:: Volume 5, Issue 1 (Military Caring Sciences 2018) ::
MCS 2018, 5(1): 34-45 Back to browse issues page
Translation, Review, and Validation of Non-Verbal Pain Scale
Tahmasbikouhpaie. N1, Zareiyan. A PhD 2, Pishgooie. SAH3
1- MSc Student of Critical Care, Iran, Tehran, AJA University of Medical Sciences, Faculty of Nursing.
2- Iran, Tehran, AJA University of Medical Sciences, Faculty of Nursing, Health Department. Email:
3- Iran, Tehran, AJA University of Medical Sciences, Faculty of Nursing, Medical-Surgical Department.
Abstract:   (5900 Views)
Introduction: Pain evaluation in patients admitted to intensive care unit (ICU) that are often not able to communicate verbally due to changes in consciousness, mechanical ventilation, and taking relaxation medications is a complicated task and one of the most basic problems for nurses. Proper pain measurement in such patients requires the use of a valid and reliable scale. Non-verbal pain scale (NVPS) includes behavioral and physiological indicators. The behavioral part of the scale includes facial expressions, activity/mobility, and guarding, and the physiological part includes the vital signs as blood pressure, heart rate, and respiration. The validity of the scale as a reliable instrument to monitor and evaluate pain in patients without verbal communications was confirmed in many studies and accordingly it was introduced by the American Pain Society, but it is not translated into Persian language and accordingly not validated in Iran.
Objective: The current study aimed at translating, reviewing, and validating NVPS in patients without verbal communication who admitted to ICU.
Materials and Methods: The current methodological research was conducted from May 2011 to May 2012 in ICUs of military hospitals in Kerman, Iran. After the translation of NVPS by experts, reviewing and reforming its items, the qualitative validity was confirmed based on the comments of the respondents and the method of determining the clinical impact was used to determine its quantitative face validity. The content validity was determined by the panel of experts and opinion polls. Structural validity was determined by the hypothesis testing method. The method of agreement between evaluators was used to estimate reliability, and by the use of intra-cluster correlation within the group, the agreement between the experts was measured.
Results: The content validity ratio was calculated based on the number of experts in the panel using the modified Lowsheh table and cut off point was 0.49. The content validity of the scale was 0.82 using the average content validity index; the relevance of the item to the pain of the patients was confirmed for all the items. The agreement between the researcher and under study nurses was assessed using the Kappa agreement coefficient for facial, activity, guard state, and excitement items as >0.4. The scale reliability was also confirmed in the items.
Discussion and Conclusion: Translation and revision of NVPS provided an appropriate and standard tool for the nurses to assess the level of pain in adult patients without verbal communication admitted to ICU. The training and application of this scale have made it possible to empower the treatment staff, especially nurses, to be able to monitor, manage, and control the pain of the patients, which by reducing the level of pain and its duration, the quality of care can also be improved in such patients.
Keywords: Intensive Care Unit, Nonverbal Pain Scale, Pain, Validation.
Full-Text [PDF 421 kb]   (1241 Downloads)    
Type of Study: Research | Subject: Special
Received: 2018/02/14 | Accepted: 2018/03/10 | Published: 2018/08/15
1. Abbasi M, Norozzade M, Aghai B, Maarefvand A, Nategh M, Saaid Y. Evaluation of painassessmenttoolsintensive care units. Iran J Cardiovasc Nurs. 2013;2(3):70-5.
2. Puntillo KA, Smith D, Arai S, Stotts N. Critical care nurses provide their perspectives of patients' symptoms in intensive care units. Heart Lung. 2008;37(6):466-75. DOI: 10.1016/j.hrtlng.2008.02.002 PMID: 18992630 [DOI] [PubMed]
3. Pronovost P, Goeschel C. Improving ICU care: it takes a team. Healthc Exec. 2005;20(2):14-6, 8, 20 passim. PMID: 15792334 [PubMed]
4. Choi HS. Respiratory review of 2013: critical care medicine. Tuberc Respir Dis (Seoul). 2013;75(1):1-8. DOI: 10.4046/trd.2013.75.1.1 PMID: 23946752 [DOI] [PubMed]
5. Asadi Noghabi AA, Gholizadeh Gerdrodbari M, Zolfaghari M, Mehran A. Effect of Application of Critical-Care Pain Observation Tool in Patients with Decreased Level of Consciousness on Performance of Nurses in Documentation and Reassessment of Pain Hayat. 2012;18(3):54-65.
