip putih tidak sakit sama sekali (0 poin), satu
chip merah berarti sakit sedikit (1 poin), dan empat chip berarti sakit paling (4 poin). anak
memilih jumlah chip yang sama dengan rasa sakit dia rasakan. PCS dirancang untuk mengukur
intensitas nyeri pada anak usia 4 tahun dan lebih tua dan telah berhasil digunakan pada anak-
anak semuda 3 tahun (Wong & Baker, 1988). Menurut Wong dan Baker (1988) menghitung
reliabilitas dan validitas enam skala penilaian nyeri pediatrik dan menemukan PCS untuk
menjadi yang terbaik untuk 3- 7-year-olds. Ini memiliki validitas konkuren diterima (r = 0,64)
dan keandalan tes-tes ulang (r = 0,56). Kami memperoleh alfa Cronbach dari 0,58 dalam
penelitian ini.

2.3.2. respon nyeri perilaku

Alasan penting kurangnya pemanfaatan instrumen apapun harus dilakukan dengan masalah
kepraktisan dan fleksibilitas dari instrumen dalam pengaturan praktek. Meskipun banyak skala
pengukuran nyeri telah dikembangkan dan divalidasi, relevansi klinis dari banyak alat-alat ini
belum diuji secara memadai. Ini menghambat integrasi mereka ke dalam praktek klinis
(Gharaibeh & Abu-Saad, 2002). Karena kemudahan penggunaan, kami menggunakan Skala
Wajah Penilaian (FRS) dari Wong dan Baker (1988) untuk mengukur respon nyeri perilaku pada
awal dan setelah pengambilan sampel vena. Perawat yang sama diamati dan dinilai tingkat rasa
sakit. skala ini terdiri dari enam kartun hitam-putih menghadapi mulai dari wajah tersenyum
tanpa rasa sakit (0 poin) ke wajah menangis untuk rasa sakit terburuk (5 poin), dengan berbagai
tingkat kesedihan di antara. nilai alpha A Cronbach dari 0,66 diperoleh untuk tes ini dalam studi
ini.

2.3.3. respon nyeri fisiologis

Respon nyeri fisiologis diukur menggunakan detak jantung dan kadar serum kortisol dan
glukosa, yang dikumpulkan selama pengambilan sampel vena dengan alat pengukur jarum 24.
Denyut jantung dihitung dengan mendengarkan dengan stetoskop selama 30 detik. Ini diukur
pada awal dan setelah pengambilan sampel vena. Peningkatan denyut jantung diasumsikan untuk
menunjukkan rasa sakit yang lebih besar. kortisol serum diukur selama pengambilan sampel
vena. Waktu di mana sampel diambil tercatat. Peningkatan kadar kortisol menunjukkan rasa sakit
yang lebih besar. Glukosa serum juga diukur selama pengambilan sampel vena, dengan
peningkatan glukosa menunjukkan rasa sakit yang lebih besar.