Original articleDevelopment and preliminary validation of the pain assessment checklist for seniors with limited ability to communicate (PACSLAC)☆
Section snippets
Study overview
This study was conducted in three phases. Phase 1 consisted of interviews with experienced long-term-care nurses and special-care aides. The interviews were designed to generate a list of behaviors that are indicative of pain among seniors with severe dementia. Based on these interviews, we developed a checklist of pain behaviors (i.e., the preliminary version of the Pain Assessment Checklist for Seniors With Limited Ability to Communicate [PACSLAC]). In Phase 2, nurses were asked to complete
Goal
The purpose of Phase 1 was to generate a list of behaviors for a pain assessment instrument designed specifically for seniors with dementia-induced limited ability to communicate.
Participants
Participants were 28 primary caregivers (i.e., registered nurses, licensed practical nurses, and special care aides) of seniors (people 65 years of age or older) who were living in long-term-care facilities and, as a result of dementia, had serious limitations in their ability to communicate. All caregivers consented
Goal
The purpose of Phase 2 was to conduct an item analysis, assess the internal consistency of the PACSLAC, and determine the extent to which caregivers considered its pain behaviors to be useful.
Caregivers
Participants were 40 registered nurses and registered psychiatric nurses who worked with older adults with cognitive impairments that limited their ability to communicate. None of these nurses had participated in Phase 1. Recruitment occurred through the long-term-care facilities of a midsize metropolitan
Goal
The purpose of Phase 3 was to conduct a preliminary evaluation of the validity of the PACSLAC.
Caregivers
Thirty-four registered nurses and six registered psychiatric nurses participated in this study. They had an average of 19 years of experience (SD = 11.6). None of them had participated in Phase 1, and 13 had participated in Phase 2. All caregivers had been caring for at least 6 months for an older person with limited ability to communicate. The average age of participating nurses was 43.8 years (SD =
Discussion
Our findings provide preliminary evidence of the validity and reliability of the PACSLAC as a pain assessment tool for seniors with dementia. Some of the methods (e.g., FACS [Ekman & Friesen, 1978], PBM [Keefe & Block, 1982]) that have been validated previously with such patients (e.g., Hadjistavropoulos et al 1997, Hadjistavropoulos et al 1998, Hadjistavropoulos et al 2000, Hadjistavropoulos et al 2001, Porter et al 1996) are either labor intensive or require special training. Methods that
Future directions
Based on the results reported here, we developed a pain assessment tool that has good potential for use in long-term-care facilities. However, additional validation is needed (e.g., factor-analytic investigation of the subscale structure, cross-validation in acute care settings). Moreover, some limitations of our study should be noted when interpreting the results. Specifically, caregivers provided retrospective reports about recent events that they deemed to be painful, calm, or distressing.
Acknowledgements
The authors thank Sue Neville and the staff of the participating long-term-care units (affiliated with the Regina Qu’Apelle Health Region) for their support of this work. Moreover, we acknowledge the valuable suggestions and advice offered to us by the editor of the journal and by two anonymous reviewers. Portions of this work were presented at the 2002 World Congress on Pain, San Diego, California, U.S.A., and the 2002 Convention of the Canadian Association on Gerontology, Montreal, Quebec,
References (27)
- et al.
Measuring pain accurately in children with cognitive impairmentsRefinement of a caregiver scale
Journal of Pediatrics
(2001) - et al.
The impact of dementia on the pain experience
Pain
(1996) The checklist of nonverbal pain indicators (CNPI)
Pain Management Nursing
(2000)- et al.
Development of an observation method for assessing pain behavior in chronic low back patients
Behavior Therapy
(1982) - et al.
A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture
Journal of Pain and Symptom Management
(2000) - et al.
Dementia and response to pain in the elderly
Pain
(1996) - et al.
Preliminary validation of an observational pain checklist for cognitively impaired, non-verbal persons
Developmental Medicine and Child Neurology
(2000) - et al.
Nursing staff members’ perception of pain indicators in persons with severe dementia
Clinical Journal of Pain
(2002) - et al.
The assessment of everyday functioning using the Present Functioning Questionnaire and the Functional Rating Scale in elderly samples
Clinical Gerontologist
(1989) - et al.
Facial action coding system
(1978)
Pain assessment in older adults who are cognitively impaired
Journal of Gerontological Nursing
An examination of pain perception and cerebral event-related potentials following carbon di oxide laser stimulation in patients with Alzheimer’s disease and age-matched control volunteers
Pain Research and Management
Toward a research outcome measure of pain in frail elderly in chronic care
Pain Clinic
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This research was supported, in part, by a Saskatchewan Health Research Foundation grant and by a Canadian Institutes of Health Research Career Investigator Award to Thomas Hadjistavropoulos.