前言
隨著老化影響，老年人普遍處於各種引起疼痛的健康問題之中。然而，中後期失智患者的語言溝通能力衰退嚴重，較難以口語清楚表達疼痛狀況。本研究的目的為建立此群失智症患者的疼痛相關定義性特徵，以協助照顧者評估與確知失智患者的疼痛狀況。

方法
本研究首先發展一非語言失智症疼痛相關定義性特徵對照表，項目內容發展過程首先經由文獻回顧以及訪談十位資深臨床護理人員，爾後請四位失智症照護領域專家協助進行專家效度與內容修訂。最後訂定為包含25項疼痛相關定義性特徵對照表。再採方便取樣方式於台灣中部以及南部地區共八家長期照護機構進行資料收集，由機構護理人員協助填答，最後以總計211位失智症個案資料進行分析。

結果
本工具之內容效度指標 (CVI) 達.90，信度分析結果顯示失智症疼痛相關精神行為症狀對照表的內在一致性KR-20為.663，測試者間一致性 kappa值範圍介於-0.47至1之間。其中17個題項kappa值達一般至良好一致性( kappa= 0.235 to 1)。效度分析方面，另以探索性因素分析抽取四個因子，總解釋變異量達51.863％。

結論
本對照表之信、效度達可接受的範圍，最後確立四個因子涵蓋於13個疼痛相關定義性特徵。本研究為台灣本土化失智症病人疼痛相關定義性特徵之初探，可作為進一步發展失智症相關疼痛評估工具之先驅。此外，失智疼痛相關定義性特徵對照表可提供臨床工作人員於評估失智患者疼痛之輔助工具。

Introduction
Pain is a common symptom among elderly people due to various chronic health conditions. However, assessment of pain in patients with advanced dementia is challenging because patients have difficulty communicating discomfort or needs. The purpose of this study was to identify the defining characteristics of pain in patients with advanced dementia.

Method
A non-verbal checklist for defining characteristics of pain was developed initially through literature review and individual interview with10 experienced clinical nursing staff. Then, 4 experts in dementia care were invited to conduct expert validity. Finally, a 25-item checklist for Pain was confirmed. Finally, observation of 211 patients with dementia by clinical nurses was conducted in eight long term care facilities in Taiwan.

Result
Finding indicated that the content validity index (CVI) was .90. and the internal consistency reliability analysis (KR-20) for the BPSD-Pain checklist was .663.The Kappa values range from -0.47to 1. 17 items revealed a moderate to high inter-rater reliability ( kappa= 0.235 to 1). Factor analysis extracted four factors which accounts for the total variance of 51.863％.

Conclusion
The reliability and validity of the Pain checklist were acceptable. This study was the preliminary one to develop defining characteristics of pain in Taiwanese patients with advanced dementia which can contribute to the development of nursing problems in patients with advanced dementia. In addition, the checklist can serve as a useful tool for healthcare providers while facing pain in patients with advanced dementia.

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