Pain Evaluation Tool for use during Newborn Circumcision, Page 5

Hello, I am Debra Neiman, RN BSN.

I have worked in Neonatal Care, at Beauregard Memorial Hospital, DeRidder for over four years. My college experience at Louisiana State University at Alexandria, resulted in a great deal of research papers, which are gathering dust in my office. My curriculum at Northwestern State University also added to this wealth of information.

I hereby begin this series to provide a way to get this information to those in the nursing field and any other person with a passing interest in these subjects.

Feel free to reference or use this information in your practice. However, Please respect my Copyright and do not "BORROW" for your HOMEWORK assignments.

BACK TO MY PAPERS ONLINE INDEX

VISIT MY GENEALOGY SITE | MY X-FILES & MYSTERIES SITE

Pain Evaluation Tool
For Use During
Newborn Circumcision
APPENDIX B

Debra Neiman, RN, BSN, Spring 1995

Prepared as Research Proposal
for Nursing Professional Transition Seminar

Northwestern State University

INDEX:

CHAPTER ONE - INTRODUCTION

CHAPTER TWO - LITERATURE REVIEW

CHAPTER THREE - METHODOLOGY

REFERENCES

APPENDICES:

Consent Forms for Participation
In Research Study

Institutional Review Board for Human Research
Consent Form

Project Title: Pain Evaluation Tool For Use During Newborn Circumcision.

Name of Subject________________________ Subject I.D. No. ______
Age ______ Sex _____ Research Protocol No. ______

a. You are invited to participate in a study of the reliability
of the Postoperative Comfort Scale to rate the pain or
discomfort levels in newborns after circumcision.
The researchers of ________________ hope to learn more about
how newborns tolerate circumcision and how we can measure
and treat any discomfort they may experience.

b. If you decide to participate, we will examine your baby for
the ten behaviors on the tool and assign a score for each.
A total score will tell us how your newborn is tolerating
any discomfort he may have following his circumcision.

c. Your participation in the study involves minimal risks for
your newborn.

d. Your newborn's medical care will not be diminished by your
participation in this study.

e. Any information obtained during this study and identified
with you or your newborn will remain confidential and will
be disclosed only with your permission. The data will be
collectively utilized and reported in material for the
Researcher, Debra Neiman RN, to complete requirements for
graduate school.

f. Your decision whether or not to participate will not
prejudice your future relation with _________. If you
decide to participate, you are free to discontinue
participation at any time.

g. If you have any questions, please ask me. If you have
any additional questions later, I will be happy to answer
them. You may contact me at 239-6257 or 462-7281.

In accordance with federal regulations, I am obliged to inform
you about _____________ policy in the event physical injury occurs.
We (____________) will provide medical care for any physical injuries
directly resulting from your participation in approved research here.

Neither the ___________ nor the State of Louisiana will provide financial
compensation for such injuries. Further information can be obtained by calling __________.

You are making a decision as to whether or not to participate. Your
signature indicates that you have read the information provided above
and decided to do so. You may withdraw at any time without prejudice
after signing this form should you choose to discontinue participation
in this study.

You will be given a copy of this form to keep.

______________________________
Signature

______________
Date

_________
Time

______________________________
Signature of Witness

______________________________
Signature of Investigator

Institutional Review Board for Human Research
Consent Form

Project Title: Pain Evaluation Tool For Use During Newborn Circumcision.

Name of Subject________________________ Subject I.D. No. ______
Age ______ Sex _____ Research Protocol No. ______
I, _____________________, the physician for Baby ______________,
do agree for him to be utilized in the above stated Research Project.
This allows Baby ________________ to be assessed by designated Nursery
Nurses using the Postoperative Comfort Scale and assigned a score prior
to and following an elective circumcision procedure, to be performed by
____________________. I understand that there are no known risks to his
assessment with this tool.

_____________________
Date

______________________________
Signature of Pediatrician

______________________
Date
______________________________
Signature of Physician to
perform circumcision (if not
Pediatrician)