Adaptation of two measurement tools used to assess sedation-agitation and pain among patients in intensive care units into Turkish: A reliability and validity study

This descriptive and methodological study was conducted to adapt the Richmond Agitation-Sedation Scale (RASS) and the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale into Turkish and to determine their validity and reliability for Turkish society. The former scale is used to assess sedation and agitation levels among patients in intensive care units and the latter scale is used to assess of pain levels among the same patients. The study was carried out between April 2014 and June 2015 in the Anesthesia and Reanimation Unit and Neurology Intensive Care Unit of Balikesir State Hospital and the General Intensive Care Unit of Bandırma State Hospital. The sample of the study comprised 150 patients who were on mechanical ventilation support, underwent analgesia and sedation, and met the inclusion criteria of the study. The study data were collected with the socio-demographic characteristics questionnaire, the Richmond Agitation-Sedation Scale, the American Association of Critical-Care Nurses' Sedation Assessment Scale, the Glasgow Coma Scale, the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale, the Visual Analog Scale, the Facial Expression Scale, the Acute Physiology and Chronic Health Evaluation II. For the validity study of the Turkish versions of the Richmond Agitation-Sedation Scale (RASS) and the Face, Legs, Activity, Cry, Consolability (FLACC) Scale, language validity, content validity, construct validity methods were used. For the reliability study of the scales, the internal consistency method was used. The correlation coefficient values obtained for the Richmond Agitation Sedation scale show that the harmony between the observers was significantly high on the first day and perfect on the second and third days. These results also indicate that the scale is a reliable measurement tool that can be used to determine the level of need for sedation among patients on mechanical ventilation support. The three-day mean total scores obtained from the Face, Legs, Activity, Cry, Consolability (FLACC) Scale indicate that the correlation coefficient value for the harmony between the observers was excellent for the face, activity and consolability items, and significantly high for the legs and cry items. These results also indicate that the scale is a reliable measurement tool to use to determine the pain level among patients on mechanical ventilation support. In conclusion, the Richmond Agitation-Sedation Scale (RASS) and the Face, Legs, Activity, Cry, Consolability (FLACC) behavioral scale are highly valid and reliable scales for the assessment of pain, and the quality and depth of sedation in adult patients receiving intensive care. Keywords: Intensive Care; Mechanical Ventilation; Sedation; Pain