Learning Objective #1: Describe characteristics of the Richards Assessment of Pain (RAP) instrument that distinguish the RAP from other pain questionnaires

Learning Objective #2: Relate nursing implications of study findings to evidence-based practice, education, and research

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Unrelieved pain is an epidemiological health care crisis. Current research evidence suggests that inadequate pain assessment practices of health care providers is the primary barrier in providing optimum pain relief. This implies the need for a systematic, global approach to multidimensional pain assessment. Therefore, the objective of this research study was to develop an empirically derived pain assessment instrument that would be psychometrically sound and sensitive to the needs of patients suffering with heterogeneous pain. Specific research goals were to: 1) identify domains of the heterogeneous pain experience, and 2) determine the influence of age, gender, ethnicity, and socioeconomic status on the domains of heterogeneous pain. Methodological triangulation was used as the research framework, employing both qualitative (Phase 1) and quantitative (Phase 2) methods of data collection, analysis and interpretation. Phase 1 (n = 33) standardized the previously researcher-developed instrument with patients who were experiencing heterogeneous pain. Phase 2 (n = 200) established the factor structure of the instrument and evaluated its psychometric properties. Three domains of heterogeneous pain were identified from the original set of 40 items by exploratory factor analysis: ‘learning to live with the pain' (nine items), ‘thinking and feeling the pain' (fifteen items), and ‘perceiving controllability of the pain' (six items). Concurrent validity was established through statistically significant correlations between the RAP factors and three of four McGill Pain Questionnaire subscales. Analysis of variance demonstrated statistically significant relationships between the RAP factors and age, ethnicity and SES, but not age. Cronbach's alpha statistic was .89. In conclusion, the RAP was shown to be psychometrically sound and sensitive to the experience of heterogeneous pain. Substantive interpretation of the domains of the RAP suggest attributes of heterogeneous pain that may contribute to a more comprehensive assessment of pain in all patients on a global scale.