A Validation Study of the Nursing Diagnosis Pain : the Defining Characteristics and Etiologies

Nurses, more than any other member of the health team, have contact with people experiencing pain. The diagnosis pain has been found to be one of the most frequently used nursing diagnoses. The purpose of this study was to contribute to the validation of the defining characteristics and etiologies for the nursing diagnosis acute pain. A survey was mailed to 240 nurses who had expressed an interest or expertise in pain/ pain research. Seventy-eight (43%) usable surveys by master-prepared nurses were returned. A six-point Likert scale was used in which the defining characteristics and etiologies of the diagosis pain were listed. The sources of these items were from the NANDA listing and a review of the literature. The nurses were asked to consider patients for whom in the past three months they had made the diagnosis acute pain. They were asked to indicate how frequently this population exhibited the specified characteristics and etiologies of the diagnosis pain ranging from 0 (never ) to 5 ( nearly always present). Analysis of data followed the steps outlined by Fehring (1987) for diagnostic content validity (DCV). Thirteen characteristics were found to be tentative major indicators, 54 to be tentative minor indicators, and 13 characteristics to be dropped from the scale. No etiologies received a weighted ratio of .80 or greater. Fifty-seven etiologies received a weighted ratio of .51 to .79. Factor analysis and cluster analysis of the thirteen tentative major characteristics revealed three distinct factors or groupings of the characteristics. These groups are described as verbalization\u27s of pain, consumed with self and behavior pattern changes. A conclusion of this study was that combined with other reviewed studies on pain characteristics there are now six indicators with reasonable research support to be labeled as tentative major or minor characteristics: communication of pain descriptors, guarding behavior, facial mask of pain, alteration in muscle tone, self-focusing and narrowed focus. This study highlighted the semantic disarray regarding the number of characteristics in the literature. Further work on identification and clarification of relevant etiologies or related factors needs to be done