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RES229
Development and Psychometric Testing of a Nonverbal Pain Assessment Tool (NPAT)
By: M. Dumpe & D. Klein; Cleveland Clinic; OH
For further information, please contact: dumpem@ccf.org
Purpose: This study was conducted to test the validity and inter-rater reliability of the Nonverbal Pain Assessment Tool (NPAT) developed for use in adult patients unable to self-report their pain score.
Background/Significance: Effective pain management requires a systematic approach in the assessment of pain. Patient self-report of pain is the gold standard, but frequently patients are unable to self-report due to illness, sedation, cognitive impairments and medical interventions. Evidence supports the use of behaviors as indicators of pain. Nurses at a large Midwestern facility requested a consistent tool to assess pain in the nonverbal adult population.
Methods: Three phases of psychometric testing were conducted to refine the NPAT and establish validity and inter-rater reliability. Validity was measured against the “gold standard” of patient self-report of pain using the Visual Analog Scale (VAS). Inter-rater reliability was assessed by teams of two RNs independently scoring patient’s pain using the NPAT Data were collected from a convenience sample of verbal and nonverbal patients from cardiothoracic surgery, cardiology, medical, and surgical ICUs and one general surgery post-operative nursing unit. Concordance correlations, Pearson correlations, kappa statistics, and scatter plots were performed using SPSS.
Results: In the final revision of the NPAT, validity was found to be moderately strong (concordance correlation coefficient of 0.66, 95-percent confidence interval). Inter-rater reliability was found to be strong (concordance correlation coefficient of 0.72, 95-percent confidence interval). Nurse reported ease of use and a consistent approach among caregivers in assessing a nonverbal patient’s pain.
Conclusions: The NPAT was shown to have moderately strong scores for validity and strong scores for inter-rater reliability, was easy to use, and provides a standard approach to pain assessment in the nonverbal adult patient. Further studies are required to determine the usefulness of this tool.
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