Validity and Reliability Study of the Baxter Animated Retching Faces Nausea Scale

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Nausea and vomiting, which are unpleasant clinical problems in the postoperative period, have negative outcomes related to patient satisfaction, morbidity, hospital stay, and medical costs. Nausea and/or vomiting may cause tracheal aspiration when unconscious after anesthesia, rupture of wound site, wound infection, recurrent and severe dehydration, and electrolyte impairments with pediatric surgery patients. It is very important to detect and prevent these clinical problems at an early period. Therefore, it is necessary to objectively assess nausea, which is a subjective perception. The aim of the current study was to discover the validity and reliability of the Baxter Animated Retching Faces (BARF) Nausea Scale among pediatric surgery patients.


The sample of the study, which was in methodological model, consisted of 82 children aged 7-18 years who were treated at inpatient pediatric surgery clinics. The BARF Nausea Scale is a pictorial nausea scale that rates nausea from neutral (no nausea) to emesis (maximum nausea) with six items and six face expressions that describe each of these items. The scale was developed in the English language and includes assessments based on perceptions; Turkish translation and back-translation procedures were not performed. For the content validity, expert reviews were obtained. While the findings obtained from the study were being evaluated, descriptive statistical methods, the Kolmogorov–Smirnov distribution test, the Mann–Whitney U test, the Kruskal–Wallis test, and Pearson correlation analyses were employed. Cochran's Q test was used to determine the suitability of scale options in theoretically measuring nausea–vomiting.


Sixty-one percent of the children aged 7-18 years were male. It was identified that 50% of the children were operated because of gastrointestinal problems, 81.1% of them did not get premedication, 91.5% of them did not use antiemetic medicines, and 41.5% of them started to eat 5-6 hours later after the surgery. It was noted that opinions of all the experts were consistent in terms of content validity and that BARF and the visual analog scale, which was found to be suitable for the Turkish people, could statistically be accepted as equal (Cochran's Q = 9, p = .437).


In the parallel test in which the visual analog scale and BARF were compared, it was understood that BARF was reliable in assessing nausea and vomiting. In light of these results, it may be suggested that the BARF Nausea Scale was a valid and reliable tool in theoretically measuring nausea–vomiting. It is recommended that the BARF Nausea Scale be used for children over 7 years old to measure nausea after operations.

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