Evaluation of two observational pain assessment scales during the anaesthesia recovery period in Chinese surgical older adults

• Published in: Journal of clinical nursing Vol. 24; no. 1-2; pp. 212 - 221
• Main Authors: Guo, Li-Li, Li, Li, Liu, Yao-Wei, Herr, Keela
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-01-2015; Wiley Subscription Services, Inc
• Subjects: Abdomen - surgery; Aged; Aged, 80 and over; anaesthesia recovery period; Anesthesia; Anesthesia Recovery Period; Asian Continental Ancestry Group; Checklist of Nonverbal Pain Indicators; China; Correlation analysis; Dementia - psychology; Female; Hospitalization; Humans; Male; Mental Recall; Middle Aged; Nursing; observational pain assessment tools; older adults; Older people; Pain; pain assessment; Pain Assessment in Advanced Dementia scale; Pain Measurement; Pain, Postoperative - diagnosis; Pain, Postoperative - etiology; Pain, Postoperative - psychology; Prospective Studies; Reliability; Reproducibility of Results; Self Report; Validity; China; anaesthesia recovery period; older adults; pain assessment; Checklist of Nonverbal Pain Indicators; Pain Assessment in Advanced Dementia scale; observational pain assessment tools
• ISSN: 0962-1067; 1365-2702
• DOI: 10.1111/jocn.12677

Aims and objectives
To evaluate the reliability and validity of the Pain Assessment in Advanced Dementia scale and the Checklist of Nonverbal Pain Indicators in Chinese older adults post surgery during the anaesthesia recovery period.
Background
Pain assessment in older surgical patients is complicated by factors such as anaesthesia and opioid administration. Although observational pain behavioural assessment tools have been validated for those unable to self‐report, research on their application during the anaesthesia recovery period is limited.
Design
A prospective correlational design.
Methods
Ninety‐three older patients admitted for scheduled abdominal surgery were recruited in a university‐affiliated hospital. The two observational scales were used to conduct pain assessments during the anaesthesia recovery period. On the first and the third postoperative day, participants recalled their pain intensity during the recovery period using the Numeric Rating Scale or the Faces Pain Scale‐Revised.
Results
The internal consistency reliability of the Pain Assessment in Advanced Dementia scale and the Checklist of Nonverbal Pain Indicators was 0·81 and 0·69 respectively. The correlation between scores of the two observational scales was 0·95. The recalled self‐reports of pain intensity were significantly correlated. The correlation of the Pain Assessment in Advanced Dementia scale and patients’ recalled self‐reports was 0·55, 0·54, and the correlation between the Checklist of Nonverbal Pain Indicators and the two recalled pain scores was both 0·60.
Conclusions
Both the two observational scales had good reliability and validity when used to assess pain in Chinese surgical older adults during the anaesthesia recovery period.
Relevance to clinical practice
Observational pain scales can be useful as a tool for patients unable to self‐report. Accurate use of one of the observational pain tools can help identify pain during the anaesthesia recovery period, when patients are unable to self‐report, to support effective pain management during this period.