6. Puntillo KA, Stannard D, Miaskowski C, Kehrle K, Gleeson S. Use of a pain assessment and intervention notation (P.A.I.N.) tool in critical care nursing practice: nurses' evaluations. Heart Lung. 2002;31(4):303-14. DOI: 10.1067/mhl.2002.125652 PMID: 12122394 [DOI] [PubMed]
7. Kaiser KS. Assessment and management of pain in the critically ill trauma patient. Crit Care Nurs Q. 1992;15(2):14-34. PMID: 1628244 [PubMed]
8. Klein DG, Dumpe M, Katz E, Bena J. Pain assessment in the intensive care unit: development and psychometric testing of the nonverbal pain assessment tool. Heart Lung. 2010;39(6):521-8. DOI: 10.1016/j.hrtlng.2010.05.053 PMID: 20888642 [DOI] [PubMed]
9. Puntillo KA, Morris AB, Thompson CL, Stanik-Hutt J, White CA, Wild LR. Pain behaviors observed during six common procedures: results from Thunder Project II. Crit Care Med. 2004;32(2):421-7. DOI: 10.1097/01.CCM.0000108875.35298.D2 PMID: 14758158 [DOI] [PubMed]
10. Chanques G, Jaber S, Barbotte E, Violet S, Sebbane M, Perrigault PF, et al. Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med. 2006;34(6):1691-9. DOI: 10.1097/01.CCM.0000218416.62457.56 PMID: 16625136 [DOI] [PubMed]
11. Cade CH. Clinical tools for the assessment of pain in sedated critically ill adults. Nurs Crit Care. 2008;13(6):288-97. DOI: 10.1111/j.1478-5153.2008.00294.x PMID: 19128312 [DOI] [PubMed]
12. Herr K, Bjoro K, Decker S. Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review. J Pain Symptom Manage. 2006;31(2):170-92. DOI: 10.1016/j.jpainsymman.2005.07.001 PMID: 16488350 [DOI] [PubMed]
13. Aslan FE, Badir A, Selimen D. How do intensive care nurses assess patients' pain? Nurs Crit Care. 2003;8(2):62-7. PMID: 12737190 [PubMed]
14. Payen JF, Bosson JL, Chanques G, Mantz J, Labarere J, Investigators D. Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit: a post Hoc analysis of the DOLOREA study. Anesthesiology. 2009;111(6):1308-16. DOI: 10.1097/ALN.0b013e3181c0d4f0 PMID: 19934877 [DOI] [PubMed]
15. Shugarman LR, Goebel JR, Lanto A, Asch SM, Sherbourne CD, Lee ML, et al. Nursing staff, patient, and environmental factors associated with accurate pain assessment. J Pain Symptom Manage. 2010;40(5):723-33. DOI: 10.1016/j.jpainsymman.2010.02.024 PMID: 20692807 [DOI] [PubMed]
16. Stites M. Observational pain scales in critically ill adults. Crit Care Nurse. 2013;33(3):68-78. DOI: 10.4037/ccn2013804 PMID: 23727853 [DOI] [PubMed]
17. Coyne ML, Reinert B, Cater K, Dubuisson W, Smith JF, Parker MM, et al. Nurses' knowledge of pain assessment, pharmacologic and nonpharmacologic interventions. Clin Nurs Res. 1999;8(2):153-65. DOI: 10.1177/10547739922158214 PMID: 10887867 [DOI] [PubMed]
18. Flowers D. The author replies: I appreciate the positive response of. Assessment. 2004;68:73.
19. Payen JF, Bru O, Bosson JL, Lagrasta A, Novel E, Deschaux I, et al. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med. 2001;29(12):2258-63. DOI: Doi 10.1097/00003246-200112000-00004 PMID: 11801819 [DOI] [PubMed]
20. Wegman DA. Tool for pain assessment. Crit Care Nurse. 2005;25(1):14-5. PMID: 15756730 [PubMed]
21. Odhner M, Wegman D, Freeland N, Steinmetz A, Ingersoll GL. Assessing pain control in nonverbal critically ill adults. Dimens Crit Care Nurs. 2003;22(6):260-7. PMID: 14639117 [PubMed]
22. Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23(3):293-7. PMID: 9220806 [PubMed]
23. Taylor GI. Principles of Nursing Discharge Management and Community Healthcare Following Reconstructive Plastic Surgery. Reconst Plast Surg Nurs Clin Manage Wound Care. 2005:190-201. DOI: Book_Doi 10.1002/9780470774656 [DOI]
24. Polit DF, Yang F. Measurement and the measurement of change: a primer for the health professions: Wolters Kluwer Health; 2015.
25. Juniper EF, Guyatt GH, Streiner DL, King DR. Clinical impact versus factor analysis for quality of life questionnaire construction. J Clin Epidemiol. 1997;50(3):233-8. PMID: 9120521 [PubMed]
26. Polit DF, Beck CT. Essentials of nursing research: Appraising evidence for nursing practice: Lippincott Williams & Wilkins; 2013.
27. Haynes SN, Richard DCS, Kubany ES. Content validity in psychological assessment: A functional approach to concepts and methods. Psychol Asses. 1995;7(3):238-47. DOI: Doi 10.1037/1040-3590.7.3.238 [DOI]
28. Rungtusanatham M, Forza C, Filippini R, Anderson JC. A replication study of a theory of quality management underlying the Deming management method: insights from an Italian context. J Oper Manage. 1998;17(1):77-95.
29. Zarein A, Ebadi A, Zarshenas L, SHarifnia H, Mijahedi M. [Fundamentals of Instrumentation in Health Sciences]. 1, editor. tehran Jameae negar; 2017.
30. Polit D, Beck C. Nursing Research: Generating and Assessing Evidence for Nursing Practice. 9th ed. NY2012.
31. Feinstein AR, Cicchetti DV. High agreement but low kappa: I. The problems of two paradoxes. J Clin Epidemiol. 1990;43(6):543-9. PMID: 2348207 [PubMed]
32. Wegman EJ. Visual data mining. Stat Med. 2003;22(9):1383-97. DOI: 10.1002/sim.1502 PMID: 12704604 [DOI] [PubMed]
33. Pasero C, McCaffery M. No Self-Report Means No Pain-Intensity Rating: Assessing pain in patients who cannot provide a report. AJN Am J Nurs. 2005;105(10):50-3.
34. Kabes AM, Graves JK, Norris J. Further validation of the nonverbal pain scale in intensive care patients. Crit Care Nurse. 2009;29(1):59-66. DOI: 10.4037/ccn2009992 PMID: 19182281 [DOI] [PubMed]
35. Arif-Rahu M, Grap MJ. Facial expression and pain in the critically ill non-communicative patient: state of science review. Intensive Crit Care Nurs. 2010;26(6):343-52. DOI: 10.1016/j.iccn.2010.08.007 PMID: 21051234 [DOI] [PubMed]

XML   Persian Abstract   Print

Volume 5, Issue 1 (Military Caring Sciences 2018) Back to browse issues page