Translation, Review, and Validation of Non-Verbal Pain Scale

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.
The current study aimed at translating, reviewing, and validating NVPS in patients without verbal communication who admitted to ICU.
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.
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 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.