Original article
Development and preliminary validation of the pain assessment checklist for seniors with limited ability to communicate (PACSLAC)

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Abstract

The purpose of this study, conducted in three phases, was to develop a clinically useful observational tool (i.e., the Pain Assessment Checklist for Seniors With Limited Ability to Communicate [PACSLAC]) to assess pain in seniors with severe dementia. In Phase 1, professional caregivers of seniors with severe dementia were interviewed in order to generate a list of pain-related behaviors that are characteristic of care recipients living in long-term-care facilities. Based on a systematic examination of interview transcripts by experienced researchers and an independent coder, a behavioral checklist (i.e., the initial version of the PACSLAC) was developed. The checklist items were organized into conceptually based subscales (e.g., facial expressions, activity/body movement). Phase 2 focused on an assessment of the internal consistency of the checklist (α = .92). Following an item analysis, the subscales of the PACSLAC (Social/Personality/Mood Indicators, Facial Expressions, Activity/Body Movement, and Physiological Indicators/Eating/Sleeping Changes/Vocal Behaviors) were found to be internally consistent. Phase 3 focused on a preliminary validation of the PACSLAC. Analyses suggest that the PACSLAC discriminated among pain events (during which there was a clear and recognizable cause for the patients’ pain), events during which patients were experiencing nonpainful distress, and situations during which patients were calm.

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,

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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.

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